Background Caries seriously affects the health of lower-grade elementary school students. Good oral health behaviors can reduce the risk of caries, and intervention based on the theory of planned behavior has been shown to be an effective way to improve oral health behaviors of lower grade pupils.
Objective This study explores factors affecting the intention of oral health behaviors among lower-grade pupils in elementary schools based on the extended theory of planned behavior (TPB).
Methods All second- and third-grade students from two elementary schools in Minhang District, Shanghai were selected as study subjects by cluster sampling method in October 2020 for a questionnaire study. The questionnaires included demographic and sociological characteristics, TPB dimensions (including direct and indirect behavioral attitudes, direct and indirect subjective norms, and direct and indirect perceived behavioral control), oral health knowledge, self-efficacy, and expected social outcomes. Exploratory factor analysis was conducted for the TPB dimensions and items, and Pearson correlation analysis and hierarchical multiple regression analysis were used to analyze the relationships of intention of oral health behaviors with the variables of socio-demographic characteristics, TPB dimensions, oral health knowledge, self-efficacy, and expected social outcomes of the pupils.
Results Among 651 participants, 51.0% were male and 49.0% were female; 37.0% were in second grade and 63.0% were in third grade. The exploratory factor analysis yielded six factors from the TPB scale used in this study: direct behavioral attitudes, direct subjective norms, direct perceived behavioral control, indirect behavioral attitudes, indirect subjective norms, and indirect perceived behavioral control. The results of Pearson correlation analysis showed that, except expected social outcomes, the variables of direct behavioral attitudes, direct subjective norms, direct perceived behavioral control, indirect behavioral attitudes, indirect subjective norms, indirect perceived behavioral control, oral health knowledge, and self-efficacy were associated with oral health behavior intention, and the correlation coefficients of these variables ranged from 0.085 to 0.762. The results of hierarchical regression analysis showed that sex (b=0.164 4), age (b=0.020 7), direct subjective norms (b=0.070 1), direct perceived behavioral control (b=0.601 2), and self-efficacy (b=0.108 0) were factors of oral health behavior intention among the lower-grade elementary school students (P < 0.05), which explained 62.3% of the variation in oral health behavior intention.
Conclusion The extended TPB model is able to explain the oral health behavior intention of lower-grade students in elementary schools. Direct subjective norms, direct perceived behavioral control, and self-efficacy can be considered as important intervention targets for oral health behavior intention among lower-grade elementary school students.
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