Abstract
The objective of this article is to develop and validate a KAP (knowledge, attitude, and practice) instrument for caregivers of children up to 36 months of age monitored by the Family Health Strategy. This methodological study was conducted in three stages: an integrative review, preparation of the initial version, and content validation by 29 judges. The instrument was validated for content and appearance. The Content Validity Index (CVI) and the FINN and Gwe-AC1 coefficients were calculated to assess inter-judge agreement. The overall CVI values of the 39-item instrument were: Clarity (0.91) and Relevance (0.95). The final version was obtained through 19 knowledge, 10 attitude, and 10 practice questions on caries, diet, oral hygiene, fluoride, breastfeeding, artificial feeding, milk teeth, and the need to take the baby to the dentist. The instrument produced can be used because it has the potential for use depending on the more global assessment of its psychometric properties.
Key words:
Knowledge; Attitudes and health Practices; Validation study; Caregivers; Oral health
Resumo
O objetivo deste artigo é construir e validar um instrumento do tipo instrumento CAP (conhecimento, atitude e prática) de cuidadores, acompanhados pela Estratégia Saúde da Família, para promoção da saúde bucal de crianças até 36 meses. Estudo metodológico realizado em três etapas: revisão integrativa, elaboração da versão inicial e validação de conteúdo por 29 juízes. O instrumento foi validado quanto ao conteúdo e aparência. Foram calculados o Índice de Validade de Conteúdo (IVC) e os coeficientes FINN e Gwe-AC1 para avaliação da concordância entre juízes. Os valores do IVC global do instrumento de 39 itens foram: IVC (Clareza) igual a 0,91 e IVC (Relevância) igual a 0,95. A versão final foi obtida mediante 19 questões (conhecimento), 10 (atitude) e 10 (prática), envolvendo os temas: cárie, dieta, higiene bucal, flúor, amamentação, bicos artificiais, dentes de leite e necessidade de levar o bebê ao dentista. O instrumento produzido poderá ser utilizado por apresentar potencial de utilização a depender da avaliação mais global de suas propriedades psicométrica.
Palavras-chave:
Conhecimentos; Atitudes e Práticas em saúde; Estudo de validação; Cuidadores; Saúde bucal
Introduction
Oral health promotion has been strengthened since the establishment of the Brasil Sorridente Program, especially in Primary Health Care (PHC)11 Comassetto MO, Baumgarten A, Kindlein KA, Hilgert JB, Figueiredo MC, Faustino-Silva DD. Access to oral health in early childhood in the city of Porto Alegre, Brazil. Cien Saude Colet 2019; 24(3):953-961.. With the emergence of the policy, oral health in early childhood has been one of the priority areas in implementing strategies, considering that few improvements in oral health indicators have been observed in recent decades22 Soares DG, Pinheiro MCX, Queiroz DM, Soares DG. Implantação da puericultura e desafios do cuidado na estratégia saúde da família em um município do estado do Ceará. Rev Bras Promoc Saude 2016; 29(1):132-138. in the age group up to 5 years.
Early Childhood Caries (ECC) affect around 600 million children worldwide, with repercussions even in adult life33 Beraldi MIR, Pio MSM, Codasski MD, Portugal MEG, Bettega PVS. Cárie na primeira infância: uma revisão de literatura. RGS 2020; 22(2):29-42.,44 Dias TKS, Ferreira GC, Almeida LHS. Cárie na primeira infância e qualidade de vida de pacientes de zero a 3 anos. Rev Uningá 2019; 56(S3):192-201.. The dental disease burden is highly concentrated in socially underserved populations, especially in Northeast Brazil, one of the poorest regions55 Lopes MVO, Silva VM, Araújo TL. Validação de diagnósticos de enfermagem: desafios e alternativas. Rev Bras Enferm 2013; 66(5):649-655.. This preventable condition must be controlled with multicausal approaches, including home and professional care55 Lopes MVO, Silva VM, Araújo TL. Validação de diagnósticos de enfermagem: desafios e alternativas. Rev Bras Enferm 2013; 66(5):649-655.,66 Essvein S, Baumgarten A, Rech RS, Hilgert JB, Neves M. Dental care for early childhood in Brazil: from the public policy to evidence. Rev Saude Publica 2019; 53(15):1-12..
