|Year : 2020 | Volume
| Issue : 3 | Page : 241-247
A comparative study of oral health attitude and behavior of dental and public health students in Ardabil, Iran using the Hiroshima University-Dental Behavioral Inventory
Safa Valizadeh Haghi1, Haleh Valizadeh Haghi2, Abolfazl Bagheri3, Nazanin Karimzadeh2
1 Department of Operative Dentistry, Tabriz University of Medical Sciences, Dental School, Tabriz, Iran
2 Department of Operative Dentistry, Ardabil University of Medical Sciences, Dental School, Ardabil, Iran
3 Department of Oral Pathology, Ardabil University of Medical Sciences, Dental School, Ardabil, Iran
|Date of Submission||18-Nov-2018|
|Date of Decision||01-Nov-2019|
|Date of Acceptance||28-Nov-2019|
|Date of Web Publication||02-Jun-2020|
Dr. Haleh Valizadeh Haghi
Department of Operative Dentistry, Ardabil University of Medical Sciences, Dental School, Ardabil.
Source of Support: None, Conflict of Interest: None
Aim: This study aimed to evaluate the self-reported oral health attitude and behavior of undergraduate dental and public health students, in Ardabil city, Iran to analyze the differences based on the field of education, gender, and level of education. Materials and Methods: This descriptive, cross-sectional study was performed on 195 (119 dental and 76 public health) students using Hiroshima University Dental-Behavioral Inventory (HU-DBI). Demographic questions including gender, educational field, and level of education were added to the questionnaire. The frequency of responses to the questions in the questionnaire was separately analyzed, tabulated, and reported. The effect of educational field and gender and level of education of students on their oral health attitude and behavior was analyzed using the chi-square test and Pearson correlation coefficient. The value of P < 0.05 was considered statistically significant. Results: There were some differences in oral health behavior between dental and public health students. Public health students showed more frequent use of hard toothbrush (P = 0.05) and hard strokes (P = 0.02). Overall, there were no statistically significant differences between female and male students (P > 0.05). No change in attitude occurred by an increase in the level of education (P > 0.05). Conclusion: There were some differences in dental health attitude and behavior of dental and public health students.
Keywords: Attitude, Behavior, Oral Health, Student
|How to cite this article:|
Haghi SV, Haghi HV, Bagheri A, Karimzadeh N. A comparative study of oral health attitude and behavior of dental and public health students in Ardabil, Iran using the Hiroshima University-Dental Behavioral Inventory. J Int Oral Health 2020;12:241-7
|How to cite this URL:|
Haghi SV, Haghi HV, Bagheri A, Karimzadeh N. A comparative study of oral health attitude and behavior of dental and public health students in Ardabil, Iran using the Hiroshima University-Dental Behavioral Inventory. J Int Oral Health [serial online] 2020 [cited 2021 Jan 16];12:241-7. Available from: https://www.jioh.org/text.asp?2020/12/3/241/285575
| Introduction|| |
In September 2016, a new definition of oral health was accepted by the food and drug administration. According to this definition, oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew and swallow, and convey emotions by facial expressions with no pain, discomfort, or craniofacial complex disease. Oral health is considered an important part of general health. Personal care and lifestyle practices constitute an important part of preventive oral health care. Empowering the individuals in this respect is a major goal in community dentistry.
Oral health attitude of oral health-care workers including dentists plays an important role in their dental care behavior and potentially affects their ability to encourage others to practice preventive measures. It also affects the public perception of preventive methods. Public health technicians also play a major role in the implementation of oral health programs in health centers and can significantly promote the oral health of the community. On the contrary, the role of non-dental professionals in general health of individuals is more prominent than dentists.
Dental students and other members of the health-care team acquire adequate knowledge and a positive attitude toward oral health during their education and eventually become a role model for their patients in the community. Creation of a positive attitude toward oral health should be emphasized in universities. Thus, it is imperative to assess the attitude of students toward oral health care to determine the efficacy of the current educational programs and curricula of universities in this regard. By doing so, the shortcomings can be identified and eliminated to enhance the knowledge and improve the attitude of the graduates and the public toward oral health directly and indirectly.,
This study aimed to assess the oral health attitude and behavior of public health and dental students of Ardabil University of Medical Sciences as they play a role in public health. The Hiroshima-University Dental Behavioral Inventory (HU-DBI) standard was used for this evaluation. This valid and reliable questionnaire was designed by Makoto Kawamura in 1987 in Japanese and has been used in many studies.,,,,, It was translated into Farsi by Khami et al.
| Materials and Methods|| |
This descriptive, cross-sectional study was performed on all dental and public health students of Ardabil University of Medical Sciences in the academic year 2016–2017 using the HU-DBI.
