Key words:
Health literacy - Iran - oral health
INTRODUCTION
Living a healthy life in the 21st century has many requirements such as being literate.[1] Literacy is not simply the ability to read and write; the UNESCO has defined literacy
as the ability to identify, understand, interpret, create, communicate, and compute,
using printed and written materials associated with varying contexts. Literacy involves
continuous teaching to enable individuals to achieve their goals, increase their awareness,
use their potentials, and have a bolder presence in a larger community.[2]
With regard to the population aged 15 years and above, the UNESCO (UIS) reported that
the global numbers of adults that are literate in 2010 were 84.1% (88.6% male and
79.7% female).
More attention has been given to health literacy in the past two decades. Parker et al.[3]
reported health literacy primarily as the ability to exert literacy skills in relation
to health matters such as prescriptions, visit cards, and pharmaceutical matters.
The most recent review carried out by Mârtensson and Hensing[4] introduced two approaches regarding the concept of health literacy. The first was
the polarized phenomenon which concentrates on the high and low levels of health literacy,
similar to the practical definition of health literacy. The second approach pointed
out the reactional and critical skills required to improve health. Patients with lower
literacy skills showed higher rates of misunderstanding of instructions given with
prescriptions.[5]
Based on the history of health literacy, the most common definition of oral health
literacy is “the level at which a person is capable of processing and understanding
basic information regarding oral health and services related to it” and the concepts
of this definition are necessary in making correct decisions in issues regarding health.[6] According to the health literacy constitution of the Institute of Medicine, oral
health literacy is the struggle between culture and the society, the health system,
and the education system such that ultimately all these factors contribute and facilitate
to the results and costs of oral health.[7]
Wehmeyer et al. reported that low oral health literacy has a negative effect on the periodontal conditions
of new and referred patients who visited the periodontology clinic in North Carolina
University.[8] Oral health literacy studies showed limitations in the level of oral health literacy
in certain groups such as people with lower education, the elderly, and the unprivileged
population.[9]
[10]
[11]
A low level of health literacy has also been reported for Iran. Based on a National
Survey in 5 provinces of Iran, 2 out of 3 adults living in Iran did not have sufficient
health literacy skills.[12]
Considering the effect of culture and tradition and socioeconomic factors on the level
of oral health literacy and the fact that these parameters vary greatly in different
cities in Iran, this study tries to investigate the level of oral health literacy
and its determinants in patients who visited Kerman Dental School clinic for the first
time.
MATERIALS AND METHODS
It was a cross-sectional study and participants were randomly selected who were visiting
the Kerman dental clinic for the first time. The inclusion criteria of the study were
being 18 years old or older and were able to read and write in Persian language. The
study was approved by the Ethical Committee of Kerman University of Medical Sciences
(KMU-KA94/558). The oral health literacy adult questionnaire which was validated by
Naghibi et al. was used in this study.[13] The questionnaire has 17 items in 4 sections that determine the individuals reading,
listening, and decision-making skills regarding oral health. Data collection was done
based on the questionnaire’s instructions. The participants completed the questionnaire
through a guided interview. Demographic data, oral health behavior such as frequency
of brushing times, use of toothpaste, the last dental visit, smoking habits, and socioeconomic
status of the person were recorded. On the basis of questionnaire instruction, the
total score of the answers would be between 0 and 17. The scores could be categorized
into three groups as follows: 0-9 as not enough OHL (low) score, 10-11 as medium score
for OHL, and 12-17 as enough OHL (high) score.[13] Statistical tests such as Chi-square and independent two-sample t-test with a significance
level of 0.05 were used to analyze the data.
RESULTS
There were 264 participants with a mean age of 37 ± 8 years old and 72.3% of them
were females. Most (38.8%) of the participants had high school certificate (diploma).
The information concerning acquired scores from the oral health literacy of individuals
in different sections is presented in [Table 1]. The mean of the total score from different parts of the questionnaire was 12.07
± 4.34 out of 17, and 62.5% of participants had enough or high level (more than 12
score) of oral health literacy.