In turn, PHC plays a decisive role in articulating and promoting interventions for early childhood, and therefore, health education strategies should prioritize accessing women and their children during this unique period of life, as it is a good opportunity to integrate effective and low-cost interventions77 Phantumvanit P, Makino Y, Ogawa H, Rugg-Gunn A, Moynihan P, Petersen PE, Evans W, Feldens CA, Lo E, Khoshnevisan MH, Baez R, Varenne B, Vichayanrat T, Songpaisan Y, Woodward M, Nakornchai S, Ungchusak C. WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol 2018; 46(1):280-287..
Child healthcare is consolidated as a care line through the National Comprehensive Child Healthcare Policy (PNAISC) in childcare88 Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, Perez-Escamilla R, Rao N, Ip P, Fernald LCH, MacMillan H, Hanson M, Wachs TD, Yao H, Yoshikawa H, Cerezo A, Leckman JF, Bhutta ZA; Early Childhood Development Interventions Review Group, for the Lancet Early Childhood Development Series Steering Committee. Nurturing care: promoting early childhood development. Lancet 2017; 389(10064):91-102. in the ESF context. Furthermore, children who receive the Bolsa Família (Family Aid) or government income transfer benefits are more vulnerable to oral problems and, thus, access more services22 Soares DG, Pinheiro MCX, Queiroz DM, Soares DG. Implantação da puericultura e desafios do cuidado na estratégia saúde da família em um município do estado do Ceará. Rev Bras Promoc Saude 2016; 29(1):132-138..
Despite the relevance of oral health in the first thousand days of life, only some international and national studies adopted instruments to verify the triad of knowledge, attitudes, and practices of caregivers in oral health99 Bartsch L, Loronha MF, Pioczkoski NP, Cavalheiro VS, Arrue AM, Jantsch LB. Influência da extensão universitária nos atributos da atenção primária a saúde no contexto da puericultura. Rev Soc Bras Enferm Ped 2021; 21(2):166-172.,1010 Nagarajappa R, Kakatkar G, Sharda AJ, Asawa K, Ramesh G, Sandesh N. Infant oral health: Knowledge, attitude and practices of parents in Udaipur, India. Dent Res J 2013; 10(5):659-665,. The KAP triad (Knowledge, Attitude, and Practice) consists of an important methodology used worldwide by the most diverse populations to gauge what they know, think, and do before a given health problem1111 Macambira DSC, Chaves ES, Costa EC. Conhecimento De Pais/Cuidadores Sobre Saúde Bucal Na Infância. Saude Pesq 2017; 10(3):463-472..
The authors’ experience with the Northeast Family Health Training Network (RENASF) and a sensitive perspective of children’s health encouraged this study to develop an instrument for decision-making regarding health promotion in PHC. Thus, this work aimed to build and validate caregivers’ KAP-like instrument (knowledge, attitude, and practice), accompanied by the ESF, to promote the oral health of children up to 36 months.
Methods
This descriptive, methodological study was developed in three stages: an integrative review, elaborating the KAP instrument’s initial version, and content validation by judges1212 Valente MMQP. Efeitos de uma intervenção de Enfermagem voltada à promoção do método dos dias fixos [tese]. Fortaleza: Universidade Federal do Ceará; 2014.,1313 Pasquali L. Psicometria: teoria dos testes na psicologia e na educação. 1ª ed. Petrópolis: Vozes; 2003..
Integrative review: based the elaboration of the instrument through extensive, in-depth analysis from January to April 2019, through the guiding question: “What evidence has been produced about the knowledge, attitude, and practice of caregivers on the oral health of young children?”. We verified the PubMed/MEDLINE (National Library of Medicine and National Institutes of Health), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and SCOPUS/Elsevier databases. The controlled MeSH (Medical Subject Headings) descriptors were “Health Knowledge, Attitudes, Practice”, “Oral Health”, “Caregivers”, and “Preschool”.
In the LILACS database (Latin American and Caribbean Literature in Health Sciences), the DeCS (Health Sciences Descriptors), the Portuguese-translated descriptors were “Health Knowledge, Attitudes and Practices”, “Oral health”, “Caregivers”, and “Pre-School”. Boolean operators “AND” and “OR” were used for the search based on inclusion and exclusion criteria. Inclusion criteria were published articles that answered the guiding question without language restriction and year of publication. Exclusion criteria were editorials, letters to readers, and repetition.
We adopted the oral health promotion recommendations of the main national and international Pediatric Dentistry bodies, according to the Bangkok Declaration of the International Association of Paediatric Dentistry (IAPD)1414 Dental Quality Alliance (DQA). American Dental Association (ADA). Guidance on caries risk assessment in children: a report of the expert panel for use by the dental quality alliance. Chicago: ADA; 2018..
