건강신념모델 논문에 대한 내용분석: 국내 건강신념모델 관련 연구 분야 현황과 모델 설명력을 중심으로

ZHOU NAN,김현미 강원대학교 사회통합연구센터 2023 사회통합연구 Vol.4 No.2

개인의 건강 행위를 설명하는 데 있어 건강신념모델(health belief model; HBM)은 가장 널리 사용되어 왔다. 본 연구는 건강신념모델을 적용한 국내논문을 대상으로 내용분석을 진행함으로써 연구들의 양상, 추세, 그리고 이론 자체의 설명력과 예측력을 살펴보았다. 2011년부터 2020년까지 10년동안 발간된 111편의 KCI 학술지 논문에 대해 코딩 및 분석을 진행한 결과는 다음과 같다: 첫째, 건강신념모델을 이용한 연구 수량은 증가 중인 것으로확인되었다. 둘째, 건강신념모델은 대중의 질병예방행위를 예측하기 위해만들어진 이론 틀로, 질병예방행위, 건강검진행위, 위생습관행위, 건강증진행위, 운동참여행위 등 건강 계열에 진행된 연구가 대다수다. 셋째, 자기효능감은 HBM의 발전과정에서 추가된 개념으로 관련 연구 중 가장 적게 언급되었으나, 다른 요인에 비해 높은 예측력을 갖고 있다. 넷째, 건강신념모델을 사용한 연구에서 제시된 연구모델은 상대적으로 단순한 양상인 것을 시사하였으며, 건강신념요인에 영향을 미치는 변수에 대한 탐색이 부족한 것으로보인다. 본 연구는 건강신념모델 연구 분야의 현황과 추세를 파악했으며, 향후 연구의 방향과 모델의 발전 방향에 대해 참고자료가 될 수 있음에 의미가 있다. Health Belief Model has been widely used to explain individuals’ health behaviors. This study examined the current status and trends of the research field, and the explanatory power of the theory itself by conducting a content analysis on Korean researches to which the health belief model was applied. We coded and analyzed 111 published in Korea Citation Index(KCI) between 2011 and 2020. Analysis results are as below: First, it was confirmed that the number of studies using the health belief model is increasing. Second, the health belief model is a theoretical framework created to predict the public's disease prevention behavior, due to which most of the studies have been conducted in the health field such as disease prevention behavior, health checkup behavior, personal hygiene, health promotion behavior, and exercise behavior ect. Third, although self-efficacy was added to HBM during its developing process and has been mentioned least among related studies, it has a stronger predictive power than other factors. Fourth, the study using the health belief model suggested that the presented research model was generally simple. A lack of exploration of predictors affecting factors of Health Belief Model was mentioned as one of our conclusions. This study looked into the current status and trends in the field of Health Belief Model, and we look forward to our study serving as a reference of future research directions and model development.

