|Year : 2016 | Volume
| Issue : 2 | Page : 66-71
Oral health knowledge, attitude and behavior of medical, pharmacy and nursing students at the University of Port Harcourt, Nigeria
Braimoh Omoigberai Bashiru1, Owoturo Enere Omotola2
1 Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
2 Department of Restorative Dentistry, Lagos State University Teaching Hospital, Lagos, Lagos State, Nigeria
|Date of Web Publication||13-Oct-2016|
Braimoh Omoigberai Bashiru
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State,
Source of Support: None, Conflict of Interest: None
Objective: The objective of the study was to assess and compare the oral health knowledge, attitude, and behavior of medical, pharmacy, and nursing students at the University of Port Harcourt, Nigeria.
Subjects and Methods: A total of 189 students including 94 males and 95 females involved in the cross-sectional surveyed. Data were collected using pretested, self-administered, structured questionnaire. The mean percentage scores, standard deviation, and frequency distribution were calculated. The Student's t-test and ANOVA test were used to test the association between variables. The linear regression analysis was used to establish any association of behavior with knowledge and attitude.
Results: The total mean percentage scores for knowledge, attitude, and behavior were more than 50% among the students. The mean percentage scores for knowledge, attitude, and behavior were significantly higher for the medical students compared to pharmacy and nursing students. All the scores were significantly higher in females than in males except for the mean score of knowledge. There was no significant association between knowledge, attitude, and behavior with age. Linear regression analysis showed a significant linear relationship between behavior and attitude, but there was no significant linear relation between behavior and knowledge.
Conclusion: The present study indicates that although the mean scores for knowledge, attitude, and behavior were more than 50% among the participants, the students' oral health knowledge, attitude, and behavior was inadequate and needs to be improved upon. The study also revealed that attitude is a determinant of oral health behavior among the students.
Keywords: Attitude, Nigeria, oral health behavior, oral health knowledge, students
|How to cite this article:|
Bashiru BO, Omotola OE. Oral health knowledge, attitude and behavior of medical, pharmacy and nursing students at the University of Port Harcourt, Nigeria. J Oral Res Rev 2016;8:66-71
|How to cite this URL:|
Bashiru BO, Omotola OE. Oral health knowledge, attitude and behavior of medical, pharmacy and nursing students at the University of Port Harcourt, Nigeria. J Oral Res Rev [serial online] 2016 [cited 2019 Mar 20];8:66-71. Available from: http://www.jorr.org/text.asp?2016/8/2/66/192209
| Introduction|| |
Health promotion is a set of process that can be used to change conditions that affect health so that the targets are not always those whose health is in question. Health promotion can be achieved through any combination of educational, social, and environmental actions conducive to the health.  The concept became popular following the adoption of the World Health Organization definition of health in 1948. This definition indicates that health should not be considered as the absence of disease alone but in addition the state of complete physical, mental, and social well-being. Health was considered the responsibility of health professionals and the government; however, the Ottawa declaration of 1986 indicates that communities, families, and individuals have a role to play in their health,  suggesting a shift of responsibility from health-care professionals to individuals. According to Steptoe et al., health behavior is defined as "the activities undertaken by people to protect, promote or maintain health and to prevent disease."  The nature of the relationship between health-related attitudes, beliefs, and behaviors is complex.  Various categories of factors that may influence health behavior include knowledge, attitudes, beliefs, values, skills, finance, materials, time, and the influence of family members, friends, coworkers, opinion leaders, and even health workers themselves.  Individuals who have assimilated the knowledge and feel a sense of personal control over their oral health are more likely to adopt self-care behavior. 
The oral health is integral and essential component of general health. A number of factors such as hygiene, tobacco smoking, alcohol, nutritional status, and stress are associated with wide range of oral diseases.  This forms the basis for the common risk factor approach to prevention of oral diseases. ,, Regarding the prevention of oral disease, oral hygiene is the most significant among these factors. The concept, importance, and practice of oral hygiene are expected to be easily understood by all literate members of a population. 
The oral health concern of an individual depends on the attitude of a person. An attitude is a relatively enduring organization of beliefs around an object, subject, or concept which predisposes one to respond in some preferential manner.  Attitude is an acquired characteristic of an individual, and people demonstrate a wide variety of attitudes toward teeth, dental care, and dentists.  These attitudes naturally reflect their own experiences, cultural perceptions, familial beliefs, and other life situations, and they strongly influence the oral health behavior. , Attitudes are acquired by social interaction. Mass media, dental professionals, and dental literature have been reported as the main sources of oral health information. 