Elaborating the instrument items: We had the following stages: I - Establishing the construct with support from the first stage; II - Defining the instrument’s objectives; III - Building items and response scales; IV - Setting a cutoff point and preparing score intervals; V - Structuring the instrument1515 Pitts N, Baez R, Diaz-Guallory C. Early Childhood Caries: IAPD Bangkok Declaration. Int J Paediatr Dent 2019; 29(3):384-386..
Validation by judges: The N= Zα². P(1-P)/e² formula for validation studies was applied to calculate the sample required for content and appearance validation, where “N” corresponds to the sample size; “Zα” corresponds to the 95% confidence level (1.96); “P” corresponds to the proportion of judges (85%); and “e” corresponds to the acceptable proportional difference (15%). Thus, the sample totaled 29 participants.
Data were collected from May to June 2019. The instrument was sent via electronic form, and judges with expertise in the study area evaluated the initial version of the instrument by completing a Likert scale concerning the criteria “language clarity” and “theoretical relevance” of each item (Example: 1 represented “very little” and 5 “very much”). Scoring 4 and 5 indicated that the assessed item met the objective proposed in this research. Judges could add changes if they deemed it necessary.
The search for judges was conducted nationwide through the Lattes Platform of the National Council for Scientific and Technological Development (CNPq) and snowball sampling, in which an expert appointed another professional. The following inclusion criteria were used: 1) having research in oral health promotion for babies or child care within primary care or KAP instrument; 2) being a dental surgeon, doctor, or nurse and with a minimum degree of specialist or related areas; 3) having at least two years of teaching or care experience in the field.
The consensus on the knowledge, attitude, and practice concepts that underpinned the definition of categories was grounded on the following parameters1616 Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Cien Saude Colet 2011; 16(7):3061-3068.:
Knowledge - Reminding specific facts or the ability to apply specific facts to solve problems or even issue concepts with the understanding acquired about a specific event.
Attitude - It is essentially having opinions but also having feelings, predispositions, and beliefs that are relatively constant, directed to a goal, person, or situation.
Practice - It is the decision-making to act. It is related to the psychomotor, affective, and cognitive domains - the social dimension.
We calculated the different CVI rates after the initial data evaluations using the Statistical Package for Social Sciences (SPSS) software, version 20.0. Then, we assessed the judges’ agreement using the FINN and Gwet-AC1 coefficients. The present study considered a 5% significance level and a 95% confidence level. After the quantitative analysis, we observed all the judges’ suggestions based on a detailed evaluation of each comment, which improved the instrument and developed synoptic tables with each KAP triad category. The study followed all ethical precepts and was approved under opinion No. 3.172.979.
Results
The literature review elucidated eight thematic categories: caries, food characteristics, oral hygiene, fluoride use, breastfeeding, artificial nipples, deciduous teeth, and visits to the dentist. In its final version, the instrument contained 39 items (19 in the practice domain, 10 in the attitude domain, and 10 in the knowledge domain) and was entitled “Instrument to Assess the Knowledge, Attitude, and Practice of Caregivers on Child Oral Health Promotion” and focused on promoting oral health of children, emphasizing those up to 36 months.
The survey stage of the judges pointed out that (89.6%) were female and mean age of 39.3 years. Twenty-five judges were pediatric dentists, two were doctors, and two were nurses. Approximately 75.9% of the participants alleged they had teaching experience, and 37.9% had a doctorate level. The results indicate that the judges represent several Brazilian regions (Northeast, Southeast, and South), through four states (Ceará, São Paulo, Vitória, and Santa Catarina) and eight cities (Fortaleza, Barbalha, Eusébio, São Paulo, Tatuí, Itatiba, Vitória, and Florianópolis).
Calculating the Content Validity Index and applying the FINN and AC1 statistical tests
The 39 items of the initial version of the KAP instrument were analyzed individually, which resulted in calculating the CVI-I for each item regarding the language clarity and relevance criteria. The instrument’s global CVI value was 0.91, with a P-value<0.001 obtained for all evaluated items.
Table 1 shows the results of applying the FINN and Gwet-AC1 statistical tests to assess the judges’ agreement, and the result was significant in both tests. Therefore, we can infer that the judges statistically produced concordant evaluation results. When comparing the Gwet-AC1 values against the classification of the ICC coefficient and the FINN values against the Kappa classification, we observe that the Gwet-AC1 values are in the moderate to good range, while FINN’s values are in the upper class of the classification.
