595122

research-article2015
HPQ0010.1177/1359105315595122Journal of Health PsychologyChan and Chin

Article

Journal of Health Psychology

Oral health knowledge and

1­–10
© The Author(s) 2015
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DOI: 10.1177/1359105315595122
of oral health behavior of hpq.sagepub.com

nursing students

Joanne CY Chan1 and Luzy SH Chin2

Abstract
This survey examined the oral health knowledge and psychological determinants of oral health behavior
of 1019 undergraduate and postgraduate nursing students. Overall, most of the students perceived their
oral health to be average, and their flossing and dental visiting frequencies were inadequate. Moreover, the
students’ oral health knowledge was suboptimal, regardless of the type of study, and it was not significantly
associated with oral health behavior. Binary logistic regression showed that toothbrushing self-efficacy and
the type of study were both significantly associated with toothbrushing behavior. Furthermore, flossing
self-efficacy and dental visiting self-efficacy were both significantly associated with flossing and dental visiting
behaviors, respectively.

Keywords
adults, health behavior, health education, self-efficacy, students

Introduction
Oral health is essential to individuals’ general not only to the profession but also to the health-
health and quality of life (Anagnostopoulos care system (While, 2014). Enriching nursing
et al., 2011; Clemmens et al., 2012). Although students’ oral health knowledge is a priority, as
nurses in general are expected to engage in oral it affects both the quality and consistency of
health promotion, as well as to collaborate with oral care (Yoon et al., 2011). Furthermore,
the dental team in the screening, referral, treat- enhancing nursing students’ oral health behav-
ment, and management of patients in multiple ior is important for strengthening their credibil-
clinical settings, their oral health knowledge is ity as role models in oral health promotion.
inadequate (e.g. Al Sharbatti et al., 2014;
Clemmens et al., 2012; Iacopino, 2010; Miller 1The Chinese University of Hong Kong, Hong Kong
et al., 2007; Potting et al., 2008). To get to the 2Xpert Dental Group Ltd., Hong Kong
root of this service gap, it is important to pre-
pare nursing students adequately for their future Corresponding author:
Joanne CY Chan, The Nethersole School of Nursing, The
roles in oral health prior to their graduation. Chinese University of Hong Kong, Rm 827, Esther Lee
Equipping nursing students to be agents of Building, Shatin, New Territories, Hong Kong.
oral health promotion and oral care is beneficial Email: chanchungyan@cuhk.edu.hk