Knowledge is defined as the "expertise, and skills acquired by a person through experience or education."  It describes a sound practical or theoretical understanding of a subject with the ability to use it for a specific purpose. One of the goals of oral health promotion is for knowledge to be shared with members of other profession. Therefore, a group of population that could easily be used for the purpose of assessing oral health awareness and practices is the professional students. It is imperative to know the level of their knowledge, attitude, and behavior toward oral health.  Adequate oral health knowledge, attitude, and behavior is a reflection of the understanding of preventive oral health measures, and this is very important for the improvement of patient's oral health. ,
The study sample comprised medical, pharmacy, and nursing students at College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria. These professional students come across a large number of patients of different age groups from different backgrounds in their day to day course of study. This is also true when they eventually graduate hence with proper knowledge and oral health behavior they can play an important role in oral health education of individuals and group. Furthermore, with the higher education background, the concept of prevention and well-being could be more easily understood, irrespective of their course of study. The objective of our study, therefore, was to assess and compare the oral health knowledge, attitude, and behavior of medical, pharmacy, and nursing students in Port Harcourt, Nigeria. The results of this study may be useful in the development of health promotion activities such as health education intervention programs and oral health promotion campaigns aimed at changing attitude and practices toward oral health among medical health professionals.
| Subjects and Methods|| |
This cross-sectional study was conducted among 189 medical, pharmacy, and nursing students from the University of Port Harcourt, who voluntarily participated in the study. The participants were selected by convenience sampling, and ethical clearance was obtained from the Research and Ethics Committee of the University of Port Harcourt Teaching Hospital.
A self-assessment questionnaire from the study of Sharda and Shetty was adopted as the survey instrument for this study.  The questionnaire was pretested among twenty students from the faculty of education in the same institution as the study sample. The pretest indicates that the questions were simple, easy to understand, and reply. The questionnaire was also adjusted in view of some habits indulged by the participants in the study of Sharda and Shetty, which is not a common habit among Nigerians. For example, the questionnaire of Sharda and Shetty explored gutkha/pan chewing or smoking habit under attitude and behavior and in our study this was replaced with cigarette smoking.
The questionnaire included 41 items designed to evaluate the oral health knowledge, attitude, and behavior of the students.
- Source of health information of the students
- Oral health knowledge: Twenty questions were asked to assess the oral health knowledge of the participants. This included questions on the number of sets of dentition, number of milk teeth, number of permanent teeth, purpose of toothbrushing, interval of change of toothbrush, meaning of plaque and its effect on dentition, meaning of gum bleeding and its reasons, methods to prevent gum bleeding, effect of soft/fizzy drinks on teeth, effect of sweet retention, reasons, effect and methods of prevention of tooth decay, effect of fluorides on teeth, causes of oral cancer, reasons for tooth loss in old age, impact of oral health on general health, effect of loss of teeth on speech, and knowledge about alignment of crooked teeth
- Oral health attitude: Six questions on attitude were asked. These included attitudes toward regular dental visits, replacement of missing natural teeth, cigarette smoking habit, services/care provided by a dentist, as well as attitude toward dental care and body care in general, and involvement in the dental treatment
- Oral health behavior: The assessment of participant's oral health behavior included 14 questions on frequency and time of toothbrushing, material used for brushing teeth, reasons for change of toothbrush, tongue cleaning, use of other oral hygiene aids, reason for visiting a dentist, frequency of consumption of sweets, behavior on noticing signs of dental caries or periodontal disease, and bad habits such as cigarette smoking.
The questionnaires were administered and completed by the participants after a regularly scheduled classroom lecture. The students were asked to respond to each item according to the response format provided in the questionnaire. All completed questionnaires were retrieved immediately after completion.