The final version of the “Instrument to Assess the Knowledge, Attitude, and Practice of Caregivers on child oral health promotion”: content validity
Judges made 63 suggestions besides the CVI-I values, culminating in the version presented in Charts 1, 2, and 3. The comments were regarding the structure, re-elaboration, and even the content of the items.
Nineteen questions were elaborated in the Practice domain. Each correct answer indicated that the practice on the subject was adequate. Therefore, the total scores of the practice domain range from 0 to 19 points and this item can be evaluated as adequate (14 to 19 points) or inadequate (0 to 13 points).
The Attitude domain can be evaluated using 10 questions. Each correct answer indicates that the attitude about the issue is adequate and should be coded into a “one-point” score. Therefore, the total scores of the attitude domain range from 0 to 10 points. As a result, attitude can be evaluated as adequate (6 to 10 points) or inadequate (0 to 5 points), as shown in Chart 2.
The Knowledge domain can be evaluated through 10 questions in the instrument. As the first two questions have multiple-choice answers and may have more than one correct answer, the total scores of this domain may range from 0 to 16 points. Thus, knowledge can be evaluated as adequate (12 to 16 points) or inadequate (0 to 11 points).
Discussion
The study advances knowledge about oral health care in early childhood, collecting evidence in a poorly explored field involving the KAP triad. The instrument’s application is an innovation in the approach, as it provides data that will support professional practice, identifying priority points for the actions of the health teams.
The application of thorough statistical tests during content validation shows the possibility of replicating the instrument, with the advantage of being user-friendly and outlining important health indicators and parenting practices.
As for the characterization of the judges, we identified several experiences from different Brazilian regions, with the important participation of dentists, doctors, and nurses, portraying the importance of the integrated perspective in childcare22 Soares DG, Pinheiro MCX, Queiroz DM, Soares DG. Implantação da puericultura e desafios do cuidado na estratégia saúde da família em um município do estado do Ceará. Rev Bras Promoc Saude 2016; 29(1):132-138..
Health promotion involves knowing the community and building healthy spaces, including the family environment. Therefore, understanding what families know about caries, for example, brings elements to work on beliefs and myths surrounding oral health, such as medication use. The literature points out particular situations where the antibiotic tetracycline, for example, contains substances that can stain the teeth enamel in children who do not perform adequate oral hygiene after each dose of the medication1717 Marinho LAB, Costa-Gurgel MS, Cecatti JG, Osis MJD. Conhecimento, atitude e prática do auto-exame das mamas em centros de saúde. Rev Saude Publica 2003; 37(5):576-582.,1818 Marshman Z, Knapp R. Child oral health-related quality of life following treatment under dental general anaesthetic (DGA). Evid Based Dent 2019; 20:46-47..
Regarding eating habits, we addressed cariogenic foods that can demineralize the tooth’s hard tissues1616 Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Cien Saude Colet 2011; 16(7):3061-3068.. Consuming easily fermentable free sugars should be avoided before two years of age1919 Tinanoff N, Baez RJ, Diaz-Guillory C, Donly KJ, Feldens CA, McGrath, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y, Twetman S. Early Childhood Caries Epidemiology, Aetiology, Risk Assessment, Societal Burden, Management, Education, and Policy: Global Perspective. Int J Pediatra Dent 2019; 29:238-248. to promote infant nutrition. A study2020 Prates CB, Passos MAS, Masquio DCL. Parental feeding practices and ultra-processed food consumption in preschool children. Rev Nutr 2022; 35:e210269. that applied a children’s food frequency questionnaire focusing on caregivers highlighted the importance of instruments to monitor dietary eating practices that identify children’s consumption of ultra-processed foods rich in sugars, fats, and salt.
The focus of instruments on caregivers highlights the relevance of family attitudes in children’s oral health. A test that used a questionnaire on the theme underscored that caregivers often have inappropriate attitudes regarding children’s oral care, reflecting an intergenerational genesis1818 Marshman Z, Knapp R. Child oral health-related quality of life following treatment under dental general anaesthetic (DGA). Evid Based Dent 2019; 20:46-47..
Furthermore, the questionnaire addresses the recommended frequency of brushing babies’ teeth, where, according to national and international recommendations, hygiene with fluoride toothpaste should be performed twice daily, after breakfast and in the last meal before going to sleep at night2121 World Health Organization (WHO). Ending childhood dental caries: WHO implementation manual. Geneva: WHO; 2019.