Table 1:
Participants’ scores in different sections of oral health literacy questionnaire
|
Total score
|
Gained score
|
|
Minimum
|
maximum
|
Mean of score±SD
|
Total number of participants
|
|
SD: Standard deviation
|
|
Reading and comprehension (6)
|
0
|
6
|
4.04±1.3
|
264
|
|
Listening and calculation (6)
|
0
|
6
|
4.66±1.4
|
264
|
|
Decision-making (5)
|
0
|
5
|
3.37±1.3
|
264
|
|
Total score in health literacy (17)
|
2
|
17
|
12.7±3.3
|
264
|
Comparison of mean score in oral health literacy between men and women showed a significant
difference (P = 0.03) where women had a higher level of literacy [Figure 1].
Figure 1: Frequency distribution of each question score on the basis of gender
Level of oral health literacy had a statistically significant relationship with oral
hygiene behaviors of the participants. [Table 2] shows the relationship between different determinants with the obtained score from
the questionnaire. Association of the determinants with oral health literacy was confirmed
through adjusted regression analysis.
Table 2:
Relationship between oral health literacy score and different determinants
|
Variable
|
Pearson χ2
|
Degree of freedom
|
Significant (two-tailed)
|
|
*Significant
|
|
Gender
|
5.561
|
2
|
0.036*
|
|
Age
|
4.253
|
4
|
0.373
|
|
Tooth brushing
|
11.780
|
4
|
0.019*
|
|
Last dental visit
|
10.162
|
2
|
0.006*
|
|
Level of education
|
23.590
|
6
|
0.001*
|
|
Living space available per person
|
2.016
|
4
|
0.733
|
In self-assessment questions, 58% of the participants were satisfied with their oral
health status and mostly stated that their source of information in the field of oral
health was dentists.
DISCUSSION
Oral health literacy is one of the main parameters in determining the oral health
status which has been verified in recent years by the World Health Organization.[14] The results of this study showed that 62% of the participants had a high level of
oral health literacy whereas Naghibi et al.’s study[15] reported a lower rate of 40%.
The mean score acquired on the oral health literacy questionnaire in this study was
12, which was again higher than the average score (10.5) reported in Naghibi’s study
carried out in the capital city, Tehran, Iran. However, this could be due to the higher
level of education of participants in this study. The results of the study are in
line with a study by Sabbahi in Canada their frame of sampling.[16]
Studies in different countries analyzing the different levels of oral health literacy
between gender reported no statistically significant difference,[9]
[10]
[16] although in Naghibi et al.’s study in Tehran female participants had a higher level of oral health literacy which
agrees with the results of this study.[15] The reason for this is attributed to the fact that women tend to pay more attention
to oral health and hygiene issues, also they use the oral health-related information
provided by the media more often.
The level of oral health literacy was reported to be higher in those with a higher
level of education which has confirmed the results of other studies in other parts
of the world.[9]
[10]
[12]
[15] Thus, it can be concluded that training in the field of oral health is more necessary
in those with lower levels of education. Results showed that the level of education
affects the level of oral health literacy; therefore, it is suggested that educational
programs in relation to oral health literacy be aimed at groups with lower literacy
skills.
The level of oral health literacy has a statistically significant relationship with
oral hygiene habits such as brushing and dentist visits, such that those with higher
literacy levels brushed more and visited dentists more often. Previous studies showed
that individuals with lower literacy skills had lower oral hygiene and brushed less.[17]
[18]
Consequently, organizing public education programs through the media in different
groups of society could be helpful in improving the oral health literacy and lead
to better overall oral hygiene status. The results showed no statistically significant
difference among people of different age groups and different socioeconomic status;
however, in Naghibi’s study, it was reported that older groups had a lower level of
literacy.[15] Other studies also showed that older age groups had a lower level of oral health
literacy meaning they had a poor level of oral hygiene.[19] The difference here may be due to different levels of education.
To summarize, this study showed that patients who visited the dental school’s clinic
had a high level of oral health literacy; however, these results may not be a representative
of the general population. Therefore, future studies among more generalized population
are recommended.
CONCLUSION
The level of oral health literacy in patients visiting Kerman Dental School clinic
was at an acceptable level. Unfortunately, there is still no feasible method to promote
oral health litera
cy throughout the whole society; it is highly recommended that oral health educational
programs be held with a special focus on older age groups and lower literacy level.
Financial support and sponsorship
Nil.
