Determinants of Oral Health Literacy Among Older Chinese Adults: A Path Analysis Based on Andersen's Behavioral Model

This study aims to identify the direct and indirect pathways associated with Oral health literacy (OHL) among Chinese older adults and to inform targeted oral health promotion strategies for older adults.

This cross-sectional study included 423 community-dwelling adults aged 65-74 years from a nationally representative key population surveillance project in China. Standardized clinical dental examinations and validated questionnaires were conducted. OHL was assessed using oral health belief (OHB) scores (0-4) and oral disease awareness (ODA) scores (0-8). Variables were categorized according to Andersen's behavioral model into predisposing, enabling/behavioral, and need factors. Poisson regression identified associated factors, followed by path analysis, mediation decomposition, and exploratory multi-group analyses.

Median OHB and ODA scores were 3 (IQR: 3-4) and 5 (IQR: 3-6), respectively. In the path analysis, gender and education level were indirectly associated with OHL through mediating factors; root decayed and filled teeth (Root DFT) were directly and positively associated with both OHB and ODA; dental prosthesis use was directly associated with higher OHB, whereas dental visit was directly associated with higher ODA. Sweetened beverage consumption ≥ 1/day showed a negative direct association with OHB, although this estimate was based on only 10 participants and should be interpreted with caution. Three total indirect effects and five specific indirect pathways reached (marginal) significance. In exploratory subgroup analyses, the patterns of path coefficients varied descriptively across education and residence subgroups, but no interaction term was statistically significant.

Among older Chinese adults, OHL was associated with a combination of predisposing, need, and enabling/behavioral factors. Dental treatment encounters may provide opportunities for reinforcing oral health education. Subgroup-tailored oral health education strategies may be beneficial.