22 American Academy of Pediatric Dentistry (AAPD). Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago: AAPD; 2020.-2323 Associação Brasileira de Odontopediatria (ABO). Orientações aos pais sobre cuidados com a saúde bucal do bebê e da criança [Internet]. 2019 [acessado 2020 jun 13]. Disponível em: https://edisciplinas.usp.br/pluginfile.php/5385038/mod_resource/content/1/ABOPED%20Orienta%C3%A7%C3%B5es%20pais%20cuidados%20s%C3%A1ude%20bucal%20beb%C3%AA%20crian%C3%A7as.pdf.
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The instrument also considers how the caregiver cleans the child’s teeth and what artifice is used to perform it. The toothbrush brush head’s size should be proportional to the baby’s mouth. Regarding fluoride paste, a concentration of at least 1000 ppm in the amount of raw rice grain should be used2020 Prates CB, Passos MAS, Masquio DCL. Parental feeding practices and ultra-processed food consumption in preschool children. Rev Nutr 2022; 35:e210269.
21 World Health Organization (WHO). Ending childhood dental caries: WHO implementation manual. Geneva: WHO; 2019.-2222 American Academy of Pediatric Dentistry (AAPD). Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago: AAPD; 2020.. Parents usually introduce brushing with fluoride toothpaste late and delay access to the dental office, facilitating the appearance of caries.
Another point concerns dental floss, which, according to the Brazilian Association of Pediatric Dentistry, should begin even with well-separated deciduous teeth, as the brush’s bristles cannot reach the region where the teeth are in contact. Dental floss is important and is performed by caregivers, which shows concern with interdental hygiene, indicating a favorable practice of oral health regarding babies2323 Associação Brasileira de Odontopediatria (ABO). Orientações aos pais sobre cuidados com a saúde bucal do bebê e da criança [Internet]. 2019 [acessado 2020 jun 13]. Disponível em: https://edisciplinas.usp.br/pluginfile.php/5385038/mod_resource/content/1/ABOPED%20Orienta%C3%A7%C3%B5es%20pais%20cuidados%20s%C3%A1ude%20bucal%20beb%C3%AA%20crian%C3%A7as.pdf.
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Regarding the thematic category of “breastfeeding”, the guidance is exclusive breastfeeding up to six months of age. It considers its contribution as a protective factor against installing occlusal changes in the primary dentition, offering a 68% reduction in the risk of malocclusions2424 França EB, Lansky S, Rego MAS, Malta DC, França JS, Teixeira R, Porto D, Almeida MF, Souza MFM, Szwarcwald CL, Mooney M, Naghavi M, Vasconcelos AMN. Leading causes of child mortality in Brazil, in 1990 and 2015: estimates from the Global Burden of Disease study. Rev Bras Epidemiol 2017; 20(Supl. 1):46-60..
When talking about breastfeeding, one cannot fail to mention the use of “artificial nipples” presented in questions: 9(C), 10(C), 7(A), 14(P), 15(P), 18(P), and 19(P). The institutional and normative publications of the Ministry of Health advise against the use of pacifiers and bottles and recommends ending this habit by the end of the first year of life2525 Abanto J, Oliveira EPS, Antunes JLF, Cardoso MA. Diretrizes para o estudo das condições nutricionais e agravos bucais dentro dos primeiros 1.000 dias de vida. Rev Assoc Paul Cir Dent 2018; 72(3):496-502.,2626 Abanto J, Duarte D, Feres M. Primeiros mil dias do bebê e saúde bucal: o que precisamos aprender! 1ª ed. Nova Odessa: Napoleão; 2019..
According to the American Academy of Pediatric Dentistry2222 American Academy of Pediatric Dentistry (AAPD). Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago: AAPD; 2020., the theme of babies’ oral health promotion demystifies the idea that the family should only take the baby to the dentist only after the first tooth’s eruption, emphasizing that the first appointment occurs by the first year. Health professionals should promote actions related to the child’s future oral health, such as the chronology of tooth eruption and its repercussions, adequate cleaning, avoiding early caries, using pacifiers and bottles, and clinically examining the entire face and its soft tissues2020 Prates CB, Passos MAS, Masquio DCL. Parental feeding practices and ultra-processed food consumption in preschool children. Rev Nutr 2022; 35:e210269..
