Factors related to children’s tooth-brushing at different ages: an application of the theory of planned behavior

ABSTRACT

Tooth-brushing is one of the most important health behaviors to teach children considering potentially serious ramifications of poor dental health. However, children’s tooth-brushing behavior is affected by various developmental factors. The aim of this cross-sectional study was to investigate factors related to the tooth-brushing behavior of children adopting the Theory of Planned Behavior. A preliminary elicitation study with 33 primary school students identified underlying beliefs related to tooth-brushing intentions. This data was analysed, synthesized, and incorporated into the development of survey items for three age-appropriate, closed-ended questionnaires administered to 709 primary public school students. Path analyses using structural equation modelling were used to discover the structural relationships among the direct and indirect determinants of tooth-brushing behaviors, and path estimates and the model fit were calculated. Social recognition, peer influence, self-motivating strategies, and cognitive aspects of tooth-brushing were found to become more influential in facilitating behavioral intention with age. In the path models, the tooth-brushing behavioral intention was significantly related to perceived behavioral control rather than behavioral beliefs and normative beliefs. Subjective norms were found to become more significant as children matured. This result suggests that education to improve children’s tooth-brushing behavior needs be appropriate to the developmental stage of children.

KEYWORDS:

• Theory of Planned Behavior
• tooth-brushing
• perceived behavior control
• cognitive development

Acknowledgments

We are grateful to the teachers of Seoul National University Elementary School and the children who participated both in the elicitation study and main survey for their support in implementing this research. The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

[Y 1-2 (7-8 years olds)] Children’s Opinion Survey about Tooth-brushing

Same format was applied for the rest of items

1. Brushing teeth at least twice a day bothers me.

2. Adults such as parents and teachers around me would think I should brush my teeth at least twice a day.

3. All my friends will brush their teeth at least twice a day.

4. Brushing teeth at least twice a day will make teeth clean and free from cavities.

5. When I brush my teeth at least twice a day, my mouth will not smell and I will feel refreshed.

6. Clean and healthy teeth is very important.

7. When my breath does not smell bad and I feel refreshed, I will feel very good.

8. My parents and the adults around me will compliment me when I brush my teeth at least twice a day.

9. My homeroom teacher will praise me when I brush my teeth at least twice a day.

10. The dentist will praise me if I brush my teeth at least twice a day.

11. I want to obey what my parents say.

12. I want to obey what the teacher says.

13. I want to obey what my dentist says.

14. When my parents help me brush my teeth well, I will be able to brush my teeth at least twice a day.

15. With a toothbrush, toothpaste, and a cup which is good for tooth-brushing, I will be able to brush my teeth at least twice a day.

16. If I have a tooth-brushing habit, I will be able to brush my teeth at least twice a day.

17. When I am not bothered or sleepy, I will be able to brush my teeth at least twice a day.

18. My parents help me brush my teeth at least twice a day well.

19. I have a toothbrush, toothpaste, and a cup which is good for tooth-brushing in my house.

20. I can brush my teeth at least twice a day, even if I am annoyed or sleepy.

21. I can have a habit of brushing teeth at least twice a day.

22. I am confident of brushing teeth at least twice a day from now on.

23. I will brush my teeth at least twice a day from now on.

[Y 3-4 (9-10 years olds)] Children’s Opinion Survey about Tooth-brushing

1. Brushing teeth at least twice a day (for example, every morning and evening) is a good thing.

2. Brushing teeth at least twice a day bothers me.

3. It is difficult and sleepy to brush teeth at least twice a day.

4. Adults such as parents and teachers around me would think I should brush my teeth at least twice a day.

5. All my friends will brush their teeth at least twice a day.

6. Brushing teeth at least twice a day will make free from cavities.

7. When I brush my teeth at least twice a day, I will feel refreshed.

8. When I brush my teeth at least twice a day, I do not have to go to the dentist.

9. It is very good to have no cavities.

10. I feel great when my mouth is fresh.

11. It’s very good not to have to go to the dentist.

12. My parents and relatives will give me praises if I brush my teeth at least twice a day.

13. The dentist will praise me if I brush my teeth at least twice a day.

14. I want to obey what my parents and relatives say.

15. I want to obey what my dentist says.

16. When my parents give me a reward or nagging to brush my teeth, I will be able to brush my teeth at least twice a day.

17. With a toothbrush good for tooth-brushing and sweet-tasting toothpaste, I will be able to brush my teeth at least twice a day.

18. If I have a tooth-brushing habit, I will be able to brush my teeth at least twice a day.

19. If I am not busy or sleepy, I will be able to brush my teeth at least twice a day.

20. My parents give me a reward or help to brush my teeth at least twice a day.

21. I have a good toothbrush and sweet-smelling toothpaste at home.

22. I can brush my teeth at least twice a day even if I’m busy or sleepy.

23. I can have a habit of brushing teeth at least twice a day.

24. I am confident of brushing teeth at least twice a day from now on.

25. I will brush my teeth at least twice a day from now on.

[Y 5-6 (11-12 years olds)] Children’s Opinion Survey about Tooth-brushing

1. Brushing teeth at least twice (for example, every morning and evening) a day is a good thing.

2. Brushing teeth at least twice a day bothers me.

3. Brushing teeth at least twice a day is a waste of time.

4. Brushing teeth at least twice a day will hurt your gums.

5. My parents and grown-ups will think I have to brush my teeth at least twice a day.

6. All my friends will brush their teeth at least twice a day.

7. When I brush my teeth at least twice a day, my mouth will not smell and I will feel refreshed.

8. Brushing teeth at least twice a day will make free from cavities.

9. When I brush my teeth at least twice a day, I will be praised for my cleanliness.

10. It’s nice to have a fresh mouth and no mouth smell.

11. It’s great if I don’t get cavities.

12. It is important to me to be praised for being clean.

13. My parents and the adults around me will compliment me when I brush my teeth at least twice a day.

14. Friends, brothers and sisters around me will compliment me when I brush my teeth at least twice a day.

15. The dentist will praise me when I brush my teeth at least twice a day.

16. Those who are sincere and clean will brush their teeth at least twice a day.

17. I want to obey what my parents and the adults around me say.

18. I want to do like my friends, brothers and sisters.

19. I want to follow the dentist’s advice.

20. I want to be a man of integrity and cleanliness.

21. With a toothbrush good for tooth-brushing and sweet-tasting toothpaste, I will be able to brush my teeth at least twice a day.

22. If I had an alarm to help brush my teeth, I could brush my teeth at least twice a day.

23. When my mother nags me to brush my teeth, I can brush my teeth at least twice a day.

24. If I understand the effect of tooth-brushing, I will able to brush my teeth at least twice a day.

25. I’ll be able to brush my teeth at least twice a day when I have time or get up early.

26. I have a good toothbrush and sweet-tasting toothpaste in my house.

27. I can set an alarm to tell when to brush my teeth.

28. My mother often nags me to brush my teeth.

29. I know the effect of tooth-brushing, or I can study about tooth-brushing on my own.

30. I can get up early and make time for tooth-brushing to brush my teeth well.

31. It’s up to me to brush my teeth at least twice a day.

32. I am confident of brushing teeth at least twice a day from now on.

33. I will brush my teeth at least twice a day from now on.

Additional information

Funding

This study was funded by the basic Science Research Program of the National Research Foundation of Korea (NRF), by the Ministry of Science and ICT (NRF- 2017R1C1B2010469), and the Dental Research Institute of Seoul National University;National Research Foundation of Korea [NRF- 2017R1C1B2010469].