Oral health literacy : implications for Hong Kong's children

Abstract

BACKGROUND: Researchers in the fields of health, education and psychology have established a causal relationship between levels of education and both health status and its management amongst adults and children. This has resulted in largescale ‘health literacy’ intervention programmes. The relationship between oral health literacy (OHL), health status and management is less understood. Indeed, ‘OHL’ is a relatively new field with limited research to date in Asia. Measurements of OHL on the whole have focused on the match or mismatch between reading fluency, vocabulary, background knowledge, and oral and written communication demands. While it may be difficult or impractical to comprehensively capture and measure all possible dimensions of OHL, several instruments have been developed to date, albeit mostly in English dominant contexts.

OBJECTIVES: The major objectives of this study were to: a) to describe the relationship between caregiver reading habits and their OHL, and their child’s oral health status; b) assess the functional OHL levels of primary caregivers in an Asian population using two new instruments; c) to describe the relationship between caregiver OHL and the oral health status of their children.

METHODS: A cross-sectional study using two locally-developed and validated OHL instruments; Hong Kong Rapid Estimate of Adult Literacy in Dentistry-30 (HKREALD-30) and Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT-P) was adopted. A random sample of 301 child/caregiver dyads was recruited from kindergartens in Hong Kong Island. Data included: socio-demographic information; caregivers’ self-reported reading habits and OHL levels; and child oral health status as a) dental caries experience - number of decayed, missing and filled teeth (dmft); and b) oral hygiene status - by the Visible Plaque Index (VPI).

RESULTS: Caregivers’ reported reading of print Chinese was significantly associated with their OHL scores: HKREALD-30 and HKOHLAT-P (p<0.01). No associations were found between caregiver’s reading habits and their children’s oral health status (p>0.05). Both OHL assessment tasks were associated with children’s oral health status. Both HKOHLAT-P and HKREALD-30 remained associated with dmft in the adjusted negative binomial regression models (accounting for socio-demographics), but HKOHLAT-P had a stronger association (IRR 0.97, P=0.02 versus 0.96, P=0.03). HKOHLAT-P was associated with VPI in the adjusted model (IRR 0.90, P<0.05), but no significant association between HKREALD-30 and VPI was evident.

CONCLUSIONS AND IMPLICATIONS: Caregivers’ habits of reading print and digital texts were significantly associated with their OHL scores. No significant associations were found between caregivers’ reading habits and their children’s oral health status, indicating that reading habits is a different attribute that may not directly affect their child’s oral health. Caregivers’ functional OHL was associated with their children’s oral health status in Hong Kong. A comprehension task tool (HKOHLAT-P) was more robust in determining such associations when compared to a simple word recognition based test (HKREALD-30).