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2 Journal of Health Psychology 
This study aimed at understanding the level
of oral health knowledge and the oral health
behavior of nursing students, which will pro-
vide nurse educators insight into the students’
strengths and weaknesses. Considering the psy-
chological factors, such as perceived oral health
and dental self-efficacy, that influence nursing
students’ oral health behavior is also important
but is currently a missing gap in the literature.
Background
Oral health knowledge and oral
health behavior of nursing students
Research on the oral health knowledge and the
oral health behavior of nursing students has
been scarce and has achieved mixed findings.
Udoye and Aguwa (2009) found that nursing
students in a Nigerian hospital had good oral
health knowledge. For example, the majority of
students knew what calculus was and the role of
fluoride in toothpaste. However, oral health
knowledge was not associated with their own
oral health behavior. On the contrary, 97 percent
of 163 undergraduate nursing students in the
United States perceived themselves as having
adequate knowledge of oral health assessment,
but only a quarter of these students could accu-
rately identify the elements of oral health
assessment (Clemmens et al., 2012).
For oral health behavior, Udoye and Aguwa
(2009) found that 68 percent of the nursing stu-
dents in a Nigerian hospital had never visited a
dentist and 53 percent brushed their teeth only
once daily. In comparison, nursing students in
Jordan had better oral health behavior, as only
12.9 percent had never visited a dentist and
35.8 percent brushed their teeth only once daily
(Alsrour et al., 2013). However, both studies
showed room for improvement in nursing stu-
dents’ oral health behavior.
Dental self-efficacy of nursing
students and perceived oral health
Self-efficacy in health behavior refers to
whether an individual “can exercise control
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over one’s health habits” (Bandura, 2004: 144).
It can also motivate individuals to adopt a health
behavior or maintain it (Schwarzer, 2008).
Sources of self-efficacy information include
mastery experience, vicarious learning, social
persuasion, and physiological and psychologi-
cal feedback (Bandura, 1997). If individuals
have a successful experience of practicing a
health behavior, if they observe the health
behavior of others, if they are verbally encour-
aged, and if they interpret their physiological
and psychological states when practicing a
health behavior positively, then they will be
more likely to have higher self-efficacy
(Bandura, 1997).
Dental self-efficacy plays a determining
role in oral health behavior and is associated
with oral hygiene (Syrjälä et al., 1999).
Research has found self-efficacy to be a sig-
nificant predictor of toothbrushing and flossing
in dental patients (e.g. Buglar et al., 2010). In
addition, toothbrushing self-efficacy, approxi-
mal cleaning self-efficacy, and dental visiting
self-efficacy were significantly associated with
oral health behavior in diabetic patients (Syrjälä
et al., 1999). To the best of our knowledge,
however, no study has examined dental self-
efficacy (namely, that of toothbrushing, floss-
ing, and dental visiting) of nursing students.
Perceived oral health refers to individuals’
subjective perception of their oral health,
and it is related to an individual’s actual oral
health status (Atchison and Gift, 1997).
Martins et al. (2011) found that in a sample of
496 adults in Brazil, positive self-perceived
oral health was associated with high resil-
ience. Piuvezam and De Lima (2012) also
found that in 587 institutionalized elderly in
Brazil, 75 percent had positive self-perceived
oral health. In a small sample of German-
speaking Mexican Mennonites, Rowden et al.
(2011) found that the majority of these indi-
viduals considered the condition of their teeth
and gums to be fair. Agudelo-Suárez et al.
(2014) analyzed the data of 80,631 partici-
pants in Colombia and found that both men
and women reported unmet dental needs, but
men had a tendency to report gum bleeding
Chan and Chin 3
while women were more inclined to report
dental caries. A research in Hong Kong found
that among young adults, 15.1 percent per-
ceived their oral health status to be good,
65.4 percent fair, and 19.4 percent poor (Lu
et al., 2015). However, to the best of our
knowledge, there has been no research on
nursing students’ perceived oral health.
Oral health education
Although nursing students agree that oral health
is important in nursing practice, there is little oral
health education or promotion, and the associa-
tions between oral health and general health have
been overlooked in the nursing curricula world-
wide (Chan and Ng, 2012; Clemmens et al.,
2012; Hein et al., 2011). It has been suggested
that, for example, “improved undergraduate,
postgraduate and continuing education in geriat-
ric dentistry for dental and other health profes-
sionals” is essential for the development of
personal skills for geriatric oral health promotion
(Chalmers, 2003: 7). Therefore, comparing
undergraduate and postgraduate nursing stu-
dents’ oral health knowledge, oral health behav-
ior, and associated factors will offer nurse
educators insight into their needs in oral health
education.
Aims
This study aimed to
1. Assess the current oral health knowl-
edge, oral health behavior, perceived
oral health, and dental self-efficacy of
nursing students in Hong Kong;
2. Compare the oral health knowledge,
oral health behavior, perceived oral
health, and dental self-efficacy between
undergraduate nursing students and
postgraduate nursing students in two
