adolescents who were selected from 48 schools using a stratified cluster sampling tech- niques. Results: Nearly 21% of the sample rated their oral health as ...
International Dental Journal (2008) 58, 349-355
Factors influencing perception of oral health among adolescents in Sri Lanka Irosha Perera
Colombo, Sri Lanka
Lilani Ekanayake
Peradeniya, Sri Lanka Aim: To determine factors associated with perceived oral health status among adolescents in Sri Lanka. Design: A descriptive, cross-sectional study where the data were collected by means of an oral examination and questionnaires to both children and their parents. Setting: Schools in the Colombo district, Sri Lanka. Participants: 1,218, 15-year-old adolescents who were selected from 48 schools using a stratified cluster sampling techniques. Results: Nearly 21% of the sample rated their oral health as poor. According to the hierarchical logistic regression models the percentage of variance in perceived oral health explained by the four groups of independent variables namely: socio-demographic variables, oral health behaviours, clinical oral health indicators and subjective measures of oral health status were 3, 1, 4 and 7% respectively. The final model indicated that poor perceived oral health was significantly associated with low household income, not using dental services, presence of gingivitis, being aware about the presence of oral disease, presence of toothache and other oral symptoms and perceived need for dental care. It accounted for 15% of the variation in perceived oral health. Conclusions: Subjective measures of oral health contributed most to the single-item perceived oral health rating of adolescents. Socio-demographic variables and normative measures of untreated caries, missing teeth and gingivitis had a limited role in explaining perceived oral health in Sri Lankan adolescents. Key words: Perceived oral health, adolescents, Sri Lanka
As oral health is recognised as a multidimensional construct, it is now considered important to assess the presence of oral diseases as well as their psychosocial consequences when measuring oral health in children and adiults1,2. Consequently information about individuals’ perception of their oral health is increasingly being used in addition to normative assessments when measuring oral health status and treatment needs3. Self-reported oral health describes how an individual perceives his/her own oral health and can be considered as an indicator of wellbeing. A number of self-reported oral health indicators have been used in dental research. They range from simple single item rating of perceived oral health which directs an individual to provide an overall assessment of his/her oral health status4 to © 2008 FDI/World Dental Press 0020-6539/08/06349-07
multi-item indicators of oral health related quality of life5. Compared to multi-item indicators that measure perceived oral health, the response burden of a single item rating is minimal. Thus a single item rating of perceived oral health is particularly appropriate to obtain information from children and adolescents. A commonly used single item rating of perceived oral health is ‘How do you rate your oral health?’ where the responses are usually recorded on a 4-5 point scale ranging from very good to very poor. Perceptions of oral health have been mainly assessed in adults. It has been shown that perceived oral health status is influenced by numerous factors such as clinical oral health status, socio-demographic factors, utilisation of dental services and a positive perceived general heath doi:10.1922/IDJ_1966Ekanayake07
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status4,6. However, little information is available about the factors influencing perception of oral health in adolescents and these studies have mainly emanated from the western countries7-9. As perceptions about health are influenced by culture, factors identified in these studies may not be the same for Sri Lankan adolescents who are culturally different to those of the west. Therefore the aim of this study was to determine factors associated with perceived oral health status in adolescents in Sri Lanka. Methods and materials
The data for the present study were obtained from a larger study, which was conducted to assess social inequalities in oral health among adolescents. Sampling
The study was carried out among 15-year-old children attending schools in the Colombo district of Sri Lanka. Schools in Sri Lanka are classified into three categories: state, private and international. Those children residing outside the Colombo district, not living with at least one parent and with learning difficulties were excluded from the sample. The hypothesis test for two population proportions was used to calculate the sample size. Using the caries prevalence rates of children whose fathers were professionals (doctors, dentists, engineers, bankers, lawyers etc) and non-professionals (business, technical, skilled and unskilled labour categories), which was obtained from a pilot study, a level of significance of 5% and a power of 90%, a minimum of 72 children were needed per socio-economic group. As there were six socio-economic groups, the minimum sample size required was 432. A stratified cluster sampling method was used to select the sample. After making adjustments for the design effect which was considered as 2 and compensate for non-responses (30%) the sample size required was 1,223. This was increased to 1,225 for practical purposes. It was evident that 15-year-olds are aggregated in the grade 10 class and the number of children in a grade 10 class in the three types of schools ranged from 2040. Consequently the ‘grade 10’ class was considered as the cluster and the cluster size as 30. Thus 41 clusters were necessary to obtain the sample (1,225/30=41). For practical purposes the number of clusters was increased to 42. Since there was a considerable variation in the number of 15-year-olds in the three types of schools, the clusters were allocated disproportionately for better representation10. Thus the number of clusters allocated to state, private and international schools were 30, 9 and 3 respectively. Selection of clusters was done in two stages. In the first stage 32, 11 and 5 state, private and international schools with grade 10 classes were randomly selected from the respective sampling frames. International Dental Journal (2008) Vol. 58/No.6
At the second stage, clusters were identified from the selected schools. Two clusters were randomly selected from state schools with 5 or more grade 10 classes, private schools with 4 or more grade 10 classes and international schools with 2 or more grade 10 classes while one cluster each was selected from all other schools. All children who satisfied the inclusion criteria in a selected class were included in the sample. Data collection
The data were collected by means of structured questionnaires to the children, their parents and a clinical examination. The questionnaires were specifically developed for the present study and were based on information obtained through focus group discussions conducted among groups of adolescents and their parents attending a dental hospital. The questionnaire to children was intended to obtain information related to subjective oral health outcomes such as perceived oral health status, awareness about oral disease and symptoms, need for dental care and oral health behaviours. The parental questionnaire included questions on parental occupation, education status, income, household assets and dwelling structure. The income categories were selected according to the monthly income deciles given in the Household Income and Expenditure Survey 200211. For the purpose of this study, the deciles were collapsed into five groups and subsequently the five income categories were adjusted using a conversion factor to account for the official poverty line of 2002. Perceived oral health status was recorded on a three point scale: good, fair and poor and for the purpose of analysis dichotomised into good /fair and poor. The first author carried out the clinical examinations of all children. Dental caries was assessed according to WHO Basic Methods12. Gingival health status was assessed by the gingival index on six index teeth13. Based on the gingival index scores, the adolescents were grouped into three categories: no inflammation (1.0). Intra-examiner variability was assessed by re-examining 10% of the children examined on a given day. Analysis
Stata Release 6.0 software was used for data analysis. Associations between categorical variables were determined by Chi-square test. All independent variables that were significant with the dependent variable- perceived oral health status at a significant level of p