Sampling method and criteria
All of the students who fully fit the criteria were asked to participate in this study. The inclusion criteria of the study were students studying in the field of dentistry or public health in Ardabil University of Medical Sciences in the academic year 2016–2017 (224 students). Sampling was carried out in a voluntary and full-census manner and no attempt was made to fill the questionnaire by absent students on the day of survey. The incompletely filled or unreadable questionnaires were excluded from the study. A total of 195 students filled out the questionnaire. The percentage of the students participated in the study was 87%.
This questionnaire was translated into Persian and the validity and reliability of the Persian version of this questionnaire were confirmed by Khami et al. Therefore, we did not attempt to translate it into Persian again. Demographic questions including gender, educational field, and level of education (academic year) were added to this questionnaire. At the end of one of the theoretical or practical classes of students, their professors asked them to stay in the class to participate in the survey. One member of the research team who implemented the design of this survey administered the questionnaire among students. After filling the informed consent, students were asked to fill in the self-reported questionnaire and then completed questionnaire were collected. All of the students that participate in the survey in the first stage, filled the informed consent, that was in parsian and include the identity of participants, design and objectives of the study. Students filled informed written consent for participation in the study and publication of the data for research and students that have no consent were excluded from the survey. The questionnaires were filled out anonymously and voluntarily; thus, there were no ethical obstacles. The study was based on a thesis for a Doctor of Dental Surgery (DDS) degree (#42) submitted to Ardabil University of Medical Sciences, School of Dentistry and recheked and approved ethically by the research ethics committee of Ardabil University of Medical Sciences at 30/06/2019. All the procedures have been performed as per the ethical guidelines laid down by Declaration of Helsinki.
Data were analyzed using Statistical Package for the Social Sciences software, version 18.0 (IBM, Chicago, Illinois). The frequency of responses to the questions in the questionnaire was separately tabulated and reported. The effect of educational field, level of education, and gender of students on their oral health attitude and behavior was analyzed using the chi-square test. The value of P < 0.05 was considered statistically significant.
| Results|| |
A total of 195 students filled out the questionnaires. The demographic profile of the study groups is provided in [Table 1]. [Table 2] shows the frequency percentage of students’ responses to questions according to their educational field. The analysis of students’ responses to each question according to gender using the chi-square test showed that there were no significant differences in this regard [Table 3]. The Pearson correlation coefficient was used to assess the oral health attitude and behavior of students according to their level of education. Every 6 months is determined as one level of education, called a semester. Dental students of the second to tenth semesters were recruited in this study. Also, foreign graduate dentists completing a complementary course in this university were evaluated and analyzed separately [Table 4]. As public health students did not respond to this question, they were eliminated from this analysis.,
|Table 2: Frequency percentage of students’ responses to questions according to their educational field|
Click here to view
|Table 3: Percentage of “agree” responses to questions according to gender and based on educational field|
Click here to view
|Table 4: Percentage of “agree” responses of dental students to questions according to their level of education|
Click here to view
| Discussion|| |
One important responsibility of health-care professionals is to teach proper oral hygiene habits to patients to prevent oral and dental diseases. To serve this purpose, dental students and those studying in other health-care-related fields must acquire evidence-based knowledge about oral health behaviors and attitude. The first step in achieving this goal is to assess the oral health knowledge, attitude, and behavior of students. This study showed that the oral health attitude and behavior of students, particularly public health students, were not favorable, which may indicate poor social background or inefficient educational system. Poor oral health behavior and attitude of dental, medical, and nursing students have also been reported in studies conducted in China, Sudan, and Yemen, which is different from the results of some other studies.,[15-17] The difference in the efficacy of educational systems and some other factors involved in behavioral change in different communities and cultures may explain this controversy in the results. In a well-designed educational system, students must be able to use the acquired knowledge to improve their attitude and behavior.
Dental students receive more focused instructions on preventive dentistry and periodontal health, and are constantly interacting with patients. Thus, they are expected to have a more positive attitude and behavior with regard to oral health as compared to non-dental students., This pattern was seen in responses of students to nine questions in our study.