pre-registration programs;
3. Explore the socio-cognitive factors that
are associated with oral health behav-
iors of nursing students.
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Methods
Participants
The final sample consisted of 831 undergradu-
ate nursing students (163 males, 667 females,
1 unreported; mean age = 20.06 years, standard
deviation (SD) = 1.72, n = 823) and 188 post-
graduate nursing students (62 males and 126
females; mean age = 26.92 years, SD = 4.41,
n = 171) in a nursing school at a university in
Hong Kong in 2012. Of the postgraduate nurs-
ing students, 3.7 percent were having braces,
16.5 percent had braces, 63.8 percent had fill-
ings, and 30.3 percent had their wisdom teeth
extracted. Of the undergraduate nursing stu-
dents, 3.6 percent were having braces, 15.6 
percent had had braces, 49.9 percent had fill-
ings, and 7.1 percent had their wisdom teeth
extracted.
Instruments
Demographics.  Students indicated their gender,
age, and type of study (undergraduate or
postgraduate).
Dental history. Students indicated their dental
history, such as whether they had braces, were
having braces, or had their wisdom teeth
extracted.
Perceived oral health.  Similar to other research
(e.g. Lu et al., 2015), we used a single-item
measure and asked students to rate their oral
health as poor, average, or good.
Oral health behavior.  Questions about oral health
behaviors were based on previous studies (Tada
and Hanada, 2004; Udoye and Aguwa, 2009).
The students indicated their frequencies of
toothbrushing (once a day, twice a day, three or
more times a day, or not every day), flossing
(never, 1–2 time(s) weekly, 3–4 times weekly,
5–6 times weekly, or daily), and dental check-
up (once a year, twice or more a year, less than
once a year, or never). In addition, the students
indicated the date of their last dental visit (in the
4 Journal of Health Psychology 
last 1 year, over 1 year ago, or never) and the
reason (check-up or treatment).
Oral health knowledge.  There were seven ques-
tions about dental terminology that tapped the
students’ oral health knowledge; these were
dental plaque, dental calculus, periodontal dis-
ease, sealant, fluoridation, sugarless, and
xylitol. The responses were “I know the mean-
ing,” “I know the meaning a little,” and “I don’t
know the meaning.” With reference to the study
by Tada and Hanada (2004), only the response
“I know the meaning” received one point and
the other two responses received no points.
Therefore, students could receive a maximum
of seven points for the seven questions.
In addition, there were four open-ended
questions regarding the causes and prevention
methods of gum disease and tooth decay. The
questions came from the 1991 Hong Kong Adult
Oral Health Survey (Schwarz and Lo, 1994).
For each question, the students could indicate a
maximum of three answers. Each acceptable
answer received one point, and thus, the maxi-
mum score was 12 (Lin et al., 2001). One of the
researchers, a dental hygienist, was responsible
for checking and scoring the answers.
Combining all the 11 items on oral health
knowledge, the students received a total score
that ranged from 0 to 19, with higher scores
indicating better oral health knowledge.
Dental self-efficacy.  We used the scales of tooth-
brushing self-efficacy and flossing self-efficacy
from the study of Buglar et al. (2010) and
adopted the measures to form an additional scale
of dental visiting self-efficacy. There were three
items for each scale, and they were rated on
5-point Likert scales from 1 “strongly disagree”
to 5 “strongly agree.” The Cronbach’s alphas for
toothbrushing self-efficacy (.70) and dental vis-
iting self-efficacy (.69) were acceptable and that
for flossing self-efficacy was good (.81). Sam-
ple items are as follows: “Dental visit is hard to
do”; “I am confident I can floss my teeth once a
day”; and “I am not sure if I can brush teeth at
least two times a day,” respectively. Negatively
phrased items were reverse-scored. By adding
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up the scores, the total score ranged from 3 to 15
for each scale. Higher scores indicated higher
levels of self-efficacy.
Ethical considerations
We obtained prior ethical approval from The
Chinese University of Hong Kong for this study,
and the procedures followed adhered to the ethi-
cal standards of the Survey and Behavioral
Research Ethics Committee of The Chinese
University of Hong Kong .
Procedure
Students who indicated their consent were asked
to complete a questionnaire that included demo-
graphic information, dental history, perceived
oral health, oral health behavior, oral health
knowledge, and dental self-efficacy. Completion
of the questionnaire took about 10 minutes.
Data analyses
The data were analyzed with IBM SPSS Version
21. Descriptive statistics, t-tests, and binary
logistic regression were used to analyze the data.
Results
Perceived oral health
Overall, students perceived their oral health to
be average. There was no statistically signifi-
cant difference between undergraduate students
(M = 1.07, SD = .43) and postgraduate students
(M = 1.09, SD = .49) (t(1016) = −.64, p = .52,
confidence interval (CI)  = −.09 to .05). For
undergraduate students, there was no statisti-
cally significant difference between male stu-
dents (M = 1.01, SD = .42) and female students
(M = 1.08, SD = .43) (t(251.30) = −1.87, p = .063,
CI = −.14 to .003). For postgraduate students,
there was also no statistically significant differ-
ence between male students (M = 1.03, SD = .51)
and female students (M = 1.12, SD = .48)
(t(186) = −1.14, p = .26, CI = −.24 to .06). There
was no statistically significant difference in the
Chan and Chin 5

