การพัฒนาแบบวัดความรอบรู้ด้านสุขภาพช่องปากสำหรับผู้มารับบริการทันตกรรมวัยผู้ใหญ่ในบริบทของสังคมไทย

Abstract

The aims of this study were to develop a valid and reliable oral health literacy assessment tool and to study the relationship between social determinants of health, oral health behaviors, oral health status and the level of oral health literacy (OHL). The OHL tool was developed based on the health literacy model of Kickbusch & Maag, which assesses levels of literacy in 3 dimensions, which are functional, communicative and critical skills. The OHL level is assessed in 4 competencies according to the subject's context including their oral health care system, home and community, marketplaces and political arena. A cross-sectional analytical survey was carried out among 20-59 year old adults in 3 border provinces who were dental clients in 7 health promotion hospitals, community hospitals and provincial hospitals. Subjects were interviewed to gather data regarding social determinants of health and oral health behaviors, and they also completed an OHL assessment form. Later, their oral health was examined to record DMFT. The data were cleaned and analyzed to assess validity and reliability of the OHL measurement. This was followed by testing the relationship between OHL and social determinants of health, oral health behaviors and oral health status. The results showed that subjects were evenly distributed over 3 provinces as 34% of the subjects lived in Muang district whereas 66% lived in rural areas. Most subjects were female Muslims with a mean age of 36 years old, 80% had finished senior high school, 65% had a universal health coverage insurance scheme, and 52% had not been to a dentist in the past 6 months. The DMFT was 12.58 ± 7.47. The OHL tool achieved good reliability with a Cronbach's alpha (α) score of 0.878 and demonstrated good discrimination and difficulty levels. OHL scores varied from 0 to 50 so the OHL score of 40 was used as a cut-off point to classify the subjects' OHL as adequate or inadequate. Those who had adequate OHL lived in Muang district, had a bachelor degree, had an income of 15,000 baht, and had a social security insurance scheme or government officer insurance scheme (p<0.05). Moreover, OHL associated with good oral health behaviors such as brushing teeth twice a day or more and using dental floss and mouthwash. However, DMFT was not associated with OHL.