Validation of an improved questionnaire assessing the social cognitive constructs of the Health Action Process Approach among parents regarding brushing their children's teeth.

OBJECTIVE: The Health Action Process Approach (HAPA) describes social cognitive constructs related to behaviour change. A validated questionnaire is needed to measure these constructs in paediatric dentistry. The aim of this study was to improve an existing HAPA-based questionnaire for parents regarding brushing their children's teeth and to assess its validity and reliability in a population of parents of high caries risk children. METHODS: Parents of high caries risk children of 3-10 years filled out the adjusted HAPA-based questionnaire. Mokken scale analysis, graded response model analyses, factor analyses and reliability analyses were performed according to the protocol of Dima. Discriminant validity was assessed by comparing the mean scores of the HAPA constructs between two groups of participants, based on different levels of caries experience, brushing frequency and education level of the mother. RESULTS: The Mokken scale analysis and factor analyses indicated a multidimensional eight factor scale. The graded response model did not fit our data. The subscale action control could be identified as a two-factor subscale. Reliability indices from the Dima protocol varied, for instance Cronbach alpha ranged from 0.73 to 0.96. The constructs coping self-efficacy, action planning and action control discriminated between brushing frequencies. CONCLUSIONS: The adjusted HAPA-based questionnaire is an improved, valid and reliable instrument that could be used to evaluate HAPA-based interventions to improve children's oral health.

Construction of a questionnaire based on the Health Action Process Approach for psycho-social cognitive determinants of parents in brushing children's teeth in the Netherlands.

BACKGROUND: The health action process approach (HAPA) model is promising to increase the frequency of brushing children's teeth by parents to improve their children's oral health. A validated HAPA questionnaire is needed as one of the measures of the effects of such an intervention. OBJECTIVES: The aim of this study was to evaluate whether our data, based on a translated and adopted version of the Health Action Process Approach (HAPA)-based questionnaire on dental flossing, supported the constructs of the HAPA model. If so, a next aim was to assess whether these constructs could be measured reliably. METHODS: In this cross-sectional study, 269 questionnaires filled out in dental offices by parents of children 1-10 years old were analysed. Scale validation was performed according to the 6-step protocol of Dima, including Mokken scale analyses (MSA), graded response model (GRM), factor analyses and reliability measures. Pearson correlation coefficients were calculated to identify divergent validity and test-retest reliability. RESULTS: MSA showed a unidimensional, medium total scale. Three items were removed based on this analysis. The total scale with the remaining 26 items did not fit the GRM. Factor analysis extracted five factors and two components for the total scale. The separate subscales, except the 'intention' construct, fitted the MSA and did not fit the GRM. The data fitted a seven-factor model better than a one-factor model. Reliability measures varied from acceptable to excellent, but were poor for 'action control'. Test-retest reliability (r's 0.60-0.83) was questionable to good. CONCLUSION: Our results did not fully support the constructs of the HAPA model. To support the HAPA constructs, modification to the subscales risk perceptions, intention, action planning, action control and self-reported behaviour are suggested. With these adjustments, the reliability and validity of the questionnaire could be significantly improved".

Health action process approach in oral health behaviour: Target interventions, constructs and groups-A systematic review.

OBJECTIVE: The aim of this study was to systematically map the Health Action Process Approach (HAPA)-based interventions in dentistry in relation to the type of intervention, the target groups and the constructs of the HAPA model that are used in the study and to assess the clinical relevance of the studies. METHODS: A search in the databases of the National Library of Medicine (MEDLINE-PubMed), PsychINFO and Cochrane-CENTRAL was conducted. A quality assessment to estimate the risk of bias and a qualitative descriptive analysis were performed. The overall gathered evidence was graded. RESULTS: Ten randomized controlled trials and three observational studies thus in total 13 studies were included. Flossing was the targeted behaviour in ten studies. The target groups consisted of students, adolescents and dental patients. Overall, all nine HAPA constructs were used, but only one study used all HAPA constructs. Six studies presented the used behavioural change techniques according to the BCT taxonomy. Based on the number of the used constructs, only two studies were classified as HAPA intervention studies. The most frequently used constructs were action control as an intervention and behaviour as an outcome measure. The overall evidence was graded with moderate certainty. CONCLUSION: In the majority of the studies, the targeted intervention was flossing and the population consisted of students, adolescents and dental patients. All studies used only a selection of the HAPA constructs. Therefore, only a minority of the studies can be considered real HAPA intervention studies.