Table 1.  Oral health behaviors of participants: toothbrushing, flossing, and dental check-up frequencies of
undergraduate and postgraduate nursing students.

Oral health Frequency Undergraduate Postgraduate All

behavior nursing students nursing students participants

(%) (%) (%)

Toothbrushing Not every day .1 .5 .2
Once a day 7.7 14.9 9
Twice a day 90.9 79.8 88.8
Three or more times a day 1.2 4.8 1.9
Flossing Never 50.5 40.4 48.7
1–2 time(s) weekly 32 27.7 31.2
3–4 times weekly 6.7 7.4 6.9
5–6 times weekly 1.7 3.2 2
Dental check-up Daily 8.4 19.1 10.4
Never 11.2 5.3 10.1
Less than once a year 33.7 23.4 31.8
Once a year 41.6 52.1 43.6
Twice or more a year 13 17.6 13.8

perceived oral health status between female stu-
dents in the undergraduate program and the
postgraduate program, and there was also no
statistically significant difference between male
students enrolled in the two programs.
Oral health behavior
The frequency of toothbrushing, flossing, and
dental visiting for all students and by the type of
study is displayed in Table 1. We compared the
percentage of students who met the recom-
mended requirements of toothbrushing (twice a
day), flossing (every day), and dental visiting
(twice a year) in the undergraduate and post-
graduate groups using chi-square tests.
The type of study had a significant relation-
ship to whether students met the daily require-
ment of toothbrushing (χ2(1, N = 1018) = 19.40,
p = .00) and flossing (χ2(1, N = 1010) = 19.70,
p = .00) but not the recommended frequency of
dental visiting (χ2(1, N = 1012) = 2.88, p = .09).
Oral health knowledge
Overall, the mean score of oral health knowledge
was 10.42 (SD = 3.80). There was no statistically
significant difference between undergraduates
(M = 10.42, SD = 3.79) and postgraduates
(M = 10.43, SD = 3.88) (t(1007) = −.039, p = .97,
CI = −.62 to .59).
Dental self-efficacy
Toothbrushing self-efficacy, flossing self-
efficacy, and dental visiting self-efficacy are
illustrated in Table 2. For toothbrushing self-
efficacy, there were no statistically significant
differences between undergraduate and post-
graduate nursing students (t(1006) = −.28,
p = .78, CI = −.44 to .33). For flossing self-
efficacy, there was a statistically significant
difference between postgraduate students and
undergraduate students (t(240.30) = −3.15,
p = .002, CI = −1.38 to −.32). Postgraduate stu-
dents had significantly higher flossing self-
efficacy compared with undergraduate
students. For dental visiting self-efficacy, there
was also a statistically significant difference
between postgraduate students and undergrad-
uate students (t(256.61) = −2.21, p = .028,
CI = −.94 to −.05). Postgraduate students had
higher dental visiting self-efficacy compared
with undergraduates.

