The impact of oral health awareness on the general oral health assessment index : Mediating effects of oral health behaviors and regulating effects of family support

다국어 초록 (Multilingual Abstract)

Research background:
With the acceleration of China’s population aging process, oral health problems among the elderly have become increasingly prominent. Oral health is closely related to overall health, such as cardiovascular diseases and diabetes. Differences in oral health awareness can lead to disparities in oral health status, which in turn indirectly affect the quality of life of the general population, especially the elderly. The Geriatric Oral Health Assessment Index （GOHAI）, as an important indicator for evaluating oral health and its influencing factors, plays a key role in the study of oral health behaviors. However, how oral health awareness affects GOHAI, as well as its mediating and moderating mechanisms, remains unclear. Therefore, exploring the pathways and mechanisms underlying the relationship between oral health awareness and GOHAI is of great significance for improving the oral health level of the elderly and enhancing their quality of life.
Research objectives:
This study aims to explore in depth the factors influencing oral health-related quality of life among the elderly population. By constructing and validating a model of oral health cognition, oral health behaviors, and family support, it identifies the factors affecting the oral health index of older adults and examines the relationship between oral health-related quality of life in the elderly. It also tests the mediating role of oral health behaviors and the moderating effect of family support, with the goal of providing a theoretical basis and practical reference for developing targeted oral health promotion strategies and public health intervention measures.
Research methods:
In March 2026, a cross-sectional study was conducted among older adults in Beijing, China, using an online questionnaire. The study included 326 participants aged 60 and above who had lived in Beijing for more than six months and resided either in the community or in elderly care institutions. The assessment covered general sociodemographic characteristics, oral health cognition, oral health behaviors, the GOHAI and family support. Statistical analysis was performed using SPSS 27.0. Pearson correlation analysis was used to examine the relationships among the scales. PROCESS Model 4 was applied to test the mediating effect of oral health behavior between oral health cognition and GOHAI, and Model 14 was used to examine the moderating effect of family support.
Research results:
（1）A total of 326 older adults in Beijing were selected for this study, including 155 males （47.5%） and 171 females （52.5%）.
（2）The correlation analysis results showed that the oral health cognition scale score was positively correlated with the oral health behavior scale score （r=0.549） and the GOHAI scale score （r=0.563） （both P〈0.001）; the oral health behavior scale score was positively correlated with the GOHAI scale score （r=0.580, P〈0.001）; the family support scale score was positively correlated with the oral health cognition scale score （r=0.439）, the oral health behavior scale score （r=0.415）, and the GOHAI scale score （r=0.533） （all P〈0.001）;
（3）The mediation analysis results showed that oral health cognition had a significant positive predictive effect on GOHAI, with a total effect value of 0.127, 95% CI （0.081–0.173）; oral health behavior had a significant predictive effect on both oral health cognition and GOHAI, with an indirect effect value of 0.046 （0.025–0.073）. This supports the pathway of “oral health cognition → oral health behavior → GOHAI”.
（4）The results of the moderation analysis showed that family support played a moderating role in the second half of the mediating pathway of the model in which oral health cognition affects GOHAI through oral health behavior （oral health behavior—GOHAI） （interaction term β = 0.109, P 〈 0.05）. The moderated mediation index was 0.0591, and Bootstrap analysis showed a 95% CI （0.0004–0.1203）, indicating that as the level of family support increases, the indirect effect of oral health cognition influencing GOHAI through oral health behavior is strengthened.
Conclusion:
This study confirmed the direct positive predictive effect of oral health cognition on GOHAI. Oral health cognition also influences GOHAI through oral health behaviors, and family support plays a moderating role in the latter part of the pathway in which oral health cognition affects GOHAI through oral health behaviors. Therefore, in oral health interventions for the elderly, it is necessary to simultaneously improve their level of oral health cognition and promote the enhancement of their oral health behaviors, while also paying attention to building a family support system for older adults.

