Factors associated with oral health behaviors of older diabetic patients in Shanghai, China

A structural equation modeling analysis based on the COM-B model

Bibliographic Data

ID22080090
AuthorsShuran Fan (Fudan University), Yanhong Gu (Fudan University, corresponding author)
Year2026
Volume14
Pages1823813-1823813
Publication date2026-06-17
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1823813
PMID42388738
OpenAlexW7165027161
LanguageEN
References cited45

Aims The study aims to analyze the association pathways of factors related to oral health behaviors among older diabetic patients in Shanghai, China, using the COM-B model. Methods A convenience sample of 358 older diabetic patients was enrolled between July 2025 and December 2025 from one tertiary hospital and a community health service center in Shanghai. Information was collected via a general information questionnaire, the Older Oral Health Knowledge, Belief and Behavior Questionnaire, the 14-item Health Literacy in Dentistry Scale, the Perceived Social Support Scale, the Geriatric Self-Efficacy for Oral Health Scale, and the 5-item Geriatric Depression Scale. Descriptive statistics, univariate analysis, correlation analysis, and path analysis were adopted to analyze the relevant factors and pathways of oral health behaviors. Results The constructed structural equation model showed satisfactory goodness of fit (χ 2 /df = 2.173, NFI = 0.987, TLI = 0.976, CFI = 0.991, RMSEA = 0.07, and SRMR = 0.0474). Capability factors, including oral health literacy ( β = 0.205) and oral health knowledge ( β = 0.155), the opportunity factor of social support ( β = 0.169), motivational factors covering oral health self-efficacy ( β = 0.377), oral health belief ( β = 0.225), and depression ( β = −0.107), could all be directly associated with oral health behaviors. Oral health self-efficacy mediated the associations of oral health literacy ( β = 0.199), oral health knowledge ( β = 0.072), social support ( β = 0.049), and depression ( β = −0.044) with oral health behaviors. Oral health belief mediated the relationships of oral health literacy ( β = 0.054) and oral health knowledge ( β = 0.135) with oral health behaviors. Depression acted as a mediator between social support ( β = −0.056) and oral health behaviors. Conclusion Capability factors, opportunity factors, and motivational factors are directly or indirectly associated with the oral health behaviors among older diabetic patients. This suggests that clinicians regularly conduct diabetes-related oral health education and cleaning skills training, encourage relatives to provide supervision, improve access to oral healthcare, and provide psychological counseling to improve patients’ oral health behaviors in terms of capability, opportunity, and motivation

Health belief model · Health literacy · Oral health · Race and health · Social determinants of health · Social support · Structural equation modeling · Dental Health and Care Utilization · Diabetes Management and Education · Oral microbiology and periodontitis research

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