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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 492-496

Conceptual measure of oral health literacy level among patients visiting a private dental institution in Dharwad: A cross-sectional questionnaire study


Department of Public Health Dentistry, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Sheetal Rai
Department of Public Health Dentistry, SDM College of Dental Sciences and Hospital, Sattur, Dharwad - 580 009, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171183

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  Abstract 

Introduction: Oral health literacy (OHL) is the ability of an individual to function independently in certain areas of oral health care activity. It has now evolved as an important determinant of oral health related behavior and practices in any population thus affecting a person's health outcome. Aim: To assess the OHL levels among the sample of a population visiting private dental college and hospital in Dharwad. Materials and Methods: A cross-sectional questionnaire study was conducted on patients visiting a private dental college and hospital in Dharwad. Data was collected from 225 subjects through questionnaire related to five different areas of health care activity. Responses were scored on a dichotomous scale. Analysis of variance and independent t-test were used. Results: Among the study population, 67.6% had medium OHL levels, 24.9% had low, and only 7.6% had high OHL level. OHL had a significant association with age and educational qualification (P < 0.05), whereas gender had no significant association (P < 0.05). Conclusion: Majority had an OHL of medium level as age advanced OHL was lower. As the educational qualification was higher, OHL also improved. This makes education an important parameter in improving the OHL. There is a need to consider OHL while planning future oral heath related programs for this population.

Keywords: Oral health, oral health literacy, questionnaire


How to cite this article:
Rai S, Shodan M, Shetty PJ. Conceptual measure of oral health literacy level among patients visiting a private dental institution in Dharwad: A cross-sectional questionnaire study. J Indian Assoc Public Health Dent 2015;13:492-6

How to cite this URL:
Rai S, Shodan M, Shetty PJ. Conceptual measure of oral health literacy level among patients visiting a private dental institution in Dharwad: A cross-sectional questionnaire study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jul 16];13:492-6. Available from: http://www.jiaphd.org/text.asp?2015/13/4/492/171183


  Introduction Top


Oral health is the most important but often neglected entity of life. Although the diseases pertaining to oral cavity are vastly distributed across the country, current day oral health care delivery systems in India are not evenly distributed. Most of the oral health care delivery systems are situated in the urban areas, thereby leaving the rural population disadvantaged.[1] Amidst this inequality, even if the patients come forward to utilize the available facility, they still face hindrances when they seek oral health care and the related information. One of the possible factors attributed to this is the patients' oral health literacy (OHL) skills which might be coming in the way of their oral health care utilization.[2] As a result, the patients with inadequate OHL are most often remain deprived of the benefits of the health care system.

OHL has been defined as "The degree to which individuals have the capacity to obtain, process, and understand basic oral health information and services needed to make appropriate health decisions and act on them."[2]

Several researchers in the past have explained the prevalence of limited health literacy and the relationship of limited health literacy with patients' knowledge, health behaviors, health outcomes, and medical costs.[3] Studies have shown that low literacy in a population is found to be associated with negative health behaviors, reduced utilization of preventive health services, poorer adherence to therapeutic protocols,[4],[5] poor oral health status, dental neglect,[6] lack of follow-through with referrals or recommended self-care, frequently missed appointments, etc.,[7] and ultimately resulting in poor health outcomes.[8],[9],[10] Whereas on the other side, the health benefits of improving health literacy are higher utilization of preventive services, lower rate of emergencies and hospitalization care, etc., resulting in lower health care expenditures, ability to know when and how to enter the health care system, and how to make the best use of health services.[11] It is also said to be an important determinant of oral health and accounts for the causal factors in health disparities among different population groups.[12]

Understanding the level of OHL among any population becomes valuable information while recommending certain necessary measures, such as planning any programs to raise oral health awareness in a particular community. The literacy rate in Dharwad district is 80% as per the 2011 census.[13] In our current day knowledge, there is a lack of information regarding the OHL levels in this population. Hence, the purpose of this study is to assess the OHL among the patients visiting a private dental institution in this area.


  Materials and Methods Top


A cross-sectional questionnaire study was conducted among the adult population, aged 18 years and above who were visiting a private dental college and hospital in Dharwad. The study protocol was approved by the Institutional Review Board. Informed consent was taken from every subject prior to administering the questionnaire. The estimated recall patients in this dental hospital are 150/day and hence by the convenience sampling procedure, a total of 225 study subjects were selected.

The questionnaire was constructed in local language Kannada and was given to a panel of experts in the field, to check for validity of the same. Once the questionnaire was found to be having a good face and content validity, it was administered to 50 subjects to check for reliability. Based on the responses, questionnaire was

slightly modified, and the test for reliability was done again. The final questionnaire had a Cronbach's alpha value of 0.894 which is acceptable. Based on the pilot study results, the final questionnaire was given to the study participants.

The questionnaire contained two parts. The first part constituted questions, for instance, filling registration slip, ability to read oral health care magazines, understanding pre- and post-treatment instructions (e.g.: Extraction), ability to read the appointment card, understanding prescriptions appropriately, capacity to choose among the available treatment options independently, awareness regarding the preventability of dental diseases, knowledge about the reimbursement through employees state insurance scheme for the dental treatment, etc.,

The second part constituted information regarding the sociodemographic characteristics of the subjects, such as name, age, and education. The responses were scored on a dichotomous scale.

Statistical analysis

Data was subjected to statistical analysis using SPSS 20 IBM SPPS software (version 20.0, Chicago, IL, USA). Chi-square test of association was used to determine if there was any association between OHL levels and the sociodemographic factors such as age, education, and gender. Analysis of variance (one-way) test was used to find the significance between different age groups and different educational groups. Independent t-test was used to find significance between male and female subjects. The significance level was set at P < 0.05.


