Determinants of Oral Health Behavior in Preschoolers: Application

of the Theory of Health Belief Model

Pahrur Razi

, Muhammad Rusdi

, Asni Johari

, Syahrial

, Asrial

and Sukmal Fahri

Department of Health Promotion, Ministry of Health Health Polytechnic Jambi, Jl. H. Agus Salim, Jambi, Indonesia

PMIPA Doctoral Program, Jambi University, Jambi, Indonesia

Department of Health Environment, Health Polytechnic, Ministry of Health Jambi, Jl. H. Agus Salim, Jambi, Indonesia

Keywords: Oral Health Behavior, health belief model, pre-schoolers.

Abstract: Oral and dental health behavior greatly influences the occurrence of dental disease, where children aged five

years have the highest incidence of dental disease, which is 93%. Regarding the use of healthy behavior

factors, people are still not aware that oral and dental health behavior is only 2.8% in the five-year age group.

This study aims to determine the predictive factors of oral health behavior in pre-school children based on the

theory of health belief model, Theory of Planned Behavior and Social Cognitive Theory. The cross-sectional

study method involved 200 mothers and children in the city of Jambi with a sampling technique using

purposive sampling. The results showed that the mean standard deviation of the children's age was 5.6 ± 1.1

years (range 5-6), and 52% were girls. The mean (SD) score for oral health behavior was 4, 8 (±1.9) out of

10. Regression analysis showed a positive relationship between all HBM, TPB and SCT structures on oral

health behavior. Conclude that Health Belief Model was an important predictor of children's oral health

behavior (p < 0.001). Effective promotional interventions can be designed based on these predictors to help

improve children's oral hygiene behavior.

1 INTRODUCTION

Dental and oral health is one of the basic components

of pre-school children's health. Young children are

completely dependent on their parents, especially

their mothers, to have proper oral health (Baghiani,

2015). The proportion of tooth brushing behavior

based on the age group of 5-9 years brushing their

teeth every day is 93.2%, but the correct brushing

time is only 1.4%. While in Jambi Province, it was

found that 96.4% brushed their teeth every day, only

1% of them brushed their teeth according to the

recommendation. Nationally, tooth brushing behavior

in Jambi province is the lowest in Indonesia

(Kemenkes RI, 2018).

Regarding the use of healthy behavior factors,

people are still not aware that oral and dental health

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behavior is only 2.8% in the five-year age group. Oral

and dental health behavior greatly influences the

occurrence of dental disease, where children aged

five years have the highest incidence of dental

disease, which is 93%. Therefore, it is highly

recommended to improve oral and dental health

behavior as an effort to prevent dental and oral

diseases in children (Publishery, 2013). Behaviors

related to oral health include eating habits, oral

hygiene habits, dental care (Branden, et al., 2014).

Several research results on oral behavior in pre-

school children, a significant predictor of individual

behavior today is attitude. The theory of planned

behavior (TPB) and the health action process

approach (HAPA) were the best predictors of

intention to engage in both behaviors (Dumitrescu Al,

et al. 2014). The Health Belief Model shows the

relationship between several structures related to

Razi, P., Rusdi, M., Johari, A., Syahrial, ., Asrial, . and Fahri, S.

Determinants of Oral Health Behaviour in Pre-schoolers: Application of the Theory of Health Belief Model.

DOI: 10.5220/0010757400003235

In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 147-150

ISBN: 978-989-758-542-5

147

personal perceptions, perceived barriers and self-

efficiency, and behavior (Baghiani, 2015). The theory

of Planned Behavior is also proven to be an important

predictor of children's oral health behavior. These

findings are useful in the formation to promote dental

and oral health behaviors of children. An effective

dental and oral health education intervention can be

designed based on this predictor (TPB component) to

increase the mother's perspective on oral health and

dental and oral health behavior of her child. Health

professionals in health care settings can provide

mothers with accurate practical information and

training on oral self-care behaviors. However, further

research is needed to confirm the results of this study

(Soltani, 2018).