건강신념모델에 기초한 20대 여성의 건강 행동 실천에 대한 식생활 지침과전통 식생활의 건강신념 수준 비교 분석: 식습관의 조절효과를 중심으로

이형주 경성대학교 산업개발연구소 2024 산업혁신연구 Vol.40 No.1

본 연구는 건강신념모델에 기초한 20대 여성의 건강 행동 실천에 대한 식생활 지침과 전통 식생활의 건강신념 수준을 비교 분석하고자 하였다. 또한 식습관의 조절 효과를 검증하고자 하였다. 서울에 거주하는 20대 여성 2명을 선정하여 심층 면접 사전조사를 실시한 후, 이를 토대로 선행연구와 함께 서울 지역 20대 여성을 대상으로 2021년 10월 5일부터 10월 15일까지 설문조사를 실시하였다. 분석결과는 다음과 같다. 첫째, 식생활 지침(골고루, 싱겁게, 칼로리 낮게) 건강신념 수준은 건강 행동 실천에 유의한 영향을 미치는 것으로 나타났으며, 식생활 지침(체중조절) 건강신념 수준(인지된 장애, 식이 자아효능감)은 건강 행동 실천에 유의한 영향을 미치는 것으로 나타났으며, 식생활 지침(건강기능식품) 건강신념 수준(식이자아효능감)은 건강 행동 실천에 유의한 영향을 미치는 것으로 나타났고, 둘째, 전통 식생활 건강신념 수준(인지된 이익, 식이 자아효능감)은 건강 행동 실천에 유의한 영향을 미치는 것으로 나타났다. 셋째, 식습관(식품선택 습관)은 식생활 지침(골고루, 싱겁게, 칼로리 낮게) 건강신념 수준(인지된 장애, 식이 자아효능감)과 건강 행동 실천 간에, 식생활 지침(체중조절) 건강신념 수준(식이 자아효능감)과 건강 행동 실천 간에 조절효과가 있는 것으로 나타났다. 또한 식습관(식 행동)은 식생활 지침(체중조절) 건강신념 수준(식이 자아효능감)과 건강 행동 실천 간에 조절 효과가 있는 것으로 나타났다. 넷째, 전통 식생활 건강신념 수준과 건강 행동 실천 간에 식습관(식품선택습관, 식 행동)은 조절 효과가 나타나지 않았다. 본 연구결과를 통해 20대 여성들을 위한 건강 행동 실천력을 향상하는데 기초자료를 제시하고자 하였다. The purpose of this study was to compare and analyze the dietary life guidelines and traditional Korean foods of health belief levels for health behavior practices of 20s’ women based on the health belief model. In addition, this study was to verify the moderating effect of eating habits. After we had conducted an in-depth interview two 20s’ women in Seoul area, a survey was conducted from October 5th to October 15th, 2021 20s’ women in Seoul. The analysis results are as follows. First, health belief level of the dietary life guidelines(evenly, not salty, low calorie) had a significant effect on health behavior practices. The health belief level(perceived barriers, dietary self-efficacy) of the dietary life guidelines(weight control) had a significant effect on health behavior practices. The health belief level(dietary self-efficacy) of the dietary life guidelines(health functional food) had a significant effect on health behavior practices. Second, health belief level(perceived benefits, dietary self-efficacy) of the traditional Koran foods had a significant effect on health behavior practices. Third, Eating habits(food selection habits) had a moderating effect between health belief levels(perceived barriers, dietary self-efficacy) of the dietary life guidelines(evenly, no salty, low calorie) and healthy behavior practices. Eating habits(food selection habits) had a moderating effect between health belief levels(dietary self-efficacy) of the dietary life guidelines(weight control) and healthy behavior practices. Also, Eating habits(eating behavior) had a moderating effect between health belief levels(dietary self-efficacy) of the dietary life guidelines(weight control) and healthy behavior practices. Forth, Eating habits had no moderating effect between health belief levels of the traditional Korean foods and health behavior practices. The results of this study gave basic data to improve health behavior practices for 20s’ women.

Education based on the health belief model to improve the level of physical activity

( Masoud Khodaveisi ),( Bahman Azizpour ),( Ali Jadidi ),( Younes Mohammadi ) 한국운동영양학회 2021 Physical Activity and Nutrition (Phys Act Nutr) Vol.25 No.4

[Purpose] This study aimed to investigate the effect of education based on the health belief model on the physical activity of the staff of the University of Medical Sciences. [Methods] This semi-experimental study was conducted on 130 university staff aged 25-50 years from the Hamadan University of Medical Sciences. Inclusion criteria were having at least 1 year of work experience, lack of acute and chronic physical and mental illnesses, and not using drugs that affect physical activity. The samples were randomly divided into two groups. The experimental group received three training sessions based on the health belief model. Before and 2 months after training, the control and experimental groups were evaluated via the following questionnaires: (1) demographic information questionnaire, (2) Health Belief Model Questionnaire, and (3) International Physical Activity Questionnaire. Finally, data were analyzed statistically. [Results] The training process resulted in a significant increase in the mean scores of the health belief model constructs in the experimental group, but changes in the control group were not significant. Self-efficacy was the strongest predictor of physical activity. [Conclusion] The health belief model is a useful model for improving individuals' understanding of the benefits of physical activity.

