牙周炎初診與回診患者在健康信念、自我效能、口腔健康知識與口腔健康相關生活品質的相關性探討

研究背景牙周炎經過完整的牙周治療，在口腔健康相關生活品質（OHIP-14）會有改善。不同的研究提出口腔健康信念和知識的增加、自我效能提升與OHIP-14問卷得分的相關性，但在牙周炎患者的關係為何仍然不清楚。研究目的比較牙周炎初診與治療後能約診回來檢查的病患，在自我效能、健康信念、口腔健康知識、與OHIP-14等問卷得分是否有明顯差異，並分別探討初診和治療後能回診的病患在這些不同面向問卷得分之相關性。材料方法於2015年10月至2016年3月在高雄醫學大學附設紀念醫院牙科部牙周病科和第一門診，以及高雄某私人牙科診所收集牙周炎初診治療前與治療後回診的患者，經簽署人體試驗同意書後，邀請受試者填寫一份結構式問卷，收集基本人口學變項、口腔健康信念、口腔健康知識、自我效能與OHIP-14等相關資料，最後有227牙周炎患者進入統計分析。結果牙周炎回診患者平均年齡明顯高於初診組 (mean ± SD; 54.0 ± 14.3 vs. 50.2 ± 11.5, p = 0.03 )，回診組比初診患者在OHIP-14 (6.1 ± 5.6 vs. 13.3 ± 9.3, p < 0.0001)、、自我效能 (19.6 ± 3.6 vs. 18.2 ± 3.8, p = 0.01)、口腔知識 (11.1 ± 8.5 vs. 9.2 ± 2.7, p = 0.03) 等問卷得分都有顯著較好的表現，但在健康信念問卷得分沒有統計上顯著的差異。牙周炎患者自我效能與OHIP-14、健康信念及口腔健康知識之問卷得分呈現顯著相關；健康信念與口腔健康知識之問卷得分呈現顯著正相關。進一步分初診組與回診組，發現健康信念、口腔健康知識和自我效能之問卷得分以及OHIP-14得分的相關性在初診組與回診組的結果是不同。線性回歸分析發現，牙周炎患者之OHIP-14得分明顯受到自我效能問卷得分的影響 (B = -0.41, 95％CI ＝ -0.73 ~ -0.08; p=0.01)，在分組後則無法觀察到類似情形。自我效能和健康信念之問卷得分會明顯互相影響，尤其在初診組，自我效能增加對健康信念得分增加的影響更大(B = 0.69, 95％CI ＝ 0.41 ~ 1.00; p = 0.0001)。自我效能 (B = 0.16, 95％CI ＝0.07 ~ 0.25; p < 0.0001) 和口腔健康知識 (B = 0.63, 95％CI ＝ 0.25 ~ 0.99; p = 0.0001) 的問卷得分會明顯互相影響只在回診組發現，口腔健康知識的增加受到自我效能得分增加的影響更大；類似的結果，健康信念 (B = 0.67, 95％CI ＝ 0.50 ∼0.84; p = 0.0001) 和口腔健康知識 (B = 0.55, 95％CI ＝ 0.42 ∼ 0.7; p = 0.0001)之問卷得分的相關性只在回診組發現。結論牙周炎回診組的OHIP-14、自我效能、口腔健康知識的問卷得分比初診患者來得好。OHIP-14、自我效能、口腔健康知識和健康信念之問卷得分彼此間的相關性在回診組和初診組是不同，未來有機會應用在改善牙周炎患者的臨床治療策略。

關鍵字

牙周炎；口腔健康相關生活品質

並列摘要

Background: Previous studies reported that the oral health-related quality of life (OHIP) will be improved after the treatment of periodontitis. The correlations between good health belief, oral health knowledge increase, self-efficacy increase, and OHIP-14 score reduction were reported in the studies of different oral diseases. However, these relationships were not clear in periodontitis patients. Purpose: Our aims were to 1) compare the differences in questionnaire scores of self-efficacy, health belief, knowledge of oral health, and OHIP-14 between primary dental visit of periodontitis and the recall patients, 2) analyze the correlations between these four questionnaire scores in primary visit, recall, and all periodontitis patients. Materials and Methods: A self-reported structured questionnaire was given to the primary visit and recall patients with periodontitis in the Department of Periodontology of KMU and a private dental clinic between October, 2015 and March, 2016. A standardized questionnaire was applied to collect the data. After the scoring system was done for each participant, statistical analysis was applied to analyze the correlations. Finally, a total of 227 participants were completed this study. Results: Primary visit patients had significantly higher age than the re-call patients did (mean ± SD; 54.0 ± 14.3 vs. 50.2 ± 11.5, p = 0.03) but no difference in the other variables was found. The scores of OHIP-14 (6.1 ± 5.6 vs. 13.3 ± 9.3, p < 0.0001) and questionnaire of self-efficacy (19.6 ± 3.6 vs. 18.2 ± 3.8, p = 0.01) and oral health knowledge (11.1 ± 8.5 vs. 9.2 ± 2.7, p = 0.03) were significantly different between primary visit and re-call patients. No significant difference in the score of health beliefs was found between these two groups. Pearson correlation analysis showed that the score of self-efficacy was significantly correlated with the scores OHIP-14, health belief, and oral health knowledge in periodontitis participants. The score of health beliefs was positive correlated with the score of oral health knowledge. Further to analyze the correlation in primary visit and re-call groups, the correlation patterns were differentiated between these two subgroups. Multivariate linear regression analysis showed an interaction between OHIP-14 score and the score of self-efficacy was found in patients with periodontitis ( = -0.41, 95％CI ＝ -0.73 ~ -0.08; p=0.01) but no such relation was found in primary visit and re-call groups. An interaction between was found between the scores of self-efficacy and health belief. However, the scores of self-efficacy had higher effect size on the score of health belief in primary care group ( = 0.69, 95％CI ＝ 0.41 ~ 1.00; p = 0.0001). The interaction between the scores of self-efficacy, health belief, and oral health knowledge were only found in re-call group. The scores of oral health knowledge were contributed a higher effect size on the scores of self-efficacy in re-call group ( = 0.63, 95％CI ＝ 0.25 ~ 0.99; p = 0.0001). Conclusion: The re-call patients with periodontitis have significantly lower OHIP-14 scores and signigficantly higher scores in questionnaires of self-efficacy and oral health knowledge compared with the primary visit group. The association patterns between the scores of OHIP-14, self-efficacy, health belief, and oral health knowledge were differentiated between primary visit and re-call groups. It is worth to apply our study results in the improvement of therapeutic strategy of periodontitis in further study.