| Objective:1.To investigate the current situation and problems of oral health literacy among community-dwelling older adults,and explore the influential pathways and extent of oral health literacy towards oral health behaviors,so as to provide a realistic basis and theoretical reference to construct an oral health literacy intervention protocol for community-dwelling older adults.2.To summarize the best evidence of oral health management for communitydwelling older adults,construct an oral health literacy intervention protocol,and design evidence-based oral health management popular science works for communitydwelling older adults and provide content guidance which provides the reference and tool support for the improvement of oral health literacy for community-dwelling older adults.3.To test the applicability of the oral health literacy intervention protocol for community-dwelling older adults by a single-group pre-post design to provide a practical reference for the improvement of oral health literacy among communitydwelling older adults.Methods:1.The current status of oral health literacy for community-dwelling older adults(1)A qualitative study of oral health literacy among community-dwelling older adults: A descriptive qualitative study was used.The community-dwelling older adults in Zhenjiang,Jiangsu were selected for semi-structured interviews(n=20)by purposive sampling and maximum variance sampling from July to September 2021.Traditional content analysis was used to analyze the problems of community-dwelling older adults in obtaining,processing,and understanding oral health information and services.(2)A quantitative study of oral health literacy among community-dwelling older adults based on the IMB model: 429 community-dwelling older adults in Zhenjiang,Jiangsu were selected for a questionnaire survey by convenience sampling from September 2021 to November 2021.The study instruments included general information,adult oral health literacy questions,oral health knowledge,beliefs and behavior questionnaire for community-dwelling older adults,oral health behavior selfefficacy scale,and social support assessment scale.Structural equation modeling(SEM)was used to analyze influential pathways and the extent of oral health literacy on oral health behaviors.2.Construction of an oral health literacy intervention protocol for communitydwelling older adults(1)Evidence synthesis on oral health management of community-dwelling older adults: We searched databases including Up To Date,BMJ Best Practice,JBI,NGC,RNAO,CMA,SIGN,NICE,GNI,SDCEP,Cochrane Library,Pub Med,CNKI.The types of literature collected were guidelines,evidence summaries,expert consensus,systematic reviews,and best practices.The best evidence for oral health management of community-dwelling older adults was summarized through literature selection,literature quality evaluation,content extraction and synthesis,and evidence grading.(2)Construction of an oral health literacy intervention protocol for community-dwelling older adults: The oral health literacy intervention protocol for community-dwelling older adults was constructed based on the current status survey and the evidence summary,guided by the Health Literacy Care Model.The focus group interview was used to revise,validate,and form the final protocol.(3)Development of oral health management popular science works for community-dwelling older adults: The topics of the oral health management popular science works were determined based on the evidence summary and oral health literacy intervention protocol,guided by the Expert Consensus on the Creation and Dissemination of Chinese Health Popular Science Works and the Health Literacy Care Model.The multidisciplinary team cooperated to develop the series of popular science works through evidence refinement and translation.The draft of the work was reviewed and revised through focus group interviews,and finally formed the oral health management popular science works for community-dwelling older adults.3.A pilot study of oral health literacy intervention protocol for communitydwelling older adultsA single-group pre-post design was conducted to test the applicability of the oral health literacy intervention protocol by selecting older adults(n=30)from September2022 to February 2023 in a community in the hi-tech zone of Zhenjiang,Jiangsu.The effectiveness and feasibility of the intervention protocol were evaluated by oral health literacy,oral health knowledge,belief,and behavior for community-dwelling older adults,oral health behavior self-efficacy,oral health situation,oral p H,etc.Paired t-test and repeated measures variance were used to compare the before and after intervention data.Results:1.The current status of oral health literacy for community-dwelling older adults(1)A qualitative study of oral health literacy among community-dwelling older adults: A total of 4 themes and 9 sub-themes were extracted including oral health cognitive bias(weak perception of needs,insufficient perception of negative effects),information access barriers(insufficient internal drive,partial understanding of information),significant oral health self-management differences(variable selfmanagement efficacy,variable social support efficacy),and impeded access to care decision-making(inaccessibility of care,poor access experience,and lack of doctorpatient trust).(2)A quantitative study of oral health literacy among community-dwelling older adults based on the IMB model: The mean scores of oral health literacy,oral health knowledge,oral health belief,oral health behaviors,oral health behavioral selfefficacy,and social support among the community-dwelling older adults were(10.39±2.99),(12.40±3.06),(11.38±2.45),(32.79±6.80),(77.95±12.37),(32.51± 5.06)points.The structural equation modeling showed that oral health literacy was positively associated with self-efficacy,and indirectly affected oral health behavior(β=0.194,P<0.05);oral health knowledge indirectly affected oral health behavior by influencing oral health literacy(β=0.044,P<0.05);motivation can affect oral health behavior directly or affect oral health behavior indirectly by influencing oral health literacy and self-efficacy(β=0.535,P<0.05).2.Construction of an oral health literacy intervention protocol for communitydwelling older adults(1)Evidence synthesis on oral health management of community-dwelling older adults: A total of 288 articles were searched,and 17 articles were finally included,containing 5 guidelines,4 expert consensuses,and 8 systematic reviews.28 pieces of evidence were summarized in 6 aspects,including assessment and examination,daily life management,dietary management,management of special oral problems,denture management,and education and training.(2)Construction of an oral health literacy intervention protocol for community-dwelling older adults: The intervention topics of the protocol included healthcare talks,skills demonstrations,companion education,behavior change plans,etc.Health literacy universal prevention tools were applied containing effective use of health education materials,clear communication,educational feedback,encouraging questions,etc.The duration of the intervention was 12 weeks,with a total of 6 sessions of 35～50 minutes each.(3)Development of oral health management popular science works for community-dwelling older adults: 5 popular science topics which includes the importance of oral health,risk factors of oral diseases,identification of dental caries and periodontal diseases,prevention and care,and use of oral cleaning tools and 16sub-themes were identified.After 2 focus group interviews to evaluate and revise the works,the series of popular science works on oral health management for communitydwelling older adults,including popular science videos and popular science manuals,were finally formed.3.A pilot study of oral health literacy intervention protocol for communitydwelling older adultsAfter the intervention,a statistically significant difference was found in oral health literacy and oral health knowledge among community-dwelling older adults(P < 0.001).However,the differences in oral health beliefs,oral health behaviors,oral health behavioral self-efficacy,oral health assessment,and oral p H were not statistically significant(P > 0.05).The repeated measures variance showed statistically significant main effects for oral health literacy,oral health knowledge,oral health beliefs,oral health behaviors,and oral health behavioral self-efficacy(P < 0.001).Conclusion:1.The oral health literacy level of community-dwelling older adults is average,with insufficient oral health knowledge,beliefs,and behaviors,and low self-efficacy levels.Various educational forms and methods should be used to carry out health education on oral health-related knowledge and skills of community-dwelling older adults,which is beneficial to improve oral health literacy,oral health knowledge,beliefs and behaviors and improve oral health outcomes.2.The oral health literacy intervention protocol for community-dwelling older adults which was constructed according to the evidence summary and the Health Literacy Care Model has a certain scientific,reliable,and theoretical value,and the evidence-based oral health management series of popular science works for community-dwelling older adults are easy to understand,vivid,interesting,and highlighted,with certain scientificity,standardization and user-friendliness.They can provide the reference and tool support for oral health literacy intervention.3.The oral health literacy intervention protocol for community-dwelling older adults by applicability testing is feasible.Although it failed to improve the oral health beliefs,oral health behaviors and self-efficacy,it enhanced the oral health literacy and oral health knowledge.The protocol will be further improved and replicated. |
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