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. 2018 Apr 12:12:539-549.
doi: 10.2147/PPA.S159621. eCollection 2018.

Complex interrelations between self-reported oral health attitudes and behaviors, the oral health status, and oral health-related quality of life

Alexandra Lucia Vigu  1 , Dorin Stanciu  2 , Lucia Maria Lotrean  3 , Radu Septimiu Campian  4
Affiliations

Complex interrelations between self-reported oral health attitudes and behaviors, the oral health status, and oral health-related quality of life

Alexandra Lucia Vigu et al. Patient Prefer Adherence. .

Abstract

Purpose: The purpose of this study was to develop and test a moderated mediation model that was able to describe the relationships between oral health-related attitudes and behaviors, oral health status (OHS), and oral health-related quality of life. The hypothesized relations corresponded to research questions such as "is a person's oral health predicted by the actions that person takes in order to prevent oral health conditions?" and "do individuals with better oral health also have higher levels of oral health-related quality of life?".

Materials and methods: A cross-sectional correlational study with selected predictor variables was conducted in Cluj-Napoca, Romania, among 191 participants, enrolled in the fourth and sixth years of study at the Dentistry School of the Medicine and Pharmacology, University of Cluj-Napoca. Participants completed the Hiroshima University Dental Behavior Inventory (HUDBI) questionnaire targeting specific behavior and attitude with respect to their dental self-care, Oral Health Impact Profile (OHIP) short questionnaire for measuring oral health-related quality of life, and the current OHS was assessed objectively using Decayed, Missing, Filled Teeth/Surfaces (DMFT) index. Statistical analyses were done using structural equation modeling software.

Results: Our research showed relevant associations between HUDBI, DMFT, and OHIP. The relationship between HUDBI and OHIP was mediated by DMFT. Furthermore, HUDBI worked as a moderator between DMFT and OHIP. Thus, our study revealed a case for moderated mediation, which is usually ignored in similar research.

Conclusion: The "straightforward" causality between oral health-related behavior and the actual OHS must be considered with caution, as well as their impact on the oral health-related quality of life. Further research is needed to investigate the interaction between variables, the strength of the interrelations and the magnitude of their interactions, and the confidence that can be placed in these measurements, with respect to the general population and/or those lacking domain-specific education.

Keywords: DMFT; HUDBI; moderated mediation; oral health; oral health-related quality of life.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Strength of the associations between HUDBI, DMFT, and OHIP-14 (after the mediation by DMFT in bold text and before mediation by DMFT in brackets). Note: The significance levels 0.05, 0.01, and 0.001 are denoted by a *, **, and ***, respectively. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; DMFT, Decayed, Missing, Filled Teeth/Surfaces; OHIP, Oral Health Impact Profile.
Figure 2
Figure 2
Moderation analysis for HUDBI and DMFT predicting OHIP-14 and their interaction effect using z-standardized data. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; DMFT, Decayed, Missing, Filled Teeth/Surfaces; OHIP, Oral Health Impact Profile.
Figure 3
Figure 3
Moderation analysis for HUDBI and DMFT predicting OHIP-14 and their interaction effect using originally scaled scores. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; DMFT, Decayed, Missing, Filled Teeth/Surfaces; OHIP, Oral Health Impact Profile.
Figure 4
Figure 4
Plot for mean interaction indicative of HUDBI as a moderator, strengthening the positive relationship between DMFT and OHIP-14. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; DMFT, Decayed, Missing, Filled Teeth/Surfaces; OHIP, Oral Health Impact Profile.
Figure 5
Figure 5
Plot for mean interaction indicative of HUDBI as a moderator, strengthening the positive relationship between DMFT and OHIP-14 using the variables’ standardized values or z-scores. Note: The blue, red, and green lines indicate the evolution of OHIP with OHS scores for −1 SD scores of HUDBI, mean scores of HUDBI, and +1 SD scores of HUDBI, respectively. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; DMFT, Decayed, Missing, Filled Teeth/Surfaces; OHIP, Oral Health Impact Profile; SD, standard deviation.
Figure 6
Figure 6
Model of moderated mediation. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; DMFT, Decayed, Missing, Filled Teeth/Surfaces; OHIP, Oral Health Impact Profile.
Figure 7
Figure 7
Model of moderated mediation with partial least squares. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; OHIP, Oral Health Impact Profile; DMFT, Decayed, Missing, Filled Teeth/Surfaces.
Figure 8
Figure 8
Model of moderated mediation using partial least squares, after bootstrapping. Abbreviations: HUDBI, Hiroshima University Dental Behavior Inventory; OHIP, Oral Health Impact Profile; DMFT, Decayed, Missing, Filled Teeth/Surfaces.
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