서울시 거주 성인의 라이프스타일에 따른 건강신념 수준과 건강행동 실천 비교

최나홍(Na Hong Choi),안홍석(Hong Seok Ahn),이승민(Seung Min Lee) 대한지역사회영양학회 2011 대한지역사회영양학회지 Vol.16 No.6

This study compared levels of health beliefs and health behavior practices according to lifestyle pattern among adults in Seoul. A self-administered survey questionnaire was collected from a total of 1,004 Seoul residents aged 30-59 years. The levels of perceived benefit, perceived barrier, and self-efficacy from health belief model and health behavior practices were measured across multiple health behavior areas including dietary behavior, drinking, smoking, exercise, functional food consumption, and weight control behavior. Factor analysis and subsequent cluster analysis based on 28 lifestyle questions divided the subjects into four lifestyles of society-, economy-, trend-, and health-oriented lifestyle. Some general characteristics were significantly different by lifestyles. The society-oriented lifestyle was significantly higher in proportions of men and overweight. The trend-oriented lifestyle was significantly younger and spent more monthly allowance. Health-oriented lifestyle was older. The levels of health belief variables and health behavior practices significantly differed by lifestyles. Overall the health-oriented lifestyle showed more desirable levels of health belief variables and health behavior practice in various health behavior areas compared to the other lifestyles, whereas the society-oriented lifestyle was found the other way. Health belief model variables including perceived benefit, perceived barrier, and self-efficacy were generally significant in predicting the levels of various health behavior practice, with somewhat differences by lifestyle pattern and health behavior type. The study findings suggest it may be useful to segment target subjects according to lifestyle pattern in planning and administering health education programs. (Korean J Community Nutr 16(6) : 683~696, 2011)

건강신념모형을 이용한 구강건강관련 식이행동 분석

나자영,오효원,이흥수 대한예방치과·구강보건학회 2023 大韓口腔保健學會誌 Vol.47 No.1

Objectives: This study aimed to investigate the relationship between oral health beliefs and oral health-related dietary behavior. Methods: The participants of this cross-sectional study were 728 middle school students living in Jeonju who were selected through convenience sampling. For the survey, self-administered questionnaires were completed in individual settings. The analysis model was the oral health belief model, and the analysis method was path analysis. Results: Among oral health beliefs, perceived susceptibility, perceived severity, perceived barriers, and self-efficacy were found to be correlated with the oral health-related dietary behavior index. Multiple regression analysis showed that factors affecting the oral health-related dietary behavior index were gender (female), perceived susceptibility, perceived severity, perceived barriers, and self-efficacy. Path analysis showed that variables that significantly impact the oral health-related dietary behavior index are perceived susceptibility, perceived benefits, perceived barriers, and likelihood of action. The factor with the greatest impact was perceived barrier; the lower the barrier, the higher the level of dietary behavior undertaken to prevent dental caries. Conclusions: Oral health beliefs are related to oral health-related dietary behavior. Since perceived barriers had the greatest correlation with oral health-related dietary behavior, measures must be taken to help remove the barriers.