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6 Journal of Health Psychology 
Table 2.  Dental self-efficacy of participants: toothbrushing, flossing, and dental visiting self-efficacy of
undergraduate and postgraduate nursing students.
Dental self- Undergraduate nursing
efficacy students, M (SD)
Toothbrushing 12.61 (2.37)
Flossing 8.58 (2.76)
Dental visiting 8.22 (2.53)
SD: standard deviation.
Binary logistic regression
Each oral health behavior was recoded in accord-
ance with the recommendations for optimal oral
health behavior practices. For toothbrushing, the
recommended frequency of twice a day (Oral
Health Education Unit, Department of Health,
The Government of the Hong Kong Special
Administrative Region, 2006) was recoded as 1
and the non-recommended options were recoded
as 0. For flossing, daily flossing was recoded as
1 and the other options were recoded as 0. The
recommended frequencies of toothbrushing and
flossing have also been used in a previous study
(Buglar et al., 2010). For visits to the dentist,
twice a year was recoded as 1 and the other
options were recoded as 0 (American Academy
of Pediatric Dentistry, 2010).
Toothbrushing.  Both toothbrushing self-efficacy
(p < .01) and the type of study (p < .05) were sig-
nificantly associated with toothbrushing fre-
quency (refer to Supplementary Table 3).
Flossing.  Only flossing self-efficacy had a sig-
nificant association with flossing frequency
(p < .01) (refer to Supplementary Table 4).
Dental visits.  Only dental visiting self-efficacy was
significantly associated with dental visiting behav-
ior (p < .01) (refer to Supplementary Table 5).
Discussion
Oral health knowledge
The results indicated that, overall, the oral
health knowledge of the students in this study
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Postgraduate nursing All participants,
students, M (SD) M (SD)
12.67 (2.55) 12.62 (2.40)
9.43 (3.40) 8.74 (2.90)
8.72 (2.85) 8.31 (2.60)
was not optimal, regardless of the program in
which they were enrolled. Such a finding is not
consistent with a previous study that found
that nurses who were more educated had better
oral health knowledge (Chan and Ng, 2012).
This may imply that both programs under the
current investigation do not offer sufficient
oral health education. To improve oral health
education for nursing students, Clemmens
et al. (2012) suggested an evaluation of the
coverage of oral health content and skills in
the nursing curricula. In addition, oral health-
care education should be composed of up-to-
date, evidence-based knowledge (Wårdh et al.,
2009). Nursing students should also be psy-
chologically prepared to work with dental
staff, as they will not have comprehensive
knowledge related to oral health even after
they become registered nurses (Wårdh et al.,
2009).
Oral health behavior
The majority of the students in this study
brushed their teeth twice a day, which is similar
to dental students in Australia and better than
nursing students in Jordan (Alsrour et al., 2013;
Messer and Calache, 2012). With regard to
flossing, only about 10 percent of the students
flossed on a daily basis and 49.1 percent had
never flossed compared with dental students in
Australia, in which 46 percent flossed daily and
15 percent did not floss (Messer and Calache,
2012). For dental visiting, 10.2 percent of the
students in this study had never visited a den-
tist, which is similar to the rate of Jordan nurs-
ing students (Alsrour et al., 2013).
Chan and Chin 7
Oral health behavior, especially flossing and
dental visiting, needs to be promoted among
nursing students. Consistent with a previous
study, oral health knowledge and oral health
behavior were not found to be significantly
associated (Udoye and Aguwa, 2009). This
implies that nurse educators cannot expect an
increase in oral health knowledge to be auto-
matically translated into an improvement in
nursing students’ oral health. There is, however,
empirical evidence that suggests that presenting
students with inflated estimates of the fre-
quency of flossing behavior of their peers led to
an increase in flossing behavior (Schmiege
et al., 2010). Therefore, nurse educators can
identify students who have good flossing
behavior and use them as role models for those
who do not have such behavior. In addition,
nurse educators can consider asking students to
create concrete plans for overcoming barriers to
flossing, as such plans are effective in increas-
ing flossing (Schüz et al., 2006). With regard to
dental visiting, there is evidence to suggest that
dental coverage will lead to an increase in the
use of dental services (Meyerhoefer et al.,
