Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children

Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents' adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler's preventive dental visits. Data regarding socio-economic demographics were collected from parents of children aged 2-6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents' sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model. Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22-48) participated in the study. The mean age of children was 3.92 years, range: 2-6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child's birthplace and mother's birthplace) significantly predicted enabling resources (family monthly income and child's dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent's SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model. The expanded TPB model explained a great deal of variance in preschooler's dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.