Abstract
Objectives. This paper examines the relationship between theoretically-driven mediators and clinical outcomes of a group randomized trial to improve oral health and hygiene of older adults in subsidized housing were compared. Methods. Six low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs) both based on Fishbein’s Integrated Model. 331 participants were recruited at baseline and 306 completed the post-assessment one month after intervention. Clinical outcome s were Gingival Index (GI) and Plaque score (PS), collected by calibrated dental hygienists. Surveys obtained data on patient background characteristics, and ten oral health beliefs, attitudes, norms and behaviors. GLMM assessed the effects of time, intervention arm, moderators and mediators and intervention by time interactions. Results. Baseline moderators were similar. Both outcomes improved significantly. GI scores changed from baseline mean of 0.38 (sd=.032) to .26 (sd=.025) and PS scores changed from baseline mean of 71.4 (sd=18%) to 59.1% (sd=21%). Fears, intentionality, norms, worries, flossing and sugar consumption improved significantly in both interventions from baseline to post intervention. Self-efficacy, perceived risk of oral health problems, locus of control and brushing improved significantly only in the counseling intervention. Mechanisms predicting GI improvement were intentionality, locus of control, brushing and flossing in association with the counseling intervention. Mechanisms predicting PS improvement were worries about oral hygiene self-management and fear of oral diseases in association with the AMI intervention. In the trimmed final models, only locus of control (predicting GI) and fears of oral diseases (predicting PS) were significant. Conclusions. GI and PS improved more in response to the counseling intervention than the campaign. The counseling intervention had a greater impact on mechanisms of change than the campaign. Locus of control, a key concept in oral hygiene interventions including the IM was the main contributing mechanism for GI. Fear, an emotional response drove improvement in PS reinforcing the importance of cognitive/emotional mechanisms in oral hygiene interventions. Improvements in mediators across both interventions suggest a closer examination of the campaign intervention impact on outcomes over time. Trial Registration: Clinicaltrials.gov NCT02419144, first posted April 17, 2015
Perception of the importance of oral hygiene in a group of adults from South-West Romania
