The level of health literacy – a comparative study between two target groups from Romania and Poland

Pages: 534-549

Ana Maria Cosma(1), Alexandru Stănculescu(2), Ruxandra Sfeatcu(3)

(1) Medic rezident Ortodonție și Ortopedie Dento-Facială, Universitatea „Lucian Blaga”, Sibiu; (2) Medic rezident Ortodonție și Ortopedie Dento-Facială, Universitatea de Medicină și Farmacie „Carol Davila”, București; (3)Șef Lucrări Dr. Disciplina de Sănătate Orală și Stomatologie Comunitară, Facultatea de Medicină Dentară, Universitateade Medicină și Farmacie ,,Carol Davila”, București

Abstract

In the context of ex-communist countries that have undergone economic, social, cultural changes over the years, this study aims to analyze the level of knowledge about oral health of individuals from the capitals of two countries, Romania and Poland.

Aim: To assess the level of oral health and health literacy in 2 adult groups from Bucharest and Warsaw, in February and March 2018.

Material and Method: The study includes 122 subjects, 61 Romanians and 61 Poles, using questionnaires with 11 questions in Romanian, respectively in English. The data was centralized and processed in Microsoft Excel 2007.

Results: Poles use dental services twice a year in 53% of cases, compared with 10% of Ro-manians. Regarding the self-assessment of oral health, 63% of the Poles consider to have a good and very good level of oral health, compared to 66% of Romanians. About the ability of filling in a medical file, the Poles have noted that they are sure and very confident in 78% of cases, while 82% of Romanians respond the same.

Conclusions: By analyzing the results obtained, we can conclude that the interest in oral health and the frequency of the visit to the dentist are better in Poland, but it is necessary to improve the level of knowledge in both populations through campaigns that promote oral health and also to enroll individuals in national education programs.

Key-words: oral health, literacy, medical record, oral hygiene

Introduction

Health literacy is of increasing importance in public health and healthcare worldwide. It represents placing the health of a person, his family and community into context, understan-ding which factors may influence the health level, and knowing how to address these factors. AsSørensen (2012) stated “An individual with an adequate level of health literacy has the abi-lity to take responsibility for one’s own health as well as one’s family health and community health” [1].The notion of literacy in health refers to an individual’s ability to read, process and under-stand medical information at the same time as the capacity to present basic information about preventing problems, solving chronic conditions, but also about the possibility of taking part in the medical decision aimed at its own health.Oral health literacy (OHL) is necessary in-formation in everyday life, given the fact that the public is subject to an increasing number of medical information. Thus, education is an important factor in the case of forward-looking development and of maintaining a good oral health level, which concerns multidimensional and anticipatory modeling of the human condi-tion. In addition to it, the ability to understand certain phenomena, notions and to prevent the spreading of diseases may influence the indivi-dual character. [2] The notion of literacy in oral health indi-cates the degree of experience the individual has, as well as his capacities related to medical treatments and/or the preservation of appropri-ate health care. In current terms, the patient is viewed as a consumer of medical services and represents the most important ‘target’ in the field of literacy in oral health and in the field of the medical system. It is necessary for the patient to have an appropriate level of information within the framework of health literacy, including the ability to acquire, understand and use the basic information in order to benefit from the quality medical services; he should also understand what type of healthcare is necessary in order to know how to choose medical care services correctly [3].

Aim and objectives

The present study aims to evaluate the level of oral health and of health literacy on adults in 2 adult groups from Bucharest and Warsaw, in February and March 2018.

Material and methods

The study included 122 subjects, 61 Romani-ans, and 61 Poles. They were given questionnai-res with 11 questions in Romanian, respectively in English. For each questionnaire, single or multiple responses to the proposed questions and the age and gender of individuals were ne-eded. Also included in the questionnaire were 5 questions related to the level of health literacy: “How confident are you filling out medical forms by yourself?”, “How sure are you that you can follow the instructions written on the label of a medicine?”, “How often did you ask for help to read the written instructions you received from the doctor”, “How do you appreciate your general health status?” and “How do you appreciate your oral health status?”.ResultsFrom the 61 Romanian participants, 31 were males; the mean age of the Romanian groupwas 37.03 years. In the Polish group, 25 participants were males, and the mean age of the Polish group was 34.83 years. (Table 1)

Table 1. Distribution by age and sex of the participants (N=122)

With regard to the frequency of dental brushing, 87% of Romanian individuals were brushing twice a day, with 3% less that the Polish. Almost 33% of the Romanians used a correct brushing technique, compared with only 13% of the Polish. (Table 2).The use of dental floss was a regular habit for 42% Romanians, in comparison with only 18% of Polish group (Table 3).

Table 2.Brushing movements in the two groups
Table 3. Auxiliary means in used by the two groups

In regard of habits after evening brushing, almost 1 out of 10 responders of both natio-nalities used to have a drink or to take a snack (Table 4).In terms of visits to the dental office, Po-les use dental services twice a year in 53% of cases, compared with 10% of Romanians. (Table 5).