Data were entered into Statistical Package for Social Sciences spreadsheet (SPSS version 20.0, IBM Statistics, New York, USA) for analysis. For the items included in the knowledge and attitude sections of the questionnaire, each correct answer was scored "one" and wrong and do not know answers were scored "zero." In the behavior section, "zero" and "one" scores were given according to the appropriateness of the option selected by the respondent. The individual scores were summed up to yield a total score. Descriptive statistics were obtained, and mean percentage scores, standard deviation, and frequency distribution were calculated for the oral health knowledge, attitude, and behavior items. The Student's t-test and ANOVA test were applied for the statistical evaluation of numerical measures. The linear regression analysis was used to find the association between knowledge and attitude with oral health behavior.
| Results|| |
A total of 189 students completed and returned the questionnaire. Of these, 96 (50.8%), 55 (29.1%), and 38 (20.1%) were medical, nursing, and pharmacy students, respectively. Approximately half of the participants were both male and female. The age range of respondents was 20-34 years, and the mean age of respondents was 25.6 ± 4.1 years [Table 1].
|Table 1: Distribution of the participants according to course of study, age, and gender|
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[Table 2] shows the mean percentage scores for knowledge, attitude, and behavior in relation to the students' field of study. The mean percentage scores for knowledge, attitude, and behavior were significantly higher among the medical students than the mean scores obtained for the nursing and pharmacy students.
|Table 2: The mean percentage scores for knowledge, attitude, and behavior according to the course of study|
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The mean percentage scores for attitude and behavior was significantly higher in female students than that of male students. Although the mean score for knowledge was higher in females than in males, this did not reach a significant level. The mean percentage scores for knowledge, attitude, and behavior were not significantly associated with age [Table 3].
|Table 3: The mean percentage scores for knowledge, attitude, and behavior according to gender and age|
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Approximately, 66% and 60% of the participants gave correct response to the behavior and knowledge questions, respectively. Similarly, about 58% of the respondents gave positive response to the attitude questions.
In the present study, all the participants irrespective of the age, gender, and course of the study used toothbrush and toothpaste as the oral hygiene tool. The use of chewing stick either alone or in combination with toothbrush and toothpaste was not observed in this study. The use of dental floss, interproximal brush and mouthrinse was not recorded in this study. Only 38% of the participants reported using fluoride-containing toothpastes.
Approximately 60% of the students cleaned their teeth twice daily. Female students significantly cleaned their teeth twice daily than that of male students (P = 0.01). Similarly, the percentage of females giving the correct response for the attitude questions was higher than their male colleagues. More females (60%) visited the dentist one or more times significantly more than their male colleagues (P = 0.01). Although it is not statistically significant in all the items, the percentage of female students giving the correct response to knowledge of preventive behaviors, such as effect of retention of sweet on dentition, effect of fluorides on dentition, methods of preventing tooth decay, reason of toothbrushing, and methods of preventing bleeding gum, was more than their male counterparts.
Regarding field of study, medical students significantly cleaned their teeth twice daily than nursing and pharmacy students (P = 0.032). More medical students visited the dentist one or more times than nursing and pharmacy students; however, this was not significant. Furthermore, medical students had significantly better knowledge of preventive behaviors than students from other course of study.
Regarding age, the younger age group cleaned their teeth twice daily, visited the dentist one or more times, and had better knowledge than the older age group. The difference was however not significant.
Regarding linear regression analysis, though oral health behavior of the participants was related to knowledge, the relationship was not significant. However, oral health behavior of the participants showed a linear relationship with the attitude of the participants (P = 0.032).
| Discussion|| |
The major concern of oral health educators is to impact a positive oral health knowledge and behavior in the society. This knowledge is usually obtained from information which subsequently translates into an action. Behavior is an outcome measure when an action is sustained. Attitudes toward oral health determine the condition of the oral cavity. Oral diseases are clearly related to behavior, and the prevalence of dental caries and periodontal disease has decreased with improvements in oral hygiene and a decrease in the consumption of sugary substances. Our study presents a comprehensive overview of oral health knowledge, attitude, and behavior of medical and paramedical students at the University of Port Harcourt, Nigeria.
The major limitation of this study is the reliance on self-reported information; such information is often subject to response bias and the responses may have been influenced by the social acceptability. The lack of standard questionnaire for assessing the oral health knowledge, attitude, and behavior also constitutes a limitation. In spite of these limitations, the information obtained from this study may be useful in the development of education intervention programs and oral health promotion campaigns aimed at changing attitude and practices toward oral health among medical health professionals.
