Building a new scale to measure worries about oral hygiene self‐management in vulnerable older adults

Schensul, Jean J.; Salvi, Apoorva; Ha, Toan; Reisine, Susan; Li, Jianghong; Moni, Yacihuilca

doi:10.1111/ger.12471

Cited by 5 publications

(5 citation statements)

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“…Several scales were based on formative research or pilot testing with the study population including fear of oral diseases and worries about oral health self-management. The latter has been validated and published [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

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Evaluating mechanisms of change in an oral hygiene improvement trial with older adults

et al. 2021

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Background This paper compares the relationship between theoretically-driven mechanisms of change and clinical outcomes across two different interventions to improve oral hygiene of older adults participating in a group randomized trial. Methods Six low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs). Both were based on Fishbein’s Integrated Model. 331 participants were recruited at baseline and 306 completed the post-assessment one month after intervention. Clinical outcomes were Gingival Index (GI) and Plaque score (PS), collected by calibrated dental hygienists. Surveys obtained data on patient background characteristics and ten mechanisms of change including oral health beliefs, attitudes, norms and behaviors. GLMM was used to assess the effects of time, intervention arm, participant characteristics, intervention mechanisms and differences between the two interventions over time in relation to outcomes. Results At baseline, both groups had similar background characteristics. Both groups improved significantly in outcomes. Overall GI scores changed from baseline mean of 0.38 (SD = .032) to .26 (SD = .025) and PS scores changed from baseline mean of 71.4 (SD = 18%) to 59.1% (SD = 21%). T-tests showed that fears of oral disease, oral health intentionality, oral health norms, worries about self-management of oral health, flossing frequency and sugar control improved significantly in both interventions from baseline to post intervention. Oral health self-efficacy, perceived risk of oral health problems, oral health locus of control and brushing frequency improved significantly only in the counseling intervention. GLMM models showed that the significant predictors of GI improvement were intentionality to perform oral hygiene, locus of control, and improvement in frequency of brushing and flossing in association with the counseling intervention. Predictors of PS improvement were worries about oral hygiene self-management and fear of oral diseases, in association with the counseling intervention. In the reduced final models, only oral health locus of control (predicting GI) and fears of oral diseases (predicting PS) were significant in association with the counseling intervention. Locus of control, a key concept in oral hygiene interventions including the IM was the main contributing mechanism for GI improvement. Fear, an emotional response, drove improvement in PS, reinforcing the importance of cognitive/emotional mechanisms in oral hygiene interventions. Conclusions Though both groups improved in outcomes, GI and PS outcomes improved more in response to the counseling intervention than the campaign. The counseling intervention had an impact on more mechanisms of change than the campaign. Improvements in intervention mechanisms across both interventions however, suggest a closer examination of the campaign intervention impact on outcomes over time. Trial Registration: Clinicaltrials.gov NCT02419144, first posted April 17, 2015.

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Section: Methodsmentioning

confidence: 99%

“…9 items rated from 1 not important to 5 important (α .672. ); oral health self-management worries scale (OHWSMS): 19 questions with responses rated 1–4 with 4 as least worried (α .93) [ 23 ]. …”

Section: Methodsmentioning

confidence: 99%

Evaluating mechanisms of change in an oral hygiene improvement trial with older adults

et al. 2021

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“…Oral hygiene self‐management worries scale (OHWSMS) 23 —19 items rated from 1 to 4 on how worried participants were about oral hygiene behaviours. Cronbach's alpha was 0.93.…”

Section: Methodsmentioning

confidence: 99%

Does sequencing matter? A cross‐over randomized trial to evaluate a bi‐level community‐based intervention to improve oral hygiene among vulnerable adults