목차 (Table of Contents)

• 국 문 초 록 1
• Ⅰ Introduction 4
• 1 The necessity of the study 4
• 2 Research purpose 6
• Ⅱ Theoretical Background8
• 1 Concept and previous research on oral health awareness11
• 2 Concept of oral health behavior and previous research12
• 3 Concept of family support and previous research 13
• 4 Concept and previous research on GOHAI 14
• Ⅲ Research content and methods 16
• 1 Research model and hypotheses 16
• 1.1 Hypotheses on the relationship between oral health awareness, oral health
• behaviors, and GOHAI. 16
• 1.2 Hypothesis on the direct association between oral health behaviors and GOHAI16
• 1.3 Family support plays a positive moderating role in the relationship between oral
• health behaviors and GOHAI. 17
• 2 Operational definition of variables 17
• 2.1 Independent variable 17
• 2.2 Dependent variable18
• 2.3 Mediating variable 18
• 2.4 Moderating variable 18
• 2.5 Overall model description 18
• 3 Structured questionnaire 18
• 3.1 Demographic and sociological characteristics 19
• 3.2 Oral health awareness 19
• 3.3 Oral health behavior 20
• 3.4 Family support 20
• 3.5 GOHAI21
• 4 Research subjects and data collection22
• 5 Research tools and statistical analysis 23
• 6 Ethical considerations24
• IV Results 26
• 1 Characteristics of the study population 26
• 1.1 Sociodemographic characteristics of the study population 26
• 1.2 Distribution of scores of core research variables 28
• 2 Reliability analysis among the scales 28
• 3 Differences in core variables across different demographic and sociological
• characteristics 29
• 3.1 Differences in oral health awareness based on sociodemographic characteristics29
• 3.2 Differences in oral health behaviors across sociodemographic characteristics .. 32
• 3.3 Differences in family support based on sociodemographic characteristics 37
• 3.4 Differences in GOHAI across sociodemographic characteristics 40
• 4 Correlation between key variables 43
• 5 Hypothesis testing44
• 5.1 Mediation analysis of oral health behaviors in the relationship between oral
• health cognition and GOHAI 44
• 5.2 Use Bootstrap analysis to verify the mediation effect 48
• 5.3 Moderating effect of family support 49
• V Discussion 53
• VI Conclusions 66
• VII References 69
• Abstract 78
• Appendix A81
• Acknowledgements 87
• Table of contents
• Table 1 sociodemographic characteristics of the study population 27
• Table 2 Distribution of scores of each core variable 28
• Table 3 Reliability analysis of each core scale29
• Table 4 Differences in oral health awareness across sociodemographic characteristics30
• Table 5 Post-hoc LSD multiple comparison analysis of oral health awareness across different
• family structures 31
• Table 6 Differences in oral health behaviors across sociodemographic characteristics 34
• Table 7 LSD post hoc multiple comparison analysis of oral health behaviors across different
• education levels 35
• Table 8 LSD post hoc multiple comparison analysis of oral health behaviors across different
• average monthly income levels 36
• Table 9 Post-hoc LSD multiple comparison analysis of oral health behaviors across different
• family structures 36
• Table 10 Differences in family support across sociodemographic characteristics38
• Table 11 Post-hoc multiple comparison analysis of family support across different family
• structures in LSD.39
• Table 12 Differences in GOHAI across sociodemographic characteristics 41
• Table13 GOHAITamhane's post hoc multiple comparison analysis of different family
• structures 42
• Table 14 Correlation analysis between variables 44
• Table15 Regression analysis of the total effect in the relationship between oral health
• awareness and GOHAI45
• Table 16 Regression analysis of the relationship between oral health cognition and oral health
• behavior （mediating path a） 46
• Table 17 Direct effects and mediation path b regression analysis of the relationship between
• oral health cognition and oral health behavior on GOHAI 47
• Table 18 Bootstrap test of the mediating effect of oral health behavior 48
• Table 19 Analysis of the moderating effect of family support on the relationship between oral
• health awareness and GOHAI 50
• Table 20 Conditional effects of oral health behaviors on GOHAI at different levels of family
• support 51