Effectiveness of personalized oral health education with behavioural modification using HAPA-MI constructs and oral care kit in residents of informal settlements.

backgroundOral health is a crucial determinant of overall well-being, yet 'residents of informal settlement', previously referred as 'slum dwellers', face significant barriers to maintaining it. Personalized oral health education and behavior modification using models like the Health Action Process Approach (HAPA) and Motivational Interviewing (MI) can address these barriers. While HAPA and MI have shown promise, their individual limitations highlight the need for a combined approach. Integrating these models with personalized education and oral care kits provides a holistic solution to address both motivational and practical barriers. This study evaluates the effectiveness of such an intervention on oral health behaviors and outcomes in residents of informal settlement. METHODOLOGY: A quasi-experimental pre and post interventional study was conducted among 45 participants aged 18-60 years from three wards in Bhubaneswar. The study was conducted between October 24, 2023, to December 24, 2023. Participants were recruited through dental camps organised by our institute. Baseline oral health behavior was assessed using a validated questionnaire based on four behavioral constructs: outcome expectancy (OE), self-efficacy (SE), intention (I), and perceived barriers (PB) by faculty and postgraduate students of public health dentistry department. Participants also received personalized oral health education and an oral care kit. Plaque index (PI), Oral Hygiene Index-Simplified (OHI-S), and behaviour towards oral health were recorded both at baseline (T0) and one-month post-intervention (T1) by same examiners. Statistical analyses included paired t-tests, chi-square tests, and Cronbach's alpha for internal consistency of the questionnaire, with p ≤ 0.05 considered significant.

resultsPost-intervention, significant improvements were observed in all behavioral constructs. The mean outcome expectancy (OE) increased from 2.49 ± 0.20 to 4.15 ± 0.07 (p = 0.000), self-efficacy (SE) from 1.90 ± 0.14 to 3.81 ± 0.14 (p = 0.000), intention (I) from 1.92 ± 0.11 to 4.30 ± 0.33 (p = 0.001), and perceived barriers (PB) from 1.85 ± 0.11 to 4.04 ± 0.03 (p = 0.002). Clinical outcomes also showed significant improvements: the mean plaque index (PI) decreased from 1.9 ± 0.8 to 0.9 ± 0.4 (p = 0.000), and the mean oral hygiene index-simplified (OHI-S) decreased from 2.3 ± 1.4 to 1.5 ± 0.9 (p = 0.003). Internal consistency of the questionnaires was good across constructs, with Cronbach's alpha values ranging from 0.715 to 0.751.

conclusionThis study demonstrates that a holistic behavioural intervention combining personalized education, behavior modification using HAPA and MI models, and oral care kit distribution significantly improves oral hygiene behavior and clinical outcomes among residents of informal settlement. The model addresses both motivational and access barriers, providing a scalable framework for improving oral health in underserved populations. Future research should explore the long-term sustainability of this approach and its applicability to other settings.