In the present study, although the total mean percentage scores for knowledge, attitude, and behavior were more than 50% among the students, the knowledge, attitude, and behavior of the students was inadequate. For instance, about 35% of the students gave incorrect response to the behavior questions, 40% gave incorrect response to the knowledge questions, and about 40% gave incorrect response to attitude questions. This indicates that although about 60% of the students showed positive attitude toward oral health care, 35% of the students showed negative oral health behavior. This negative behavior was particularly related to the frequency of sweet consumption, frequency of toothbrushing, time of brushing, and use of dental floss, and it is suggestive of lack of adequate knowledge among the students. Regarding knowledge, areas where incorrect responses were given include knowledge about the effect of loss of teeth on speech, alignment of crooked teeth, effect of fluorides on dentition, the preventive role of fluorides in toothpaste, the reasons for gum bleeding, dental decay, and loss of teeth in old age; Methods of prevention of tooth decay, sets of dentition and the number of milk teeth. Similar findings have been reported in other studies. ,
In this study, the level of oral health knowledge, attitude, and behavior was significantly higher among the medical students, compared to pharmacy and nursing students. The greater number of medical students volunteered to participate in this study, this difference in number may play a role in the difference observed. Furthermore, the medical students at the University of Port Harcourt take a course in Community Oral Health in course of their training; this may be responsible for the difference observed. This suggests the need of incorporation oral health into the curriculum of the nursing and pharmacy students. This result is in agreement with the findings of Prasad et al. and Sharda and Shetty. , However, in the study of Prasad et al., though the medical students had significant higher knowledge and attitude score, the pharmacy students had significant higher behavior score.
In general, females have been reported to exhibit better oral health knowledge, positive attitude, and behavior toward oral health. Observations from our study showed that females had significantly higher oral health attitude and behavior scores compared with male students. Although the knowledge score was higher in females than in males, the difference was however not significant. This observation is consistent with the results of previous studies ,,,,, but in contrast to the study of Khami et al. among senior Iranian dental students. The study showed no gender difference in the knowledge, attitude, and behavior of the students.  The students in the Iranian study were senior dental students who have been equally exposed in matters relating to oral health; this may account for the reason why there was no gender difference in the knowledge, attitude, and behavior reported in the study. The result of our study also showed that age was not a significant factor affecting attitude and behavior. This is in tandem with cross-cultural study done among dental students in Japan, Greece, Finland in Hong Kong, and West China. ,,
The present study showed a statistically significant linear relationship between oral health behavior and the attitude of the students, but no significant linear relationship between oral health behavior and knowledge. These results indicate that behavior depended on "attitude" of the students, which means that a positive attitude and adherence to good oral hygiene behavior lead to a better overall oral health and that not all acquired "oral health knowledge" is translated to positive "oral health behavior." This finding corroborates the results of previous studies which reported similar findings. ,, These studies reported that although oral health knowledge is considered an essential prerequisite for health-related behavior, only a weak association seems to exist between knowledge and behavior. ,,
The present study revealed that all the students used toothpaste and toothbrush to clean their teeth. This was comparable to 100% reported among medical and engineering students in a study by Doshi et al.  However, Olusile et al. reported that 81% of sample in their study used toothbrushes and paste for cleaning. The exclusive use of toothbrush among the participants may be an indication of a shift toward the use of modern tools among the Nigerian population. In addition, no student in the present study used dental floss or other interdental cleaning aids. This is in contrast to the findings of other studies where the use of dental floss and mouthwash was reported. ,, In the present study, 60% of the study population reported brushing their teeth at least twice a day. This was higher than findings reported in previous studies , but lower than that reported in other countries. , The improvement in the practice may not be unrelated to consistent oral health campaign in the University campus carried out by the Faculty of Dentistry through the annual Faculty "Dentistry day" and the "World Oral Health Day."
Regular visit to the dentist is not a common event in developing countries. In this study, only about 33% of the students have visited the dentist in the past. Other studies have reported similar trend. , The poor attitude toward dental visits may be a result of motivation of dental visit due to pain or the need for emergency care.  Furthermore, female students (60%) showed significantly positive attitude toward dental visits than male students. This result was similar to the findings of other studies. , The difference between males and females may be ascribed to females being more concerned and caring about their health, body, and appearance than males.
| Conclusion|| |
The present study indicates that although the mean scores for knowledge, attitude, and behavior were more than 50% among the participants, the students' oral health knowledge, attitude, and behavior was inadequate and needs to be improved upon. This can be achieved through the development of education intervention programs and oral health promotion campaigns. The study also revealed that oral health attitude is a determinant of oral health behavior among the students.
The authors would like to thank the final year dental students (2015 sets) and the course representatives for the medical, nursing and pharmacy students who assisted in distributing and retrieving the questionnaires from the participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]