  Results Top


In the current study, it was found that 67.6% of the study participants had medium OHL level, 24.9% belonged to low OHL level, and only a meager proportion (7.6%) had high literacy score [Figure 1]. Among the subjects in the study, 55% were males and 45% were females. However, there was no statistically significant association between gender and OHL level (P > 0.05) [Figure 2].
Figure 1: Distribution of study population according to oral health literacy levels

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Figure 2: Mean oral health literacy score among males and females

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Majority of study participants were in the age group of 25–44 years. Age was found to have a statistically significant association with the OHL level (P < 0.05) as age advanced, the OHL level was lower [Figure 3]. Education level of the study participants was found to be statistically significant with their OHL level (P < 0.05). Among the people who had never attended school, 95% had low OHL levels. Among the graduates, 57% had high scores and the remaining 43% had medium score. Among the postgraduates, 40% had a high score and the rest 60% had medium OHL score [Figure 4].
Figure 3: Mean oral health literacy score among age groups

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Figure 4: Mean oral health literacy score among education levels

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Among the study population, 61% of them believed that dental caries cannot be prevented; 54% said they needed help from either their family or friends to choose the appropriate treatment for them when the dentist provides them with various treatment options; 48% said they find difficulty in understanding prescriptions all by themselves and explanation by the dentist or the chemist was required. About 52% said they were not able to properly understand the oral health education materials written in complete English and 90% opted television as the primary source of their oral health care information [Figure 5].
Figure 5: Sample questions and subject responses

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  Discussion Top


Good oral health is an outcome of the ability of an individual to understand and process basic oral health related information. In the current era, most often patients are expected to find health care related information on their own, understand and accept new rights and responsibilities and make decisions for themselves.[14] Patients commonly feel stress and anxiety related to health care interactions, especially during times of new diagnoses such that even people with above average OHL skills may not be able to understand or act on information critical to their health and well-being. Low health literacy may also be a factor in health disparities,[15] and it might make an individual ignorant toward the process of disease causation and progress. To successfully function in the present day oral health care system, OHL skills of an individual become a very important asset and hence, a necessity.

Factors at both the individual and community level such as socioeconomic status, age, sex, ethnicity, and health insurance coverage can affect the relationship between literacy and health outcomes.[16] Low OHL level, independent of education, and other socioeconomic determinants has been shown to be a predictor for poor self-reported oral health.[17]

The present study showed that 67.6% of the patients had medium OHL levels. The reason for this could be that this study was conducted in an urban dental hospital setting. This was followed by24.9% having low OHL levels, and 7.6% had high OHL levels. Whereas in the study by Ramandeep et al., majority of the participants had low OHL levels (60.2%).[18]

The study results showed that age and educational qualification had a significant association with the OHL level, whereas gender did not. This finding is in accordance with the study conducted by D'cruz and Shankar Aradhya in 2013 using Chew et al. questionnaire,[19] for measuring OHL levels.[20] The reason could be the current study was conducted in an urban region where there is easy access to oral health care information material and oral health care facilities to all the people.

As age advanced, OHL level was found to be lower. This is similar to a study done by Shea et al., where the authors had reported that literacy skills were related to age, with younger patients having better health literacy.[21] The reason for this could be because the younger population are more exposed to the various informative sources in urban areas and their ability to understand and process the information could have been better as compared to the older age group.

A study conducted by Haridas et al.[22] found that OHL was not associated with sex, age, or ethnicity in their sample population, which is partially in agreement with our study and partially contrasting. In the current study, age had a significant association with OHL levels whereas gender did not.

Among the study population, 61% of them believed that dental caries cannot be prevented irrespective of any measures taken and hence probably they approached less of preventive oral health care services. A study done by Ratzan and Parker et al. has reported that low health literacy may be associated with barriers to utilizing oral health care and also with seeking preventive care.[23]

In a report "Healthy People 2010" by the U.S Department of Health and Human Services, it has been stated that Persons with low health literacy are more likely to have chronic diseases, and they poorly manage the condition.[24] Many past studies have also shown a clear correlation between inadequate health literacy and oral health problems even when those diseases are preventable and treatable.[2]

Cohen et al. in their study have concluded that those people with low health literacy skills often have difficulty in describing the dental problems to their dentist and understanding what was told to them by the dentist.[25] Almost 54% of the current study population said they needed help from either their family or friends, to choose the appropriate treatment for them when the dentist provides them with various treatment options. 48% said they find difficulty in understanding prescriptions all by themselves, and explanation by the dentist or the chemist was required.

When asked about the primary source of oral health care information, more than 90% of the population opted television, followed by dentists. This finding is in accordance with the study conducted in Tehran, Iran,[26] America,[27] and Saudi Arabia.[28] About 52% of the people said they were not able to properly understand the oral health education materials written in complete English. The reason could be that health literacy involves the skills of reading and writing as well.[14]

The present study was conducted in a hospital-based setting, and the sample included only the patients visiting the hospital, chosen by convenience sampling technique. This makes the external validity of the study, questionable. Hence, there is a need for future research assessing the OHL levels in a larger population, selected by probability sampling technique, in order to identify the determinants of OHL, particularly among those with low literacy levels.


  Conclusion Top


The study population has medium OHL levels. This can pose difficulties for them in attaining and maintaining optimum oral health. In other words, better OHL aids an individual to understand, incorporate, and adapt to healthy practices and reduce risk behaviors. As a part of oral health promotion, OHL should be given the priority and measures should be taken to improve the same, which in turn will help people to improve their oral health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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