모바일 헬스케어 애플리케이션 수용에 관한 연구

Zekun Zheng(鄭澤坤) 한국정책과학학회 2015 한국정책과학학회보 Vol.19 No.3

현대인의 스마트폰 이용이 증가하면서, 스마트 애플리케이션도 우리 삶과 밀접한 수단이 되고 있다. 인구 고령화에 따른 건강에 대한 관심을 반영하여 헬스케어 애플리케이션의 수요가 증가하고 있다. 본 연구는 모바일 헬스케어 애플리케이션 수용에 관한 연구로서 건강신념모형(HBM)과 통합기술수용모형(UTAUT) 이론을 기반으로 헬스케어 애플리케이션의 건강행위와 기술적인 특성에 맞는 요인을 분석하였다. 또한 이러한 요인들의 수용에 관련 사용자의 이용의도와 실제사용에 유의한 영향을 주는지에 대한 고찰을 실시하였다. 더불어 이용의도를 매개변수로써 실제 이용에 대한 영향을 미치는 요인에 대한 검증도 실시하였다. 본 연구의 독립변수는 기존 UTAUT모델에서 이용의도에 영향을 미치는 핵심 변수로 검증된 4개의 변수인 ‘성과기대’, ‘노력기대’, ‘사회적 영향’, ‘촉진조건’에 건강신념모형에서 정의된 ‘질병에 대한 심각성 인식’, ‘질병에 대한 민감성 인식’ 그리고 ‘지각된 장애요인’을 추가하였다. 이를 토대로 스마트폰 사용자 대상으로 설문을 실시하였다. 연구 분석방법은 구조방정식모형분석(SEM분석) 방법을 사용하였으며, 가설 검증의 신뢰도를 높이기 위해 SPSS를 이용하여 변수에 대한 기술통계분석, 요인분석, 정규성 검증, 상관관계분석, 신뢰도와 타당성 분석을 실시하였다. 그 다음 ‘2단계 접근법(two-step approach)’에 따라 AMOS를 이용하여 확인적 요인분석을 실시하였다. 연구의 타당성을 높이기 위해 측정모형의 타당성은 집중타당성과 판별타당성으로 구분하여 검증하였다. 그 결과는 모든 측정변수들이 통계적으로 유의하고 모형에 부합한 것을 확인하였다. 수정지수를 이용해서 제안모델의 적합도를 향상시키고 수용이 가능한 수준에서 구조적 관계가 성립한 것으로 나타났다. 구조방정식 모형분석으로 기본 가설들을 검증하였고, 이용의도의 매개효과를 확인하기 위해 AMOS에서 Bootstrap를 이용하였다. 연구 결과는 다음과 같다. 우선 ‘사회적 영향’과 ‘질병에 대한 심각성 인식’이 이용의도에 대해 영향을 미친 것으로 나타났고, ‘촉진조건’, ‘질병에 대한 민감성 인식’ 그리고 ‘지각된 장애요인’이 실제이용에 영향을 미친 것으로 나타났다. ‘사회적 영향’과 ‘질병에 대한 심각성 인식’은 매개변수인 이용의도를 통해 실제 이용에 대한 간접적인 영향이 있는 것으로 분석되었다. 본 연구의 함의는 선행연구와 달리 UTAUT모델을 기반으로 건강신념모형의 핵심변수가 외부변수로 결합된 새로운 연구모형을 만들어서 모바일 헬스케어 애플리케이션 수용에 영향을 미친 요인을 탐색함에 있다. 모바일 헬스케어에 대한 관심 증대와 시장의 높은 성장 가능성을 고려할 때 본 연구의 결과를 바탕으로 정부의 헬스케어 애플리케이션의 활성화 방안과 고도화 추진 정책, 헬스케어 개발 기업의 지원 정책 등 실시에 유용한 자료가 될 것으로 생각된다. 뿐만 아니라 기업의 헬스케어 애플리케이션 영업전략, 지원 전략 그리고 개발전략 등 기업 활동전략 수립에 대한 학문적, 실무적인 시사점을 제시하였다는 측면에서 의의가 있다. With the growth in smartphone users, mobile application is increasingly closely linked to our life. As the aging population is on the rise, people are attaching more and more importance to health. This also enlarges the demand for health care application. Focusing on health care application and based on health belief model and the technology acceptance model, efforts were made in the paper, by literature review, to study the health behavior and technological characteristics of health care application. Targeted analysis was made of relevant factors, in an attempt to ascertain whether these factors exert any influence on the intention to use and actual using behavior of users, from the theoretical perspective. Besides, with the intention to use serving as medium variables in the paper, efforts were made to study whether there was any factor indirectly influential to actual use. Independent variables of the paper: the addition of HBM’s ‘Perceived Susceptibility’, ‘Perceived Severity’ and ‘Perceived Barriers’ while testing the UTAUT model core variables ‘Performance Expectancy’, ‘Effort Expectancy’, ‘Social Influence’ and ‘Facilitating Conditions’, which were influential to the intention to use. The research hypothesis was based on smartphone users. Structural Equation Modeling(SEM) served as the primary research approach. To improve the reliability of hypothesis testing, technical statistics and analysis, relevant factor analysis, test of normality and correlation analysis were performed among all variables with SPSS. Then deterministic analysis was conducted with AMOS based on two-step approach. To improve the reliability of model adequacy inspection, the model-inspection adequacy was classified into centralized adequacy and discriminant adequacy. The inspection results showed that all the inspection variables were statistically significant, and the model met the essential requirements. With the adoption of practice index, the model fitness improved. Besides, assumptions presented in the paper were analyzed with SEM, and tested with the Bootstrap approach of AMOS by using the media effect of intention. The research results are shown as follows: ‘Social Influence’ and ‘Perceived Severity’ had an influence on the intention to use; ‘Facilitating Conditions’, ‘Perceived Susceptibility’, and ‘Perceived Barriers’ affected the actual use. ‘Social Influence’ and ‘Perceived Severity’ exerted an indirect influence on actual using behavior through the medium variable ? the intention to use. The paper is of referential significance, both academically and practically. Different from previous studies, HBM core variables were introduced into the paper, based on UTAUT model, as exogenous variables for the first time, and used as a completely-new integrated model to ascertain which factors would affect the use of health care application. Besides, with the rise in people’s concern about health care application and the rapid development of the market, the research results of the paper can be used by enterprises to collect marketing and development strategies. Also they can be used by governments as reference for the promotion and policy-making of health care application.

