Does health literacy affect women’s oral health self-care behavior? A cross-sectional study in health centers of Tabriz, North West of Iran

Document Type: Original Article(s)


1 PhD Candidate, Department of Health Education and Health Promotion, Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Torabinejad Dental Research Center AND Department of Pediatric Dentistry, School of Dentistry ,Isfahan University of Medical Sciences, Isfahan, Iran

4 Assistant Professor, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

5 Assistant Professor, Health Sciences Research Center AND Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

6 Professor, Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran


BACKGROUND AND AIM: In public health, health literacy (HL) is rather a new conception. In this regard, oral health as a critical public health issue that affects women’s health. The objective of the present study was to determine oral health self-care behavior and its relationship with HL.METHODS: This cross-sectional study was performed on 232 women who referred to health centers of Tabriz, Iran, in 2015. Data were collected using a self-administered questionnaire including demographic characteristics, oral health behavior, and HL [assessed using the Newest Vital Sign (NVS) scale]. Data were analyzed by one-way analysis of variance, independent samples t-test, and multiple regressions.RESULTS: The mean age of the subjects was 33.4 years [standard deviation (SD) = 8.2; range = 18-49]. The mean ± SD of oral health self-care behavior and HL score was 4.4 ± 1.9 and 3.3 ± 2.0, respectively. Totally, 24.6% of the participants had limited HL (57/232). Only 19.4% (45/232) of participants brushed their teeth twice daily or more, and 28.9% (67/232) had dental check-up less than 6 months ago. The HL had positive association with oral health self-care behavior (β = 0.37, P < 0.001). In multiple linear regression models, oral health self-care behavior was associated with HL and education level (P < 0.001). HL and education level explained 19.5% of the variance in behavior.CONCLUSION: The findings of this study suggest that HL was a predictor of oral health self-care behavior in women. However, more studies are needed to confirm the results of this study. Hence, promoting oral health interventions and designing effective educational materials based on HL might be beneficial to improve oral health behavior and status.


  1. Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 2012; 12: 80.
  2. Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000; 15(3): 259-67.
  3. Nutbeam D. Health promotion glossary1. Health Promot Int 1998; 13: 349-64.
  4. Ueno M, Takeuchi S, Oshiro A, Kawaguchi Y. Relationship between oral health literacy and oral health behaviors and clinical status in Japanese adults. J Dent Sci 2013; 8(2): 170-6.
  5. Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century-the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3-23.
  6. Maes L, Vereecken C, Vanobbergen J, Honkala S. Tooth brushing and social characteristics of families in 32 countries. Int Dent J 2006; 56(3): 159-67.
  7. Hessari H, Vehkalahti MM, Eghbal MJ, Murtomaa HT. Oral health among 35-to 44-year-old Iranians. Med Princ Pract 2007; 16(4): 280-5.
  8. Shamsi M, Hidarnia A, Niknami S, Rafiee M, Karimi M. Oral health during pregnancy: A study from women with pregnancy. Dent Res J 2013; 10(3): 409-10.
  9. Asgari F, Majidi A, Koohpayehzadeh J, Etemad K, Rafei A. Oral hygiene status in a general population of Iran, 2011: A key lifestyle marker in relation to common risk factors of non-communicable diseases. Int J Health Policy Manag 2015; 4(6): 343-52.
  10. Jones K, Brennan DS, Parker EJ, Mills H, Jamieson L. Does self-efficacy mediate the effect of oral health literacy on self-rated oral health in an Indigenous population? J Public Health Dent 2016; 76(4): 350-5.
  11. Guo Y, Logan HL, Dodd VJ, Muller KE, Marks JG, Riley JL 3rd. Health literacy: A pathway to better oral health. Am J Public Health 2014; 104(7): e85-e91.
  12. Wehmeyer MM, Corwin CL, Guthmiller JM, Lee JY. The impact of oral health literacy on periodontal health status. J Public Health Dent 2014; 74(1): 80-7.
  13. Tsai HM, Cheng CY, Chang SC, Yang YM, Wang HH. Health literacy and health-promoting behaviors among multiethnic groups of women in Taiwan. J Obstet Gynecol Neonatal Nurs 2014; 43(1): 117-29.
  14. Bridges SM, Parthasarathy DS, Wong HM, Yiu CK, Au TK, McGrath CP. The relationship between caregiver functional oral health literacy and child oral health status. Patient Educ Couns 2014; 94(3): 411-6.
  15. Rabiei S, Mohebbi SZ, Yazdani R, Virtanen JI. Primary care nurses' awareness of and willingness to perform children's oral health care. BMC Oral Health 2014; 14: 26.
  16. Fazelpour F, Soltani N, Soltani S, Rosen MA. Assessment of wind energy potential and economics in the north-western Iranian cities of Tabriz and Ardabil. Renew Sustainable Energy Rev 2015; 45: 87-99.
  17. Buunk-Werkhoven YA, Dijkstra A, van der Schans CP. Determinants of oral hygiene behavior: A study based on the theory of planned behavior. Community Dent Oral Epidemiol 2011; 39(3): 250-9.
  18. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: The newest vital sign. Ann Fam Med 2005; 3(6): 514-22.
  19. Poorman E, Gazmararian J, Elon L, Parker R. Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population? Arch Public Health 2014; 72(1): 13.
  20. Javadzade SH, Sharifirad G, Reisi M, Tavassoli E, Rajati F. Health literacy among adults in Isfahan, Iran. J Health Syst Res 2013; 9(5): 540-9. [In Persian].
  21. Shealy KM, Threatt TB. Utilization of the newest vital sign (NVS) in practice in the United States. Health commun 2016; 31(6): 679-87.
  22. Parker EJ, Jamieson LM. Associations between indigenous Australian oral health literacy and self-reported oral health outcomes. BMC Oral Health 2010; 10: 3.
  23. Lee JY, Divaris K, Baker AD, Rozier RG, Vann WF Jr. The relationship of oral health literacy and self-efficacy with oral health status and dental neglect. Am J Public Health 2012; 102(5): 923-9.
  24. Blizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association of oral health literacy with oral health behaviour and oral health status in Belarus. Community Dent Health 2015; 32(3): 148-52.
  25. Naghibi Sistani MM, Yazdani R, Virtanen J, Pakdaman A, Murtomaa H. Determinants of oral health: Does oral health literacy matter? ISRN Dent 2013; 2013: 249591.
  26. Peltzer K, Mongkolchati A, Satchaiyan G, Rajchagool S, Pimpak T. Sociobehavioral factors associated with caries increment: A longitudinal study from 24 to 36 months old children in Thailand. Int J Environ Res Public Health 2014; 11(10): 10838-50.
  27. Kojima A, Ekuni D, Mizutani S, Furuta M, Irie K, Azuma T, et al. Relationships between self-rated oral health, subjective symptoms, oral health behavior and clinical conditions in Japanese university students: A cross-sectional survey at Okayama University. BMC Oral Health 2013; 13: 62.
  28. Silva AE, Menezes AM, Assuncao MC, Goncalves H, Demarco FF, Vargas-Ferreira F, et al. Validation of self-reported information on dental caries in a birth cohort at 18 years of age. PLoS One 2014; 9(9): e106382.
  29. Mohebbi SZ, Sheikhzadeh S, Ezzati-Givi N, Shekarchizadeh H. Self-perceived oral health and its determinants among adult dental patients in a University Dental Clinic in Tehran, Iran. J Oral Health Oral Epidemiol 2015; 4(1): 30-7.