The students’ responses to questions regarding tooth brushing with a toothbrush with hard bristles and hard strokes showed that public health students were not well aware of the adverse effects of hard toothbrush and hard strokes and used outdated brushing techniques. Moreover, difference in response of public health students and dental students to questions regarding the gingival status such as tendency to bleeding during tooth brushing, dissatisfaction with gingival color, and worsening of dental status despite daily tooth brushing indicates that the proper oral hygiene measures are not practiced and there is an obvious need for further instructions on periodontal health. This finding was further confirmed by the students’ responses to question 10, declaring that they never received professional instructions on correct tooth brushing.
No significant difference was found in students’ responses to 11 questions in our study. These questions were mainly related to attitude of students and reflected the taught topics prior to university education related to personal care and behavior. These findings indicate the presence of relatively positive sensitivity and attitude toward oral health parameters, which can be considered as an opportunity for further education and instruction.
Another important finding with regard to public health students’ responses was that a considerable percentage of them said that they would not visit a dentist as long as they have no toothache. Absence of regular dental visits deprives the individuals from encouragement and instructions provided by dentists. Absence of regular dental visits is a common pattern reported by dental students, hygienists, medical students, and engineering students.,,[19-21] High cost of dental care services, fear of pain, having a bad dental experience, and inadequate knowledge about dental procedures are among the factors responsible for this finding. A previous study showed a different pattern between Americans and Asians in this respect and this difference was attributed to different behavior and reaction of individuals to health and disease in different communities. In this study, no significant difference was noted in behavior and attitude of male and female dental and public health students, which was different from the results of Peker and Alkurt in Turkey and a meta-analysis conducted in Greece. It is believed that females have better oral health behaviors as they pay more attention to their body and appearance. In the study by Khami et al., on Iranian students, no significant difference was noted between males and females in oral health behaviors (except for a few parameters), which was in good agreement with our findings. This may be due to the fact that both males and females receive equal oral health instructions.
Students often have low level of knowledge when entering the university. By an increase in their academic education, their level of knowledge improves and this knowledge leads to a change in attitude and behavior. In this study, public health students did not mention their academic year; thus, this variable was eliminated from statistical analysis. No significant difference was noted in attitude and behavior of dental students in different academic years for most questions, which was in contrast to the results of some previous studies.,,, Khatoon et al. showed that there was no significant difference in dental behavior among nursing students of different years and education program. This finding may indicate the inefficacy of the educational curriculum in changing the attitude and behavior of students or may reflect other social obstacles against behavioral change. However, our results in this respect were not highly reliable as the number of students in some academic years was too low and this might have affected the results.
Studies showed that different factors, such as personality profile of individuals, can affect their behaviors, for example, oral health behavior. In our study, the sample size was limited and we can say that performing similar studies in different universities of Iran and analysis of the personality factors, educational systems’ factors, and socioeconomic factors can be helpful in complete understanding of problem and can be helpful in revision of educational systems if needed.
| Conclusion|| |
Considering the results of this study, revision of educational curricula in universities, more efficient instruction of oral health care to non-dental students studying in health-related fields, and use of novel educational systems are recommended to promote the knowledge, attitude, and behavior of students. This can directly and indirectly affect the oral health knowledge, attitude, and behavior of the public. The oral health knowledge and attitude of students, assessed by the HU-DBI, was correlated with their educational field but had no correlation with gender or academic year of students. Both dental and public health students require further instructions on preventive dentistry to reinforce their behaviors.
Ethical policy and institutional review board statement
This study was previously approved by the university research council, the approval of which is equivalent to approval by the research ethics committee of Ardabil University of Medical Sciences on June 30, 2019. All the procedures performed in the study were in accordance with the ethical guidelines laid down by the Declaration of Helsinki (2013).
Data availability statement
The data supporting the findings of this study are available within the article and on request from Haleh Valizadeh Haghi ([email protected]).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
We would like to thank Dr. Khatereh Isazadehfar for consulting statistical analysis and Dr. Hamed Zandian for technical editing of the article.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Br Dent J 2016;221:792-3.
Folayan MO, Khami MR, Folaranmi N, Popoola BO, Sofola OO, Ligali TO, et al
. Determinants of preventive oral health behaviour among senior dental students in Nigeria. BMC Oral Health 2013;13:28.
Daly B, Batchelor P, Treasure E, Watt R. Essential Dental Public Health. Vol. 23. Oxford: Oxford University Press; 2013.
Shirjang A, Alizadeh M, Mortazavi F, Asghari JM, Jeddi A. Relevance of public health BSc curriculum to job requirements and health system expectations: Views of graduates on courses syllabi and content. Iran J Med Educ 2013;12:768-77.
