Abstract

Background and
Aim: Oral
health literacy plays an important role in oral health promotion. This study
aimed to assess the level of oral health literacy of senior medical and
pharmacy students.

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Materials and
Methods: This cross-sectional study was conducted on senior medical and
pharmacy students (n=300) of Tehran University of Medical Sciences in 2015. The oral health literacy-adult questionnaire (OHL-AQ)
was used for data collection. This questionnaire has 17 items in four sections.
The first section relates to the assessment of the perception of oral health.
The second section is for the assessment of the ability to calculate values
related to
antibiotic and mouthwash prescriptions. The third section assesses the efficacy
of communication skills, and the fourth section is about decision-making with
regard to oral health problems. Chi-square and linear regression were used for
descriptive analyses.

Results: The mean score
of oral health literacy was 12.09±3.85 for medical
students and 10.48±4.29 for
pharmacy students. University degree of the father (P<0.001) and being a medical student (P=0.002) were significantly correlated with a higher level of oral health literacy. The comparison of the mean score of oral health literacy and its correlation with oral health behavior showed a significant correlation between a high level of oral health literacy and a higher frequency of tooth brushing, use of toothpaste, regular dental visits, and dental visits during the last 1-2 years (P=0.001). Conclusion: Considering the moderate level of oral health literacy of medical and pharmacy students, it is necessary to include oral health topics in the curricula of medical and pharmacy schools.   Key Words: Oral Hygiene, Health Literacy, Medicine, Pharmacy     Introduction Health literacy is one of the factors determining the occurrence of health problems. Individuals with a low level of health literacy often have greater health problems 1. Limited health literacy is a global dilemma, and about half of the adults in the United States, one-fifth of the British and Canadian adults, and over half of the Iranian adults have a limited health literacy 2-6. Oral health literacy, similar to general health literacy, plays an important role in the maintenance and promotion of oral health 7. Oral health literacy is described as the ability of individuals to perceive and analyze oral health information for decision-making with regard to oral health promotion 8. A low level of oral health literacy can independently be a predictor of a poor oral health status in adults 9. All health-care providers, aside from dentists, can play a role in oral health promotion. People more commonly refer to pharmacists and physicians compared to dentists, and this can be an opportunity to promote their oral health 10,11. Pharmacists and physicians should participate in preventive and educational programs and should refer the patients to dental centers 12. Obviously, they can play a role in public oral health promotion given that they have an adequate level of oral health literacy themselves. The Association of American Medical Colleges (AAMC) has designed and incorporated oral health instruction guidelines in medical education curricula 13. Since studies on the oral health literacy of medical and pharmacy students are limited, this study aimed to assess the level of oral health literacy and behavior of senior medical and pharmacy students attending Tehran University of Medical Sciences in 2015.                                 Materials and Methods This cross-sectional study was conducted on senior medical (n=200) and pharmacy (n=100) students of Tehran University of Medical Sciences in 2015. The data collection tool in our study was the oral health literacy-adult questionnaire (OHL-AQ). The validity and reliability of this questionnaire for use among the Iranian and English-speaking population have been previously confirmed 14,15. The self-administered questionnaire was distributed among the students at their classes, dormitories, hospital, and pharmacy. This questionnaire has 17 items in four sections for the assessment of oral health literacy. The first section (perception) includes six questions to assess the perception and knowledge of the students with regard to oral health. The second part is the calculation section and includes four questions for the assessment of the values in prescriptions related to mouthwashes and antibiotics. The third section is the listening section and includes two questions for the assessment of the efficacy of communication skills, and the last section is the decision-making section and includes five questions related to common dental problems and items retrieved from the medical history form. Each correct answer was allocated a score of one, while each wrong answer or no answer was given a score of zero. Based on this scoring system, the lowest and highest acquired scores were 0 and 17, respectively. For further analysis, the scores were assigned into three categories of 0-9: inadequate, 11-12: borderline; and 12-17: adequate 9,14. The demographic variables including age, gender, level of education, and the grade point average (GPA), and oral hygiene behaviors such as the frequency of tooth brushing, consumption of sugary foods between meals, use of toothpaste, and dental visits as well as self-report questions regarding oral health status were also included. Socioeconomic status was self-reported by each student as very good, good, moderate, poor, or very poor. Data were analyzed by using descriptive and analytical statistics. Chi-square test was applied to compare the answers to each question, while multiple linear regression was used to compare the level of oral health literacy between the groups and to determine its correlation with the demographics and oral health behavior and practice. The confounders were adjusted as covariates. The significance level was set at 0.05. The study protocol was approved by the ethics committee of Tehran University of Medical Sciences.M1  TheM2  students participated in the study voluntarily and filled out the questionnaire anonymously.   Results Out of 300 questionnaires, 265 were returned. 178 questionnaires belonged to medical students (response rate=89%), and 87 questionnaires belonged to pharmacy students (response rate=87%). The mean age of medical students was 24.99±1.80 years, and the mean age of pharmacy students was 25.04±1.89 years. Also, 88 (50.9%) medical and 38 (44.2%) pharmacy students were males. The mean GPA was 15.43±1.52 (of a total of 20) for medical students and 15.81±1.48 for pharmacy students. With regard to the level of education of the parents, the majority of the parents had a bachelor's degree in both groups. Also, most medical students reported a moderate socioeconomic status, while most pharmacy students reported their socioeconomic status to be poor. The mean score of oral health literacy was 12.09±3.85 (of a total of 17) for medical and 10.48±4.29 for pharmacy students. The results showed that 31.6% of medical and 51.2% of pharmacy students had an inadequate level of oral health literacy (Figure 1). Regarding the knowledge of medical and pharmacy students about oral and dental conditions, the highest frequency of correct answers belonged to pharmaceutical instructions as 164 (95.9%) medical and 80 (95.2%) pharmacy students gave correct answers to the question "if you take the first capsule at 2 p.m., at what time should you take the next capsule?". In both groups, the lowest number of correct answers was given to the question "what teeth erupt in the mouth at six years of age?" since 67 (39.2%) medical and 31 (36.5%) pharmacy students gave a correct answer to this question (Table 1). Most students in both groups responded correctly to the questions regarding how to manage oral and dental problems and to the following two questions: what does this sentence mean? "The dentist is not held responsible for unwanted consequences." and "What does it mean to have a history of hypersensitivity or allergy?". The lowest number of correct answers by medical students was given to the question "What is the best action when bleeding following the use of dental floss?" as ninety (52.3%) medical students gave a correct answer to this question. Among pharmacy students, the lowest frequency of correct answers belonged to the question "What is the best action when feeling swelling and pain in the mouth?" as only 33 (38.8%) pharmacy students gave a correct answer to this question (Table 2). In terms of the oral hygiene behaviors and practice, 90 (51.7%) medical students and 51 (60%) pharmacy students replied "once daily" to the question regarding the frequency of tooth brushing per day. Ten (5.7%) medical students and one (1.2%) pharmacy student reported that they never brush their teeth or they do it very rarely. In both groups, most students had visited a dentist one or two years ago. Medical students reported a higher frequency of consuming sugary snacks compared to pharmacy students. About one-third of the students stated that they had a good oral health status (Table 3). The current results showed that oral health literacy was not significantly correlated with gender (P=0.313). The father's level of education (P<0.001) and the field of study (pharmacy or medicine, P=0.002) were significantly correlated with oral health literacy. The higher the father's level of education, the higher was the oral health literacy of the students. Medical students had a higher level of health literacy compared to pharmacy students. However, the mother's level of education, GPA, and socioeconomic status showed no significant association with the level of oral health literacy (P>0.05). The comparison of the mean score
of oral health literacy and oral health behaviors showed that a significant
association existed between a high level of oral health literacy and a higher
frequency of tooth brushing per day, use of toothpaste, regular dental visits,
and the date of the last dental visit (P=0.001). No significant association
existed between the consumption of sugary snacks and the self-reported
oral health status of students and the mean level of oral health literacy
(P>0.05).

