A Health Belief Model-Based Instrument for Assessing Factors Affecting Oral Health Behavior During Pregnancy

Background: Maintaining optimal oral health behavior (OHB) during pregnancy could preserve short-term and long-term health of women and their children. Objectives: By applying the health belief model (HBM), this study aimed at developing and analyzing the psychometric properties of an instrument evaluating pregnant women’s beliefs regarding OHB. Methods: In this instrument development study that carried out in Tehran (2015 - 2016), a preliminary 134-item questionnaire was developed, and content and face validity were assessed. The construct, convergent, discriminant, and criterion-oriented validity of the questionnaire were evaluated through a pilot study on 221 pregnant women, attending public health centers, by performing confirmatory factor analysis (CFA) and Linear Regression analysis. Cronbach’s alpha coefficient, composite reliability (CR) and intra- class correlation coefficient (ICC) were calculated to examine reliability. Results: The mean age of participants was 27.5 ± 5.6 years with mean gestational age of 21.5 ± 8.5 weeks. Based on CFA, the data fitted the HBM model. Root Mean Square Error of Approximation (RMSEA) was 0.052, Non-Normed Fit Index (NNFI) was 0.95, and Comparative Fit Index (CFI) was 0.96. The final HBM-based questionnaire with 79 items was associated with individual OHB (P = 0.001 and B = 0.4). The overall Cronbach’s alpha was 0.94 and ICC ranged between 0.84 and 0.99. Conclusions: This valid and reliable HBM-based questionnaire may identify the potential barriers of optimal OHB among pregnant women.