건강신념모델에 근거한 모바일 헬스케어 이용자의 경험분석: 포커스 그룹 인터뷰

박나영,황정해,최윤경,박성희,이연경 한국보건교육건강증진학회 2019 보건교육건강증진학회지 Vol.36 No.3

Objectives: The purpose of this study is to investigate the experiences of users of mobile health (mHealth) in the public health center, to describe the phenomenon and to identify the problems. This is a qualitative study conducted by a focus group interview. Methods: Voluntary decision making by individuals is important for participation and maintenance of mHealth for health promotion, which is consistent with the health belief model. The main factors of the health belief model (HBM) were investigated by focus group interview (FGI) with 25 experienced mHealth users divided into two groups. The thematic analysis method was conducted as the axis of the research question. Results: As a result of the research, meaningful statements were extracted as codes and integrated into 20 subcategories, structured into 8 categories and 4 themes which were ‘Personal perception of health risks’, ‘Likelihood of action’, ‘Cues to action’, ‘Sustainability likelihood of action’. were derived as key elements of the HBM. Conclusions: This research is based on the use of mobile as a means of health promotion. The findings suggested mHealth has a number of valued features such as delivering healthcare anywhere and anytime, numerical feedback, interaction with an health expert, networks within mobile and inducing participate through the gamification. The findings provided insight into the opportunities and challenges involved in delivering health-related behavioral interventions through mHealth.

건강신념모델을 적용한 의생활 안전교육 교수⋅학습 과정안 개발 및 효과평가

김류경,심현섭 한국가정과교육학회 2020 한국가정과교육학회지 Vol.32 No.1

본 연구는 건강신념모델에 근거한 가정과 의생활 안전 교수⋅학습과정안을 개발하고, 이를 활용한 수업이 건강신념에 미치는효과를 알아보는 데 목적을 두고 있다. ADDIE 모형에 따라 ‘의복 및 섬유제품의 생산, 착용, 세탁, 보관 과정에서 노출될 수 있는 유해물질’, ‘친환경 섬유’, ‘천연세정제’와 같이 3가지 학습요소에 대하여 건강신념모델을 적용하여 6차시의 교수⋅학습 과정안을 개발하였다. 개발된 교수⋅학습 과정안으로 경기도 안양시 소재 남녀공학 중학교 3학년 7개 학급, 총 229명의 학생을 대상으로 2018년 8월 20일부터 9월7일까지 1주에 2시간씩 3주에 걸쳐 총 6차시로 수업을 실행하였다. 건강신념을 측정한 사전⋅사후 자료는 통계 프로그램SPSS/win(version18.0)을 이용하여 대응표본 t-test를 실시하였다. 개발된 교수⋅학습 과정안을 수업에 적용한 결과 인지된 위협(인지된 민감성과 심각성의 조합), 인지된 이익, 자기효능감 모두 통계적으로 유의미하게 향상되었고, 인지된 장애는 통계적으로유의미하게 감소되었다. 이상의 결과 건강신념모델을 적용한 가정과 의생활 안전교육 수업은 중학생들이 유해물질로부터의 안전한 의생활을 실천할수 있도록 하는 안전교육으로서 큰 의미가 있다고 볼 수 있다. 이 연구 결과는 가정과 특색에 맞는 안전교육은 물론 의생활안전교육을 활성화시키는데 도움이 되기를 기대한다. The purpose of this study is to develop the clothing safety teaching/learning plan in Home Economics based on the health belief model and to examine the effects of the course using the developed teaching/learning plan on the health belief. Based on ADDIE model, 6 clothing safety teaching/learning plans were developed by applying the health belief model. They consisted of three learning factors of 'harmful substances that can be exposed during the production, wear, wash, and storage of clothes and textile products', 'environment friendly fibers' and 'natural detergents’. Then they were implemented on 7 classes in middle school located in Gyeonggi-do Province from August 20 to September 7 in 2018. The health beliefs data collected before and after the course were analyzed with paired t-test with SPSS/win. As a result, the perceived threat(combination of perceived severity and perceived susceptibility), the perceived benefit, and the self-efficacy were significantly improved. And the perceived barrier was significantly reduced. In conclusion, the home economics clothing safety education course using the health belief model was meaningful as the safety education to enable middle school students to practice safe clothing life from harmful substances. The results of this study are expected to be helpful for activating safety education in home economics.