2014). The university may consider providing
dental coverage to nursing students. In addition
to these strategies, the results also imply that
fortifying students’ dental self-efficacy may be
effective in improving oral heath behavior.
Perceived oral health
The majority of the students in this study per-
ceived their oral health to be average, which is
consistent with young adults in Hong Kong (Lu
et al., 2015), whereas fewer students perceived
themselves as having poor or good oral health
compared with other young adults in Hong
Kong (Lu et al., 2015). Although this is a sub-
jective evaluation, it may imply that students
perceived that there was room for improvement
in their oral health. Nurse educators can help
nursing students set goals to attain better
oral health and highlight the importance of oral
health behavior as a means to improve oral
health. Reminding students that they should
prepare themselves to be influential role models
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as nurses may also put oral health into perspec-
tive (While, 2014).
Dental self-efficacy
Students had the highest self-efficacy in tooth-
brushing, followed by flossing and dental visit-
ing. Self-efficacy was significantly associated
with each of these oral health behaviors. Nurse
educators can identify students who do not
practice the recommended international stand-
ards of oral health behavior and aim to enhance
their self-efficacy. Nurse educators should also
recognize that barriers to oral health behavior
are often due not to its technical difficulty but to
the challenge of integrating such behavior into
everyday life (Schwarzer et al., 2015).
With reference to the four sources of self-
efficacy information, the following actions are
recommended. For mastery experience, nurse
educators can facilitate nursing students in
thinking back to their previous successful expe-
rience of engaging in oral health behavior regu-
larly, such as in childhood. For vicarious
learning, nurse educators can appoint nursing
students who practice oral health behavior as
role models to demonstrate how they engage in
toothbrushing, flossing, and dental visiting reg-
ularly. For social persuasion, nurse educators
themselves can provide verbal encouragement
to support nursing students in practicing oral
health behavior. For psychological and physio-
logical feedback, nurse educators may collabo-
rate with dental professionals to educate
students on how to alleviate the discomfort they
may experience, especially during flossing and
dental visiting, and interpret the discomfort in a
positive light.
Contributions
This is the first study to examine the associa-
tions among oral health knowledge, oral health
behavior, perceived oral health, and dental
self-efficacy of nursing students. Not only
does this study have theoretical implications
for a better understanding of self-efficacy and
oral health behavior, it also illustrates
8 Journal of Health Psychology 
the current level of oral health knowledge of
nursing students and pinpoints areas for
improvement. The assessment of oral health
knowledge by a dental hygienist increased the
reliability of the results.
Limitations and future research
directions
This study has several limitations. Oral health
behavior and oral health knowledge were
based on self-report measures. There is the
possibility of the issue of social desirability.
Part of the test on oral health knowledge asked
students to indicate whether they knew the
meaning of seven items of dental terminology.
Students might have claimed to know the
meanings, but in fact they did not. Thus, we
added four open-ended questions that required
students to recall the meaning to compensate
for this shortcoming. Future studies that
include an oral health examination can increase
the reliability of oral health status. In addition,
future studies can use a longitudinal approach
to better understand the psychological mecha-
nisms between dental self-efficacy and oral
health behavior. Other psychological factors
that may affect oral health, such as dental anxi-
ety (Diercke et al., 2013; Hittner and Hemmo,
2009) and dental fear (Abrahamsson et al.,
2002) or lifestyle factors such as alcohol con-
sumption (Neff et al., 2013, 2014), should also
be taken into consideration in future studies.
The nursing students in this study were from
one nursing school of one university, and this
might have limited the generalizability of the
results. Future studies should recruit a more
representative sample of nursing students from
different institutions.
Conclusion
The nursing students in this study had room