 

Discussion

This study was
conducted on senior medical and pharmacy students as
health-care providers. These individuals can promote community oral health as
non-dental professionals 10. The AAMC has included oral health guidelines in
medical curricula to achieve this goal 13. The level of oral health literacy
and behavior of these groups can, to some extent, determine their role in oral
health promotion. Physicians and pharmacists can play a role in public oral
health promotion only when their level of oral health literacy and oral health
behaviors improve 16.

Our study
showed that the level of oral health literacy and behavior of senior medical
and pharmacy students was inadequate and similar to that of the general
population of Tehran city 9. One-third of medical and half of pharmacy
students had an inadequate oral health literacy. This difference can be
explained by the fact that most courses provided for medical students in their
curriculum are clinical, while pharmacy students mainly receive paraclinical
and basic science courses. Pharmacy students require more extensive oral health
educational programs in their curriculum. This finding is in line with that of
other studies on the oral health knowledge of medical students 17,18. The
lack of educational programs on oral health is the reason behind the low level
of knowledge about oral health among students. These results highlight the need
for oral health instructions and inclusion of such courses in the curricula of
medical and pharmacy schools.

Our study
showed that oral health literacy had no significant association with gender.
Naghibi et al 9 evaluated the health literacy of adults in Tehran in 2013 and
showed that the mean level of health literacy of females was higher than that
of males. In 2009, Sabbahi et al 4 evaluated adults in Canada and showed that
gender was not correlated with health literacy. Our study was conducted on
medical and pharmacy students, which may explain the difference with the
results of the studies conducted on the general population since, in the
general population, males and females may have different levels of education. However, there is no need to provide separate
oral health instruction programs for males and females in universities.

In terms of the
perception of the topic and decision-making with regard to dental
problems, approximately one-third of the students gave correct answers to the
questions in our study. These results confirm the low mean level of oral health
literacy and highlight the inadequate dental knowledge of the students. This
indicates the need for inclusion of oral health topics in the educational
curricula. These programs can promote the oral health of students and the
public since these students are the future health-care providers of the
community.

The mean score
of oral health literacy and its association with oral health behaviors showed
significant correlations between a high level of oral health knowledge and a
higher frequency of tooth brushing per day, use of toothpaste, regular dental
visits, and the date of the last dental visit. These results show that a high
level of oral health literacy results in proper oral health behaviors which
lead to individual and public oral health promotion. Parker and Jamieson 19
showed that individuals who do not regularly brush their teeth have a lower
level of oral health literacy.

Based on the
results of the present study, subjects with a higher level of oral health
literacy reported a better oral health status. This finding was in agreement
with those reported by Naghibi et al 9 and Parker and Jamieson 19 on the
oral health status of adults. However, the present assessment was subjective
(self-reported by the students), and future clinical studies are required to confirm this
finding and to validate the accuracy of self-reports by students.

We used the
OHL-AQ in our study, which is one of the most comprehensive and up-to-date
questionnaires for the assessment of oral health literacy in adults 14,15.
This questionnaire simultaneously evaluates perception, knowledge, calculation
skills, communication skills, and decision-making. Clinical examinations
combined with the use of this questionnaire can yield more accurate results in
future studies.

 

Conclusion

The results of
the present study showed that senior medical and pharmacy students, as future
health-care providers, demonstrated a moderate level of oral health literacy. The oral
health literacy of these students can be promoted by inclusion of oral health
courses in their educational curricula.

 

 M1

 M2Please insert the ethical code.