基于健康行动过程方法的口腔卫生指导对65岁以上患者的有效性：一项随机对照试验。
Effectiveness of HAPA-based oral hygiene instruction in patients over 65 years of age: a randomized controlled trial.
作者信息
Baumann Linn, Klusmann Verena, Bamberg Charlène, Rüttermann Stefan, Gerhardt-Szép Susanne
机构信息
Department of Operative Dentistry, Carolinum Dental University-Institute gGmbH, J.W. Goethe University, Frankfurt/Main, Germany.
Department of Health, Medical and Life Sciences, Health Promotion and Prevention, Furtwangen University, Furtwangen, Germany.
出版信息
BMC Oral Health. 2025 Jul 19;25(1):1209. doi: 10.1186/s12903-025-06615-w.
OBJECTIVE
The aim of the study was to provide oral hygiene instructions tailored to behavioral stages based on the Health Action Process Approach (HAPA) and to assess their impact on oral health compared with standardized instructions in patients aged 65 and older.
METHODS
A total of 67 university clinic patients were randomly assigned to an intervention ( = 33) and a control group ( = 34) and 62 patients, aged 65 to 87 years ( = 71.3, = 5.3), participated in both the baseline and the follow-up visit. To assess oral hygiene, the parameters Gingival Bleeding Index (GBI) and Plaque Control Record (PCR) were recorded at baseline and 12 weeks after instruction. In the intervention group, a questionnaire was used at the beginning of both visits to survey oral hygiene behavior and motivation to change behavior. For both groups, the first visit included a survey on oral hygiene parameters followed by either HAPA-based or standard instruction with demonstration of oral hygiene aids.
RESULTS
Analyses of covariance with baseline control revealed no difference in GBI between the intervention and control group at the 12-week follow-up. Both the intervention group, (29) = 3.91, <.001, = 0.71, as well as the control group, (31) = 3.67, <.001, = 0.65, demonstrated significant improvement in GBI. In contrast, only the intervention group showed a significant improvement in PCR at reevaluation, (29) = 2.29, =.03, = 0.42. Additionally, the intervention group reported a significant increase in motivation and the frequency of interdental care, (29), 6.67, <.001, = 1.22.
CONCLUSION
This study provides first evidence on the HAPA model being effectively applicable in the context of dental prophylaxis among university clinic patients older than the age of 65. A positive effect on patients’ behavior and oral hygiene could be demonstrated. While general instruction proved effective in reducing gingival bleeding, the theory-based HAPA intervention offered specific advantages in motivation, interdental care, and plaque buildup.
TRIAL REGISTRATION
German Study Register of Clinical Studies (DRKS, ID DRKS00030040, German Clinical Trials Register, Date of registration 22.03.2023).
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s12903-025-06615-w.
目的
本研究旨在基于健康行动过程方法（HAPA）提供针对行为阶段的口腔卫生指导，并评估其与标准化指导相比对65岁及以上患者口腔健康的影响。
方法
共有67名大学诊所患者被随机分配到干预组（n = 33）和对照组（n = 34），62名年龄在65至87岁之间（平均年龄=71.3岁，标准差=5.3岁）的患者参与了基线和随访检查。为评估口腔卫生状况，在基线和指导后12周记录牙龈出血指数（GBI）和菌斑控制记录（PCR）参数。在干预组，两次就诊开始时均使用问卷来调查口腔卫生行为以及改变行为的动机。两组患者在首次就诊时均接受了口腔卫生参数调查，随后分别接受基于HAPA的指导或标准指导，并演示了口腔卫生辅助工具。
结果
协方差分析及基线对照显示，干预组和对照组在12周随访时GBI无差异。干预组（n = 29），F(1, 29)=3.91，p <.001，η² = 0.71，以及对照组（n = 31），F(1, 31)=3.67，p <.001，η² = 0.65，GBI均有显著改善。相比之下，仅干预组在重新评估时PCR有显著改善，F(1, 29)=2.29，p =.03，η² = 0.42。此外，干预组报告其动机以及牙间隙护理频率显著增加，t(29)=6.67，p <.001，d = 1.22。
结论
本研究首次证明HAPA模型可有效应用于65岁以上大学诊所患者的牙科预防。对患者行为和口腔卫生有积极影响。虽然一般指导在减少牙龈出血方面被证明是有效的，但基于理论的HAPA干预在动机、牙间隙护理和牙菌斑形成方面具有特定优势。
试验注册
德国临床研究注册库（DRKS，ID DRKS00030040，德国临床试验注册库，注册日期2023年3月22日）。
补充信息
在线版本包含可在10.1186/s12903-025-06615-w获取的补充材料。
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