for improvement in both their oral health
knowledge and oral health behavior.
According to Hahn et al. (2012), increasing
nurses’ oral health knowledge can help meet
the public’s oral health needs. The nursing
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curriculum should prepare nursing students
with a sound base of oral health knowledge
for oral health promotion and oral care for
patients. However, nurse educators also need
to be aware that increasing oral health knowl-
edge may not directly improve oral health
behavior. With evidence that dental self-effi-
cacy is an important factor that contributes to
oral health behavior, nurse educators can con-
sider empowering nursing students’ dental
self-efficacy through the four sources of self-
efficacy information. Encouraging students to
make regular dental visits, enhancing stu-
dents’ self-efficacy in flossing and flossing
frequency, and increasing the coverage of oral
health knowledge must be the priorities of
nurse educators in the domain of oral health
education.
Acknowledgements
We would like to thank Doris Leung for her advice.
We would like to thank Emily Sit, Lau Wai Ming,
Bowie Sy, and Carmen Wong for their help in the pro-
ject and colleagues from The Chinese University for
their help in data collection. Part of this study was pre-
sented at The Fourth Asian Conference on the Social
Sciences, Osaka, Japan, 2013. This study was also
presented at the Annual Symposium on Management
and Social Sciences, Seoul, Korea, 2014.
Funding
This work was supported by a departmental grant of
The Nethersole School of Nursing, The Chinese
University of Hong Kong.
References
Abrahamsson KH, Berggren U, Hallberg LR, et al.
(2002) Ambivalence in coping with dental fear
and avoidance: A qualitative study. Journal of
Health Psychology 7(6): 653–664.
Agudelo-Suárez A, Martínez-Herrera E, Posada-
López A, et al. (2014) Ethnicity and self-
perceived oral health in Colombia: A cross-
sectional analysis. Journal of Immigrant and
Minority Health 16(1): 111–118.
Al Sharbatti S, Sadek M, Sreedharen J, et al. (2014)
Nurses’ knowledge of oral health among old
people in Ajman, United Arab Emirates. Asian
Journal of Gerontology & Geriatrics 9(1): 27–32.
Chan and Chin 9
Alsrour SS, Nassrawin N and Al-Tawarah YM
(2013) Oral health knowledge, attitudes
and behavior of nursing students in Mutah
University (Jordan). Pakistan Oral & Dental
Journal 33(1): 102–109.
American Academy of Pediatric Dentistry (2010)
Guideline of periodicity of examination, pre-
ventive dental services, anticipatory guidance/
counseling, and oral treatment for infants, chil-
dren, and adolescents. Pediatric Dentistry 32:
93–100.
Anagnostopoulos F, Buchanan H, Frousiounioti
S, et al. (2011) Self-efficacy and oral hygiene
beliefs about toothbrushing in dental patients:
A model-guided study. Behavioral Medicine
37(4): 132–139.
Atchison KA and Gift HC (1997) Perceived oral
health in a diverse sample. Advances in Dental
Research 11(2): 272–280.
Bandura A (1997) Self-Efficacy: The Exercise of
Control. New York: Freeman.
Bandura A (2004) Health promotion by social cog-
nitive means. Health Education & Behavior
31(2): 143–164.
Buglar ME, White KM and Robinson NG (2010) The
role of self-efficacy in dental patients’ brushing
and flossing: Testing an extended Health Belief
Model. Patient Education and Counseling
78(2): 269–272.
Chalmers JM (2003) Oral health promotion for
our ageing Australian population. Australian
Dental Journal 48(1): 2–9.
Chan EY and Ng IHL (2012) Oral care practices
among critical care nurses in Singapore: A ques-
tionnaire survey. Applied Nursing Research
25(3): 197–204.
Clemmens D, Rodriguez K and Leef B (2012)
Knowledge, attitudes, and practices of bacca-
laureate nursing students regarding oral health
assessment. Journal of Nursing Education
51(9): 532–535.
Diercke K, Bürger GD, Bermejo JL, et al. (2013)
The management of dental anxiety and impact
of psychosomatic factors on dentistry: Is recent
scientific research translated into German den-
tal practices? Journal of Health Psychology
18(12): 1519–1529.
Hahn JE, FitzGerald L, Markham YK, et al. (2012)
Infusing oral health care into nursing curricu-
lum: Addressing prevention health in aging
and disability. Nursing Research and Practice
2012: 157874 (10 pp.).
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on October 13, 2015
Hein C, Schönwetter DJ and Iacopino AM (2011)
Inclusion of oral-systemic health in predoctoral/
undergraduate curricula of pharmacy, nursing,
and medical schools around the world: A pre-
liminary study. Journal of Dental Education
75(9): 1187–1199.
Hittner JB and Hemmo R (2009) Psychosocial pre-