Research by Makuch et al (2011) stated that the

use of games, exercises, performances/theatre and

puppets aimed at children's development is more than

just presenting didactic information. From the model

given above, it can be stated that the development of

oral health skills is carried out using an exclusive

approach and a program that aims to improve the oral

health abilities of pre-school children. An

unsupportive approach was taken by Garbin, et al

(2009), where pre-school children were involved in

programs using role-play programs, painting using

numbers, audiovisual, music, and playing programs.

As a result, pre-schoolers can pass on the knowledge

gained at school to their parents who change their

family members' dental health routines.

In addition to the approach mentioned above,

changes in oral health behavior are mostly carried out

through the application of program models as

researched by Yevlahova, et al (2009) that the

transtheoretical model, has been found to be the most

effective approach to updating health behavior.

From a preliminary study of pre-school-aged

children in Jambi City, it was shown that the oral

health behavior of pre-school children in TK/PAUD

was not optimal, ie 2.2 criteria were lacking. The oral

health behavior of pre-school children in Jambi City

still needs to be improved. These data are supported

by facts found when interviewing pre-school

children, kindergarten teachers and parents, such as:

(1) Pre-school children's oral health behavior is not

optimal, (2) Unable to maintain oral health at home,

(3) Does not know the function and shape of teeth, (4)

likes to eat foods that can damage teeth, (5) only gets

oral health information from television, and (6) tends

to receive oral health information obtained by the

teacher without being followed by understanding the

material obtained so that it is less able to maintain oral

health.

Based on the analysis presented above, the

problems faced are the low oral health behavior of

pre-school children and understanding of oral health

materials. So the authors feel it is necessary to know

the determinants of oral health behavior in pre-school

children in developing an intervention model for

changing oral and dental health behavior for pre-

school children according to the characteristics of the

intervention material.

2 MATERIALS AND METHODS

Cross-sectional study This study was conducted on

200 mothers and children with children aged 4-6

years in Kindergarten in Jambi City, Indonesia with

the sampling technique in this study is non-

probability sampling, which in this study was chosen

purposive sampling, the reason for choosing this

sampling technique is considering the sample of this

study, namely parents of kindergarten children who

are willing to have specific information on children's

oral health behavior. Inclusion criteria were

willingness to participate in the study, mothers with

children aged 4-6 years actively enrolled in

Kindergarten school year 2020/2021, and not

suffering from any physical or mental illness.

Data were collected through a questionnaire that

was filled out by the mother herself. They were

informed of the purpose of the study and

subsequently, they signed a written informed consent.

Filling out the questionnaire takes approximately 25

minutes. The participants were awarded several

prizes (such as toothpaste and toothbrush) for their

voluntary participation in the study.

2.1 Measurement

The implementation of data collection techniques is

adjusted to the Covid-19 health protocol, carried out

through the google form. The link (link) of the

questionnaire will be distributed to all parents of

kindergarten children via WhatsApp. The

questionnaire consisted of three parts: demographic

characteristics, children's oral health behaviors, and

the construction of HBM (perceived benefits, barriers

to action, and self-efficacy). However, because the

Covid-19 pandemic is still collecting data on the

perceived severity component, the signal for action

cannot be taken. Demographic characteristics include

age of mother and child, gender of child, age of

mother's occupation and education (illiteracy,

elementary, junior high, high school, diploma, and

ICSDH 2021 - International Conference on Social Determinants of Health

148

academic) and economic status (weak, moderate,

good).

2.2 Children's Dental and Oral Health

Behavior

Children's oral health behavior was evaluated through

10 questions about oral health. Scores may range

from 0–10, with higher scores indicating better oral

health behaviors.