Table 4.Habits after evening brushing in the two groups
Table 5. Visits to the dental office in the two groups

41% Poles were going for a regular check-up and 34% for emergency cases. On the other side, only 11% Romanians went for a regular check-up, with more that 62% going on emergency (Table 6).

Table 6. Reason of visits to the dental office in the two groups

At the question “How confident are you filling out medical forms by yourself?”, 78% of the Poles have noted that they are “Sure” and “Very sure”in their ability of filling in medical files, while 82% of Romanians had the same answers (Figure 1). At the question “How sure are you that you can follow the instructions written on the label of a medicine? 95% of Romanians considered that they are “Very sure” and “Pretty sure”, compared to 79% of the Poles (Figure 2).At the question “How often did you ask for help to read the written instructions you received from the doctor?”, almost 30% Polish people have responded “Never”, in comparison with almost 50% Romanians (Figure 3).Regarding the question “How do you appre-ciate your general health status?”, 72% of the Poles consider having a “Good” and “Very good” level of general health, compared to 89% of Ro-manians. (Figure 4).

Regarding the question “How do you appreci-ate your oral health status?”, 63% of the Poles consider having a “Good” and “Very good” level of oral health, compared to 66% of Romanians. (Figure 5)

Fig. 1. Ability of filling in a medical file.
Fig. 2. Can read and understand the label of a medicinal product.
Fig. 3. Seeking help to read the instructions given by the doctor.
Fig. 4. Self-assessment of general health
Fig. 5. Self-assessment of oral health.

Discussions

The 5 questions related to the level of health literacy have been used in studies over time to assess the capacities of people to meet the complex demands of health in modern society. Sørensen [4], in a study conducted on 8000 subjects from 8 countries, found that at least 1 out of 10 respondents showed insufficient health literacy and almost 1 in 2 had limited health literacy. Sabbahi [5] found out in his study that 40% of the participants visited the dentist every 6 months (compared to 10% of Romanians and 53 % of Polish); also, the patients that visited the dental office twice a year had significantly higher levels of oral health literacy than those visiting only when they felt pain. Masayuki [6] stated that “individuals with higher oral health literacy had higher mean number of natural teeth” and “participants with higher oral health literacy also had fewer decayed teeth”. Moham-mad [7] had identified that patients who brushed more frequently had significantly higher OHL levels. Firmino [8] did a cross-sectional study, in which he found out that there was a connec-tion between dental caries and lower levels of OHL. Also, he related that “A reduced number of teeth and loss of attachment were associated with lower levels of OHL”.Baskaradoss [9] analyzed data collected from 150 respondents and, from the results, subjects with limited OHL had significantly higher number of missing teeth and lower number of filled teeth, and higher percentage of subjects with limited OHL had severe periodontitis. Regarding the questions related to the level of health literacy, Wallace [10] recommended using the ‘‘somewhat’’ response to ‘‘How confident are you filling out medical forms by yourself?’’ to identify patients with limited or marginal health literacy skills.

Conclusions

Limited health literacy and oral health liter-acy represents an important challenge for health practices. Regarding the oral hygiene behavior, the group of respondents from Romania has shown an increased interest for the use of the auxiliary means of dental prophylaxis (dental floss), as well as the use of correct dental brushing techniques, compared to the subjects in the Polish group.By analyzing the results obtained in the study of the two group population (Romanians and Polish), we can conclude that the interest in oral health and the frequency of the visit to the dentist are better in Poland.Campaigns that promote oral health and natio-nal education programs are necessary to improve the level of knowledge in the targeted population (Romanians and Polish).

ACKNOWLEDGMENT: This work was supported by ”Carol Davila” University of Medicine and Pharmacy from re-search project number 33898/11.11.2014.

References

1. Sørensen K,et al.Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health12,80 (2012).

2. ADA – Glossary of common dental terminology. Chi-cago (IL): American Dental Association, 1999.

3. Sfeatcu IR,et al.Conceptul de alfabetizareînsănătatea-orală. EdituraCurteaVeche, București, 2016.

4. Sørensen K, et al. Health literacy in Europe: com-parative results of the European health literacy survey (HLS-EU), European Journal of Public Health, April 5, 2015: 1–6.

5. Sabbahi DA, et al. Development and evaluation of an oral health literacy instrument for adults. Community Dent Oral Epidemiol 2009; 37: 451–462.

6. Masayuki U, et al. Relationship between oral health literacy and oral health behaviors and clinical status in Japanese adults, Journal of Dental Sciences (2013) 8: 170-176.

7. Mohammad MNS, et al. New oral health literacy in-strument for public health: development and pilot testing, Journal of Investigative and Clinical Dentistry (2014), 5, 313–321.

8. Firmino RT, et al. – Oral health literacy and associated oral conditions, The journal of the American Dental As-sociation, 2017 Volume 148, Issue 8: 604–613.

9. Baskaradoss JK. Relationship between oral health literacy and oral health status, Baskaradoss BMC Oral Health, 2018; 18:172.

10. Wallace LS, et al. BRIEF REPORT: Screening Items to Identify Patients with Limited Health Literacy Skills, J GEN INTERN MED 2006; 21:874–877.

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