Wilson Anne R, Mulvahill Matthew J, Tiwari Tamanna
School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Front Public Health. 2017 Aug 28;5:228. doi: 10.3389/fpubh.2017.00228. eCollection 2017.
Latino children experience one of the highest rates of early childhood caries requiring interventions based on valid conceptual frameworks. The Health Belief Model has relevance as a predictor of compliance with health recommendations based on perceptions of a health condition and behaviors to avoid the condition. The model encompasses four perceptual constructs (susceptibility, severity, benefits, barriers) and, for complex conditions, includes self-efficacy as an extended model. This study evaluated individual (self-efficacy and health beliefs) and cultural (acculturation status) level factors and the inter-relationship to determine if items assessed for the Extended Health Belief Model (EHBM) were valid measures of maternal factors.
A cross-sectional study was conducted with 100 mother-child dyads at the Dental Center of Children's Hospital Colorado, Aurora, CO, USA. Participating mothers completed a survey in English or Spanish with items from the Basic Research Factors Questionnaire encompassing sociodemographic characteristics, oral health knowledge and behavior, and psychosocial measures including the EHBM. Language preference was a proxy for maternal acculturation. Children were examined to measure decayed, missing, and filled tooth surfaces. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of the EHBM subscales with oral health-related measures and language preference.
The benefits and self-efficacy scales reflected good reliability. Maternal education was the strongest predictor of health beliefs with significant associations for barriers, benefits, and susceptibility. Perceived benefits increased with each additional year in the household. There was a significant association between maternal oral health knowledge and higher perceived benefits and increased self-efficacy, and the same was found for higher knowledge of dental utilization which was also associated with children perceived as having increased susceptibility to early childhood caries. Less acculturated participants perceived more barriers to behavioral adherence and fewer barriers as knowledge increased. As dental utilization knowledge improved for Spanish-speaking participants, they perceived greater benefits from adherent oral health behavior compared to English-speaking participants.
Items assessed for the EHBM were valid as measures of maternal factors influencing children's oral health outcomes in a Latino population.
拉丁裔儿童患幼儿龋齿的比例很高，需要基于有效的概念框架进行干预。健康信念模型作为一种预测因素具有相关性，它基于对健康状况的认知以及避免该状况的行为来预测对健康建议的依从性。该模型包含四个认知结构（易感性、严重性、益处、障碍），对于复杂状况，还包括自我效能感作为扩展模型。本研究评估了个体层面因素（自我效能感和健康信念）和文化层面因素（文化适应状况）及其相互关系，以确定扩展健康信念模型（EHBM）所评估的项目是否是对母亲因素的有效衡量。
在美国科罗拉多州奥罗拉市儿童医院牙科中心，对100对母婴进行了一项横断面研究。参与的母亲用英语或西班牙语完成了一份调查问卷，问卷内容来自基础研究因素问卷，包括社会人口学特征、口腔健康知识和行为，以及包括EHBM在内的心理社会测量指标。语言偏好作为母亲文化适应的一个指标。对儿童进行检查以测量龋坏、缺失和充填的牙面。使用克朗巴赫α系数评估每个子量表的内部一致性信度。使用线性回归评估EHBM子量表与口腔健康相关测量指标和语言偏好之间的关联，以此评估收敛效度。
益处和自我效能感量表显示出良好的信度。母亲的教育程度是健康信念最强的预测因素，与障碍、益处和易感性有显著关联。家庭中每多一年教育，感知到的益处就会增加。母亲的口腔健康知识与更高的感知益处和增强的自我效能感之间存在显著关联，对于更高的牙科利用知识也有同样的发现，这也与被认为患幼儿龋齿易感性增加的儿童相关。文化适应程度较低的参与者认为行为依从性的障碍更多，而随着知识的增加障碍减少。对于说西班牙语的参与者，随着牙科利用知识的提高，与说英语的参与者相比，他们从依从性口腔健康行为中感知到更大的益处。
EHBM所评估的项目作为影响拉丁裔人群中儿童口腔健康结果的母亲因素的衡量指标是有效的。
