Action and coping planning with regard to dental brushing among Iranian adolescents

Abstract

The aims of this study were two-fold: (i) to examine the validity of the proposed three-factor structure (intention, action-, and coping planning) in an Iranian sample of adolescents, and (ii) to assess the predictive ability of the Theory of Planned Behavior (TPB) measures of action planning and coping planning for dental brushing. Eight hundred adolescents were randomly selected to participate in the study. 90% (721) of adolescents agreed to participate. Perceived behavioral control, action and coping planning scales and a self-report questionnaire related to dental brushing behavior were completed by the adolescents at baseline. One month later (time-point 2), the adolescents were asked to reassess their frequency of dental brushing over the four week period. Data were analyzed by a confirmatory factor analysis (CFA) on an original three-factor structure (intention, action plan, and coping plan). A hierarchical linear regression analysis was also performed. The CFA for the original three-factor structure showed a good fit index (χ² = 637.60, degrees of freedom df = 116), goodness-of-fit index (GFI) = 91, and root mean square error of approximation (RMSEA) = 0.079. Adjusting for demographic variables, action- and coping planning together accounted for 7.9% of the variance associated with dental brushing behavior at one month. In conclusion, results suggest that action planning and coping planning are associated with higher frequency in dental brushing among Iranian adolescents.

Keywords:

• adolescents
• behavioral science
• oral health
• planning
• tooth-brushing

Notes

1. Two trained bilingual Iranians translated these scales into Iranian, acting independently of one another. Both versions were revised by a specialized translator who evaluated the level of difficulty in terms of translation, using a scale of 0 (“not at all difficult”) to 100 (“most difficult”), as well as the equivalence of each item and response scale, using a ranking of 0 (“not at all equivalent”) to 100 (“exactly equivalent”). The translators compared their results, reconciled their discrepancies, and arrived at a unified Iranian version suitable for use with Iranian adolescents. The feasibility of the instrument and the difficulties found by the adolescents were evaluated by a panel including experts in psychology, public health, dentistry as well as eight adolescents with different educational backgrounds. Changes were made based on the difficulties the adolescents had in understanding the questionnaire, and a dictionary of synonyms was used to establish a more simple vocabulary. Subsequently, the final version was translated back into US English by two additional translators, both of whom were native English speakers. Discrepancies between the back-translations were resolved.

2. The CFI and NFI ranges from 0 to 1, where a CFI or NFI close to 1 indicates a very good fit and a value greater than 0.9 indicates an acceptable fit. RMSEA is a measure of the discrepancy of the model to the collated data, expressed per degree of freedom, with a typical cut-off point for the RMSEA values in the range of 0.05–0.08 were taken to indicate acceptable fit, values in the range of 0.08–0.10 to indicate marginal fit, and values larger than 0.10 to indicate poor fit. Previous studies (Marsh, Hau, & Wen 2004; Byrne, 1998) have suggested a cut-off point equal to or greater than 0.90 for GFI and AGFI. SRMR is the standardized difference between the observed covariance and predicted covariance. A value less than 0.08 is considered a good fit for the SRMR (Marsh et al., 2004; Byrne, 1998).