The differential predictive utility of two caregiver-targeted self-efficacy measures to promote oral health of underserved children.

Abstract

Objective: Oral health self-efficacy is a modifiable determinant of early childhood caries, which is one of the most prevalent childhood diseases. Yet, two common measures of self-efficacy (i.e., context-specific and behavior-specific) lack validation and clarity in the prediction of children's oral health behaviors. This study examined the psychometric properties of two caregiver oral health self-efficacy measures and investigated the predictive ability and age-varying effects of caregiver oral health self-efficacy on child oral health behaviors. Method: In this secondary data analysis of caregiver-child dyads (n = 754, M child age = 2.4, 56.2% Black or African American, 68.3% below poverty level), caregivers reported their oral health selfefficacy and their child's tooth brushing frequency, diet, and sugar-sweetened beverage (SSB) consumption at baseline and 4, 12, and 24 months. Psychometrics were examined with confirmatory factor analyses (CFAs) and the predictive ability and age-varying effects of caregiver self-efficacy on child oral health behaviors were examined with time-varying effect models (TVEMs). Results: The context-and behavior-specific oral health self-efficacy CFA models indicated mixed model fit. In the predictive TVEM models, greater behavior-specific, but not context-, oral health self-efficacy predicted greater child tooth brushing across all ages. Greater context-specific oral health self-efficacy predicted healthier child diet throughout childhood, but greater behavior-specific self-efficacy only predicted healthier child diet in older children. Greater behavior-specific self-efficacy predicted lower SSB consumption throughout childhood while greater context-specific self-efficacy only predicted lower SSB consumption in younger children. Conclusions: Both caregiver oral health self-efficacy measures were psychometrically comparable and differentially predicted oral health behaviors across varying childhood ages. Public Significance StatementThe current study suggests that two widely used oral health self-efficacy measures predict pediatric oral health behaviors. However, their predictive utility differs by child age and by the specific target behavior. These results help researchers choose which measure might be best to use in their study population and research question as well as help providers to decide how to assess self-efficacy in their patients.