뷰티서비스 종사자의 코로나19 감염 예방을 위한 건강행동 의도 - 확장된 건강신념모델을 중심으로 -

이종숙 ( Jong Sook Lee ),어흥선 ( Heung Sun Eu ) 대한미용학회(구 대한미용과학회) 2021 대한미용학회지 Vol.17 No.1

This study examined health behavioral intentions for COVID-19 prevention by applying an extended health belief model targeting 233 beauty service workers. For statistical processing, confirmatory factor analysis, reliability analysis, correlation analysis, and path analysis were performed using the SPSS 21.0 program and the AMOS 21.0 program. The main results are as follows. First, perceived susceptibility of beauty service workers to COVID-19 had a positive effect on health behavior intentions. Second, perceived severity of beauty service workers to COVID-19 had a positive effect on health behavior intentions. Third, perceived benefit of beauty service workers to COVID-19 had a positive effect on health behavior intentions. Fourth, perceived barriers of beauty service workers to COVID-19 did not influence on health behavior intention. Fifth, cues to action of beauty service workers to COVID-19 had a positive effect on health behavior intentions. Sixth, self-efficacy of beauty service workers to COVID-19 had a positive effect on health behavior intentions. In order to increase the health behavior of beauty service workers for the prevention of Corona 19, it will be important to increase percieved susceptibility and perceived severity by clearly understanding the risks of Corona 19, and to increase the cues to action and self-efficacy that can lead to practical preventive actions.

유아의 구강건강 실천행동 의도의 사회인지적 예측변인에 대한 탐구

손영곤(Young Kon Sohn),이병관(Byoung Kwan Lee) 한국광고홍보학회 2010 한국광고홍보학보 Vol.12 No.1

본 연구는 유아들의 구강건강 행동을 이해하고 예측하기 위한 중재 프로그램의 효과를 건강신념모델(HBM)과 계획된 행동이론(TPB)을 적용하여 비교·분석함으로써 향후 효과적인 중재 프로그램을 위한 가이드라인을 제공하고자 하였다. 이를 위해 유치원 유아대상 중재 프로그램의 사후조사를 통해 수집된 자료를 이용하였으며 총 471명의 유아들의 응답 자료를 분석을 위해 사용하였다. 연구결과 HBM이나 TPB 모두 유아의 구강건강 행동의도를 예측하는 데 모델의 적합도나 설명 변량 측면에서 적절한 것으로 나타났다. 그러나 모델의 간명성 측면에서는 TPB가 HBM에 비해 우수한 것으로 나타났다. TPB에 따른 검증 결과, 지각된 행동통제가 높고 구강건강태도가 긍정적일수록 구강건강 행동의도가 증가하고 있었으나 주관적 규범에 의한 행동의도의 변화는 발견되지 않았다. 본 연구는 HBM과 TPB를 이론적 모델로 하여 유아들의 구강건강을 설명하였다는 점에서, 그리고 효과적인 중재 프로그램의 실행과 공중 커뮤니케이션 캠페인 메시지 전략 방향을 수립하고 전개하기 위한 지침을 제공하고 있다는 점에서 이론적 및 실무적 함의를 가진다고 할 수 있다. The main purpose of the present study was to examine predictors behavioral intention to preventive oral health among kindergarten children with the health belief model (HBM) and the theory of planned behavior (TPB), and to compare the models` predictive power and fit to the data. The post-test data (471 kindergarten children) collected from the kindergarten-based oral health intervention was analyzed for the study. Structural equation modeling (SEM) techniques were used in analysis of the data. Results showed that the TPB model is a better model compared with HBM in terms of model parsimony, even though both model showed a good fit to the data. Within the TPB model, attitudes and subjective norm had a positive relationship to behavioral intention for preventive oral health. Both theoretical and practical implications of the results for oral health intervention are discussed.