Walker KK, Jackson RD. Oral health beliefs and behaviors of nurse and nurse practitioner students using the HU-DBI inventory: An opportunity for oral health vicarious learning. J Nurs Educ Pract 2017;7:19-26.
Halboub ES, Al-Maweri SA, Al-Jamaei AA, Al-wesabi MA, Shamala A, Al-kamel A, et al
. Self-reported oral health attitudes and behavior of dental and medical students, Yemen. Global J Health Sci 2016;8:143-50.
Tanny L, Komabayashi T, Long DL, Yahata Y, Moffat SM, Tãne H. The effect of education on oral health students’ attitudes in Australia and New Zealand. Eur J Dent 2016;10:491-5.
] [Full text]
Jaramillo JA, Jaramillo F, Kador I, Masuoka D, Tong L, Ahn C, et al
. A comparative study of oral health attitudes and behavior using the Hiroshima university-dental behavioral inventory (HU-DBI) between dental and civil engineering students in Colombia. J Oral Sci 2013;55:23-8.
Kawabata K, Kawamura M, Miyagi M, Aoyama H, Iwamoto Y. The dental health behavior of university students and test-retest reliability of the HU-DBI. J Dent Health 1990;40:474-5.
Komabayashi T, Kwan SY, Hu DY, Kajiwara K, Sasahara H, Kawamura M. A comparative study of oral health attitudes and behaviour using the Hiroshima university-dental behavioural inventory (HU-DBI) between dental students in Britain and China. J Oral Sci 2005;47:1-7.
Dagli RJ, Tadakamadla S, Dhanni C, Duraiswamy P, Kulkarni S. Self reported dental health attitude and behavior of dental students in India. J Oral Sci 2008;50:267-72.
Daou D, Rifai K, Doughan B, Doumit M. Development of an Arabic version of the Hiroshima university-dental behavioral inventory: Cross-cultural adaptation, reliability, and validity. J Epidemiol Glob Health 2018;8:48-53.
Khami MR, Ghadimi S, Zare H, Rabbani M. Attitudes towards oral health behavior among students of dental schools in Tehran. J Islamic Dent Assoc Iran 2010;22:223-32.
Al-Shiekh L, Muhammed ME, Muhammed AE, El-Huda MA, Hashim NT. Evaluation of dental students’ oral hygiene attitude and behavior using HU-DBI in Sudan. Sci Postprint 2014;1:1-5.
Al-Wahadni AM, Al-Omiri MK, Kawamura M. Differences in self-reported oral health behavior between dental students and dental technology/dental hygiene students in Jordan. J Oral Sci 2004;46:191-7.
Yildiz S, Dogan B. Self reported dental health attitudes and behaviour of dental students in Turkey. Eur J Dent 2011;5:253-9.
Polychronopoulou A, Kawamura M. Oral self-care behaviours: Comparing Greek and Japanese dental students. Eur J Dent Educ 2005;9:164-70.
Ng JV, Noorani TY, Ghani NRNA, Moheet IA. Self-reported differences in oral health attitudes and behaviors of health-care students at a University in Malaysia. Eur J Gen Dent 2018; 7:7-13. [Full text]
Kawamura M, Spadafora A, Kim KJ, Komabayashi T. Comparison of United States and Korean dental hygiene students using the Hiroshima university-dental behavioural inventory (HU-DBI). Int Dent J 2002;52:156-62.
Al-Omari QD, Hamasha AA. Gender-specific oral health attitudes and behavior among dental students in Jordan. J Contemp Dent Pract 2005;6:107-14.
Peker I, Alkurt MT. Oral health attitudes and behavior among a group of Turkish dental students. Eur J Dent 2009;3: 24-31.
Mamai-Homata E, Koletsi-Kounari H, Margaritis V. Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data. J Int Soc Prev Community Dent 2016;6:60-8.
Barrieshi-Nusair K, Alomari Q, Said K. Dental health attitudes and behaviour among dental students in Jordan. Community Dent Health 2006;23:147-51.
Khatoon S, Shah SY, Javaid H, Rajput ZA, Ali Z, Ahmed I. Oral health behavior and practice among nursing students in Hyderabad city, Pakistan. J Dow Univ Health Sci 2019;13:13-23.
Al-Omiri MK, Alhijawi MM, Al-Shayyab MH, Kielbassa AM, Lynch E. Relationship between dental students’ personality profiles and self-reported oral health behaviour. Oral Health Prev Dent 2019;17:125-9.
[Table 1], [Table 2], [Table 3], [Table 4]