Development and validation of a health belief model scale for oral health behaviors among adolescents.

Objective: This study aims to develop and validate an Oral Health Beliefs Questionnaire/Scale (OHBQ) based on the Health Belief Model (HBM), focusing on key oral health behaviors such as tooth brushing, dental flossing, and sugar consumption, for measuring adolescents' beliefs related to these behaviors.

Methods: A mixed-method design was employed to validate the OHBQ. Content validity was established by an expert panel who evaluated each item for relevance and clarity. Confirmatory Factor Analysis (CFA) was conducted with a sample of 1124 adolescents to validate the questionnaire structure and model fit. Reliability was assessed using Cronbach's alpha to determine internal consistency. To assess predictive validity, the relationships between each domain of the questionnaire and the three oral health behaviors were analyzed using the logistic regression models.

Results: The final 53-item HBM-based OHBQ confirmed a six-factor structure: perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy. The CFA on the three behaviors showed excellent model fit. For tooth brushing, the CMIN/DF = 5.67, CFI = 0.91, GFI = 0.90, RMSEA = 0.064, and SRMR = 0.056; For dental flossing, the CMIN/DF= 6.04, CFI = 0.92, GFI = 0.90, RMSEA = 0.067, and SRMR = 0.046; For sugar consumption, the CMIN/DF = 5.30, CFI = 0.92, GFI = 0.90, RMSEA = 0.062, and SRMR = 0.050. All subscales demonstrated high internal consistency, with Cronbach's alpha coefficients ranging from 0.74 to 0.93. Significant associations (p<0.05) were found between specific HBM constructs (perceived susceptibility, perceived barriers, cue to action, self-efficacy) and the respective oral health behaviors, supporting the OHBQ's predictive validity.

Conclusions: The developed HBM-based Oral Health Beliefs Questionnaire/Scale (OHBQ) is a reliable and valid instrument for measuring health beliefs related to oral health behaviors among adolescents.

Clinical Significance: The validated OHBQ can serve as an effective tool to assess beliefs related to oral health behaviors. The robust psychometric properties and high construct validity make it a valuable instrument for researchers and practitioners in planning oral health promotion.