2.3 TPB Arrange Items

The HBM construct related to children's oral health

behavior was assessed through 18 items derived from

the available literature in accordance with HBM

procedures and guidelines. The HBM-based

questions address perceived vulnerabilities,

perceived benefits, perceived barriers and self-

efficacy. Responses to all items were scored on a 5-

point scale ranging from 1 (strongly disagree) to 5

(strongly agree).

dapatkah Anda menjelaskan berapa banyak item

sebelum dan sesudah uji validitas dan reliabilitas?

2.4 Reliability and Validity

When tested for the validity of the contents of all the

questionnaires confirmed to be valid. The mean was

0.81 (p>0.6) and the total reliability (Cronbach's

alpha) was 0.89, indicating good internal consistency.

Tes statistik seperti apa?

Statistic analysis

All data were analyzed using SPSS version 16

software. The analysis was carried out using

univariate and bivariate analysis (linear regression)

with a level of <0.05.

3 RESULTS AND DISCUSSION

Table 1 displays the demographic characteristics of

the participants. The mean ± SD children's age was

5.24 ± 0.61 years; and 52% were women. The mean

age ± SD of the mother was 31.25 ± 1.27. About 28%

of mothers have a bachelor's degree; 92 mothers

(46%) worked; and 66% good economic status and

24% mother's knowledge about oral health is good.

Then the average oral health behavior is 4.23,

susceptibility is 2.24, benefit is 2.27, barrier is 2.28

and efficacy is 2.29.

Table 1: Distribution of socio-demographic characteristics,

oral health behaviors and the construct of HBM (n = 200)

Variable Total (N) (%)

Child Gender

- Man

- girl

Mother's Education

- high school

- Diploma

- University

Mother's

Employment Status

- Work

- Unemployment

Economic Status

- Weak

- Good

Mother's

Knowledge

- Not good

- Goo

104

108

132

152

Variable Average SD

Mother's Age

(years)

Child's Age (years)

31.25

5.24

1.27

0.61

Oral health

behavior

Vulnerability

Benefits

Resistance

Self efficac

4.23

2.24

2.27

2.28

2.29

0.86

0.73

0.69

0.68

0.66

Table 2 of the relationship between perceived

vulnerability, benefits, barriers and self-efficacy

shows a positive correlation with low

strength/closeness of the relationship on perceived

vulnerability (r = 0.236), perceived benefits (r =

0.458), perceived barriers (r = 0.351) and self-

efficacy (r = 0.499). This means that the higher the

vulnerability, benefits, barriers and self-efficacy, the

higher the child's oral health behavior. However, the

perceived susceptibility variable can only explain

5.6%, and 5.5% (perceived benefits and barriers), and

4.4% (self-efficacy) variations in children's oral

health behavior variables. Although this relationship

was statistically significant (p < 0.05). All

components of the HBM are the main predictors of

oral health behavior in pre-school children.

Determinants of Oral Health Behaviour in Pre-schoolers: Application of the Theory of Health Belief Model

149

Table 2. Analysis of Correlation and Linear Regression

Oral health behavior and components of HBM

Variable R R2

Line

Equation

(Oral

Health

Behavior)

value

ulnerabilit

0.236 0.056

3.599 +

0.279

0.001

Benefits 0.235 0.055

3.562 +

0.292

0.001

Resistance 0.235 0.055

3.548 +

0.297

0.001

Self efficac

0.209 0.044

3.603 +

0.271

0.003

4 CONCLUSIONS

Health Belief Modelproven to be an important

predictor of oral health behavior in pre-school

children. These findings are useful in designing a

conceptual framework for promoting oral health

behaviors in pre-school children. Effective oral health

promotion interventions can be designed based on

this predictor (HBM component) to improve oral

health behaviors in pre-school children. However,

further research is needed to confirm these results

especially in the development of a health promotion

model to improve oral health behavior in pre-school

children.

ACKNOWLEDGEMENTS

The authors would like to thank the Director of

Poltekkes, Ministry of Health, Jambi, for their

support. We also appreciate all the promoters who

have taken the time to complete this research.

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