Exploring dental behaviours of carers of adults with disabilities: oral health literacy and psycho-social factors.

Abstract

Background: People with physical and intellectual disabilities (PID) depend on their carers for daily oral care at home and attending regular preventive dental visits. However, very few carers seem to receive training in oral care for people with PID. Carers’ oral health literacy, and psycho-social factors (carer dental efficacy, carer oral health competency, and carer activation measure) may be associated with the ability of carers to provide good oral care to their care recipients. The oral health care provided could be further associated with the environment, such as the residential setting of the care recipients where the care is provided. Thus, the aims of the study were to describe and compare oral health literacy and psycho-social factors among carers, and assess any associations with preventive dental behaviours. Favourable associations could then be utilised to make recommendations for the development of appropriate education programmes for carers, that match their oral health literacy and psycho-social preparedness, so that carers can provide more appropriate care for their care recipients. Methods: The research was a follow-up study of carers of adults with PID living in Adelaide in three residential settings: family home; community housing; and institutions. Data were collected (February 2009 - April 2010) through a structured face-to-face interview of 100 carers. Oral health literacy (OHL) and general literacy (GL) were measured using text passages and prompts with a total of 25 items to assess comprehension and numerical ability of carers, based on five domains: accessing dental care, understanding appointments, completing medical history and consent forms, and following medication instructions. Carer dental efficacy (CDE) was measured using five items on oral care behaviours. Carer perceived oral health competence (COHC) was measured using five items on managing oral health care. Carer activation measure (CAM) was used to determine capability or readiness to engage in desired oral health behaviours. CAM included 13 items on three subscales- Knowledge, Skills and Confidence. The key outcome measures were toothbrushing and dental visiting pattern. Results: GL score was higher than OHL score among all groups, but neither of the literacy scores were significantly associated with the toothbrushing and dental visit frequency of the care recipients. After adjusting for carer and care recipient characteristics, multivariate analysis showed that twice a day toothbrushing was significantly associated with higher CDE [OR= 4.2 (1.5, 11.6)]. Regular dental visit among the care recipients was significantly associated with higher CDE [OR= 4.7 (1.3, 17.2)], COHC [OR= 5.7 (1.4, 23.4)], and CAM-Skills [OR= 4.3 (1.1, 15.9]. Conclusions: OHL among carers was not associated with key dental behaviours for care recipients. However, psycho-social factors (carer dental efficacy, carer oral health competence, carer skills) were associated with dental visit frequency. CDE was also associated with toothbrushing frequency. These psycho-social factors may be enhanced by providing encouragement and positive reinforcement to carers, and by specific interventions that match their level of preparedness. Providing such support and guidance to carers may then improve their ability to provide appropriate oral health care for their care recipients.