dictors of dental anxiety. Journal of Health
Psychology 14(1): 53–59.
Iacopino AM (2010) Models for interprofessional
practice: Innovative collaboration between
nursing and dentistry. Journal of Canadian
Dental Association 76: a16.
Lin HC, Wong MC, Wang ZJ, et al. (2001) Oral
health knowledge, attitudes, and practices of
Chinese adults. Journal of Dental Research
80(5): 1466–1470.
Lu HX, Wong MCM, Lo ECM, et al. (2015) Oral
health related quality of life among young
adults. Applied Research in Quality of Life
10(1): 37–47.
Martins AB, Dos Santos CM, Hilgert JB, et al. (2011)
Resilience and self-perceived oral health: A
hierarchical approach. Journal of American
Geriatrics Society 59(4): 725–731.
Messer LB and Calache H (2012) Oral health atti-
tudes and behaviours of final-year dental stu-
dents. European Journal of Dental Education
16(3): 144–155.
Meyerhoefer CD, Zuvekas SH and Manski R (2014)
The demand for preventive and restorative den-
tal services. Health Economics 23(1): 14–32.
Miller M, Taylor A, Kearney N, et al. (2007)
Evaluation of the feasibility and acceptability of
an oral care diary by patients during chemother-
apy. International Journal of Nursing Studies
44(5): 693–701.
Neff JA, Kelley ML, Walters ST, et al. (2014)
Effectiveness of a screening and brief inter-
vention protocol for heavy drinkers in dental
practice: A cluster-randomized trial. Journal
of Health Psychology. Epub ahead of print 14
January. DOI: 10.1177/1359105313516660.
Neff JA, Walters ST, Braitman AL, et al. (2013) A
brief motivational intervention for heavy alco-
hol use in dental practice settings: Rationale and
development. Journal of Health Psychology
18(4): 542–553.
Oral Health Education Unit, Department of Health,
The Government of the Hong Kong Special
Administrative Region (2006) Oral health care
zone for grown-ups. Available at: www.toothclub.
10 Journal of Health Psychology 
gov.hk/en/en_adu_01_02_01.html#start (accessed
26 February 2015)
Piuvezam G and De Lima KC (2012) Self-perceived
oral health status in institutionalized elderly in
Brazil. Archives of Gerontology and Geriatrics
55(1): 5–11.
Potting CMJ, Mank A, Blijlevens NMA, et al. (2008)
Providing oral care in haematological oncology
patients: Nurses’ knowledge and skills. European
Journal of Oncology Nursing 12(4): 291–298.
Rowden PM, Paschal AM, Hawley SR, et al. (2011)
Oral health attitudes and practices among a
German Mexican Mennonite farmworker com-
munity. Journal of Immigrant and Minority
Health 13(6): 1159–1167.
Schmiege SJ, Klein WMP and Bryan AD (2010)
The effect of peer comparison information in
the context of expert recommendations on risk
perceptions and subsequent behavior. European
Journal of Social Psychology 40(5): 746–759.
Schüz B, Sniehotta FF, Wiedemann A, et al. (2006)
Adherence to a daily flossing regimen in uni-
versity students: Effects of planning when,
where, how and what to do in the face of bar-
riers. Journal of Clinical Periodontology 33(9):
612–619.
Schwarz E and Lo ECM (1994) Use of dental ser-
vices by the middle-aged and the elderly in
Hong Kong. Community Dentistry and Oral
Epidemiology 22(5): 374–380.
Schwarzer R (2008) Modeling health behavior
change: How to predict and modify the adoption
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on October 13, 2015
and maintenance of health behaviors. Applied
Psychology 57(1): 1–29.
Schwarzer R, Antoniuk A and Gholami M (2015) A
brief intervention changing oral self-care, self-
efficacy, and self-monitoring. British Journal of
Health Psychology 20(1): 56–67.
Syrjälä AM, Kneckt MC and Knuuttila ML (1999)
Dental self-efficacy as a determinant to oral
health behaviour, oral hygiene and HbA1c level
among diabetic patients. Journal of Clinical
Periodontology 26(9): 616–621.
Tada A and Hanada N (2004) Sexual differences
in oral health behaviour and factors associated
with oral health behaviour in Japanese young
adults. Public Health 118(2): 104–109.
Udoye C and Aguwa E (2009) Oral health related
knowledge and behavior among nursing stu-
dents in a Nigerian tertiary hospital. The Internet
Journal of Dental Science 7(2). Available at:
https://ispub.com/IJDS/7/2/11424
Wårdh I, Paulsson G and Fridlund B (2009) Nursing
staff’s understanding of oral health care for
patients with cancer diagnoses: An interven-
tion study. Journal of Clinical Nursing 18(6):
799–806.
While AE (2014) Are nurses fit for their public
health role? International Journal of Nursing
Studies 51(9): 1191–1194.
Yoon MN, Lowe M, Budgell M, et al. (2011) An
exploratory investigation using appreciative
inquiry to promote nursing oral care. Geriatric
Nursing 32(5): 326–340.