Reisine

Schensul

Salvi

et al. 2021

Comm Dent Oral Epid

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Objectives To evaluate whether the cumulative effect of an individual‐level intervention followed by a building‐level intervention, both based on Fishbein's Integrated Model of Behavior Change, has a better effect on oral hygiene clinical outcomes than the sequence of the building‐level intervention followed by the individual‐level intervention; to determine the added effect of each intervention on the other; to identify the psychosocial mechanisms that might explain the differences. Methods Six low‐income senior housing complexes were enrolled in the study, and participants were recruited from these buildings. Buildings were randomly assigned to receive either the individual counselling intervention first followed by the building‐level intervention, or the building‐level intervention first followed by the individual intervention. Participants were assessed for gingival inflammation using the gingival index (GI) and plaque scores (PS) at T0, prior to the interventions, T1, about one month after each intervention and T2, about a month after the interventions switched and were completed. Data were collected on background moderators and cognitive/emotional/behavioural mediators in surveys administered at T0, T1 and T2. General linear mixed models were used to assess changes over time by condition and to analyse the effects of moderators and mediators over time. Results Three hundred and thirty‐one people completed T0; 306 completed T1 assessments (92.4% retention rate) and 285 completed T2 assessments (86.1% retention rate). All participants improved on GI and PS at T1 and T2 compared to T0. Those in the individual‐level intervention condition improved more than those in the building‐level condition. Those who were in the building‐level intervention followed by the individual intervention continued to improve on GI from T1 to T2. Those in the individual‐based intervention followed by the building intervention did not improve significantly from T1 to T2 but remained about the same. For PS, neither group improved significantly from T1 to T2. Several cognitive/behavioural variables significantly affected improvements in GI and PS. Conclusions Both interventions were successful in improving GI and PS. The building‐level intervention did not provide much additional benefit when it followed the individual intervention although it may have had a sustaining effect. The findings on the cognitive/emotional/behavioural variables support the importance of these factors and should be considered when implementing oral hygiene interventions.

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“…Cognitive mediators to be targeted by the intervention included Oral Hygiene Self-Management Worries Scale (OHWSMS) consisting of 19 statements about specific worries management of oral hygiene and consequences of poor management, derived from formative work with the study population and validated (Schensul, Salvi, et al, 2020) with responses rated 1 most to 4 least worried (Cronbach’s α = .93); intentionality , a six-question scale with responses rated as 0 ( no intention ) to 2 ( high intention ) (α = .72); perceived oral health risks (chances of getting specific health problems because of oral health mismanagement), five questions with responses rated 1 to 4 with 4 as least chances (α = .76); fear of oral diseases , four items rated 1 to 4, with 4 as no fear (α = .82); oral health self-efficacy (five items, α = .603); locus of control (seven items, α = .72) with responses as 4-point Likert-type scales ranging from 1 to 4 with 4 as high in both scales, adapted from Sherer et al (1982); and importance of oral health behavior , nine items from 1 ( not important ) to 5 ( important ); alpha = .672. (See Schensul, Reisine, et al, 2019, for more detail on cognitive mediators.…”

Section: Methodsmentioning

confidence: 99%

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults

Schensul

Salvi

et al. 2020

J Appl Gerontol

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Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS). Individual logistic regression was performed for all predictors in relation to GI and PS. Multiple logistic regression was performed with significant predictors of GI and PS only. Greater locus of control and more brushing predicted lower GI; greater locus of control predicted lower PS. Both cognitive and behavioral domains impact GI, requiring more prolonged effort for improvement while locus of control, a cognitive variable, predicts PS, immediately improved by daily brushing/flossing. A streamlined IM including locus of control and tooth brushing should improve oral hygiene of low-income older adults.

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Building a new scale to measure worries about oral hygiene self‐management in vulnerable older adults

Cited by 5 publications

References 62 publications

Evaluating mechanisms of change in an oral hygiene improvement trial with older adults

Evaluating mechanisms of change in an oral hygiene improvement trial with older adults

Does sequencing matter? A cross‐over randomized trial to evaluate a bi‐level community‐based intervention to improve oral hygiene among vulnerable adults

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults

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