@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2019;6(1):17-23

Background
One of the most commonly diagnosed chronic diseases in the world is diabetes.
Previous Studies
According to the guidelines of the American Diabetes Association, diabetes self-management education is a process to facilitate the development of knowledge, attitude and practice in self-care of diabetic patients [14]. Baghiani Moghadam et al. also in a study on the effect of using educational messages based on the Health Belief Model on adopting of self-care behaviors in patients with type 2 diabetes in Birjand, found the increased awareness, sensitivity and severity of the complications of diabetes, and also understanding the benefits and barriers for a helpful health behavior [16]. Mardani Hamuleh & Shahraki Vahed have also shown the impact of using this model in changing the diet of type 2 diabetic patients [17].
Aim(s)
The present study was conducted to survey the effective factors on the oral and dental health of patients with diabetes mellitus type 2 based on the health belief model.
Research type
This research is a cross-sectional descriptive-analytical study.
Research society, place and time
This study was done on 320 patients with diabetes mellitus type 2, who referred to Kashan Diabetes Clinic in 2018.
Sampling method and number
The sample size was calculated 297 subject (α=5% and β=0.1) and considering the possible falling of 10%, a total sample size of 320 people was estimated to increase the accuracy of the study. To perform the sampling, Kashan Diabetes Clinic was referred and the samples were selected from the 2,500 records available in the clinic using randomly systematic method based on the inclusion criteria. The patients were informed about the study and voluntarily enrolled.
Used devices&materials
A researcher-made questionnaire was used to collect data. It comprised of 21 questions about demographic information, 9 questions about knowledge (diabetic patients’ knowledge about the factors causing tooth decay, the number of brushing times and time spent on brushing, etc.), 7 Questions about perceived sensitivity (for example, due to diabetes, I am more prone to oral and dental problems than other people in the community), 10 questions about perceived severity (e.g., If I do not observe oral hygiene, I will get gum inflammation), 7 questions about perceived barriers (for example, due to lack of time, I can not regularly brush up teeth), 8 questions about the perceived benefits (for example, tooth decay s less likely, if I brush up every day), 11 questions about self-efficacy (for example, I can brush my teeth regularly, despite fatigue, numbness, and disability), 4 questions about the internal cue of action (for example, the importance of having my oral and dental health is the most important part of my oral health care), 5 questions about the external cue of action (e.g. nurse and diabetes center staff recommendations are effective for oral hygiene) and 10 questions about the oral health care function (for example, do you brush your teeth twice or more during the day). The reliability of the questionnaire was also measure using Cronbach's Alpha on 30 diabetic patients who were similar to the population studied and confirmed with the values more than 0.7. Prior data collection, the samples were informed about the study objectives, the consent was obtained and they were assured of the confidentiality of information. The researcher-made questionnaire was then completed. Data was analyzed by SPSS 16 software. Data analysis was performed using Pearson correlation test to examine the correlation between research variables and linear regression analysis for assess the predictive power of health belief model constructs in improving oral health behaviors in diabetic patients. Oral hygiene behaviors were considered as the dependent variable and health belief model constructs were regarded as independent variables.
Findings by Text
The mean age of the patients was 52.55±5.1 years. The mean fasting blood glucose level in these subjects was 166.2±57.0 mg/dl and mean Hb1AC was 8.1±4.2%. Also, most of the studied patients were married with elementary education, housewives and covered by insurance (Table 1).Among the constructs for assessing patients' attitudes, the perceived severity obtained the highest score and the function had the lowest score. Also, self-efficacy had the highest correlation coefficient with function. There was no significant correlation between external and internal cues of action with function (Table 2).Knowledge, perceived barriers and self-efficacy constructs were the strongest predictors of behavior compared with other structures and predicted 34% of the variance of oral and dental health care behavior in diabetic patients (p <0.001; Table 3).
Main comparison to the similar studies
In this study, the mean score of knowledge was 2.26±0.31, which is very low in diabetic patients, which can be due to the demographic characteristics of the studied population, as most of them had elementary education. This result is consistent with the study by Upadhyay et al. [21]. Also, in the study by Omar & Lai San, 53.7% of the patients had high level of knowledge. However, knowledge scores declined significantly with age and education levels [22]. In the present study, the perceived sensitivity and severity of the patients were 3.36±0.69 and 4.27±0.67 respectively, which indicates that patients are sensitive to their health and can see themselves at risk. On the one hand, it was a positive factor for the proper function of patients and also he actually can find himself more vulnerable to the disease, indicating the appropriate perceived sensitivity. These results are consistent with the study of Baghiani Moghadam et al. [16] in diabetes care.
Suggestions
It is suggested that interventional studies should be carried out on diabetic patients with the aim of improving their oral and dental health behaviors.
Limitations
Patients' behavior could not be observed and information was collected through self-report, which is one of the limitations of this study.
Conclusions
Awareness, self-efficacy, and perceived barriers are predictors of oral and dental health behaviors.
Acknowledgments
Patients participated in this study are appreciated.
Conflict of interest
None declared.
Ethical Permissions
This research was approved by the Ethics Committee of Arak University of Medical Sciences (Ethics code: IR.ARAKMU.REC.1395.444).
Funding Sources
The present study is extracted from a master's degree thesis (ID: 1711).

TABLES and CHARTS

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