Thus, promoting children’s oral health, and emphasizing the prevention of dental caries, should be introduced into children’s routines as early as possible, considering that good habits influence the quality of life and adequate knowledge for caregivers. Thus, education has been closely related as a practice that promotes children’s oral health2323 Associação Brasileira de Odontopediatria (ABO). Orientações aos pais sobre cuidados com a saúde bucal do bebê e da criança [Internet]. 2019 [acessado 2020 jun 13]. Disponível em: https://edisciplinas.usp.br/pluginfile.php/5385038/mod_resource/content/1/ABOPED%20Orienta%C3%A7%C3%B5es%20pais%20cuidados%20s%C3%A1ude%20bucal%20beb%C3%AA%20crian%C3%A7as.pdf.
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We should note that changes were made to the response pattern of the complementary questions in the “practice” domain (Questions 14, 15, 18, and 19). Despite these being recall questions, we chose to keep them in the instrument due to their importance in identifying possible associations with early weaning since they are intended to assess when the habit of bottle-feeding and pacifier sucking was introduced and removed2323 Associação Brasileira de Odontopediatria (ABO). Orientações aos pais sobre cuidados com a saúde bucal do bebê e da criança [Internet]. 2019 [acessado 2020 jun 13]. Disponível em: https://edisciplinas.usp.br/pluginfile.php/5385038/mod_resource/content/1/ABOPED%20Orienta%C3%A7%C3%B5es%20pais%20cuidados%20s%C3%A1ude%20bucal%20beb%C3%AA%20crian%C3%A7as.pdf.
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,2525 Abanto J, Oliveira EPS, Antunes JLF, Cardoso MA. Diretrizes para o estudo das condições nutricionais e agravos bucais dentro dos primeiros 1.000 dias de vida. Rev Assoc Paul Cir Dent 2018; 72(3):496-502..
Regarding the type of recall question about children’s hygiene frequency, some authors warn about the limitation of this type of question. They affirm that the family is an indispensable factor for childcare and that knowledge on oral hygiene, cleaning frequency, diet, and changing harmful habits is passed on through guidance to parents or caregivers by the dentist to continue education promoted by these professionals2727 Costa ALS, Costa BJA. Atividades lúdicas como estratégia para a promoção da saúde bucal infantil. Rev Saude Pesq 2017; 10(2):365-371.,2828 Dias TKS, Ferreira GC, Almeida LHS. Cárie na primeira infância e qualidade de vida de pacientes de zero a 3 anos. Rev Uningá 2019; 56(S3):192-201..
In order to reinforce the practice, instructions were added to the applicators to verify how the caregiver puts the toothpaste on the child’s brush to verify the amount dispensed. This instrument application action favors the educational process of families, as the KAP model is based on the understanding that health behavior is a sequential process, starting with acquiring scientifically correct knowledge2929 Oliveira LMC, Gomes LO, Silva HS, Chariglione IPFS. Knowledge, attitude and practice: concepts and challenges in the area of education and health. Rev Educ Saude 2020; 8(1):190-198.,3030 Knorst JK, Menegazzo GR, Emmanuelli B, Mendes FM, Ardenghi TM. Effect of neighborhood and individual social capital in early childhood on oral health-related quality of life: a 7-year cohort study. Qual Life Res 2019; 28:1773-1782..
Conclusion
The study produced the instrument entitled “Knowledge, Attitude, and Practice of Caregivers on Child Oral Health Promotion”, totaling 39 questions involving oral health promotion themes: caries, diet, oral hygiene, fluoride, breastfeeding, artificial nipples, milk teeth, and the need to take the baby to the dentist. The global CVI values were for Clarity (91.5%) and Relevance (95.4%), which scored high and showed their internal consistency.
Besides the instrument’s validity regarding the promotion of children’s oral health, we concluded that this material is unprecedented and innovates in identifying oral healthcare gaps from caregivers’ perspective, producing health promotion knowledge because it can be adopted depending on the more global assessment of its psychometric properties. The instrument could identify weaknesses in caregivers’ knowledge, beliefs, and behaviors, thus improving the quality of life and health.
Referências
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1Comassetto MO, Baumgarten A, Kindlein KA, Hilgert JB, Figueiredo MC, Faustino-Silva DD. Access to oral health in early childhood in the city of Porto Alegre, Brazil. Cien Saude Colet 2019; 24(3):953-961.
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2Soares DG, Pinheiro MCX, Queiroz DM, Soares DG. Implantação da puericultura e desafios do cuidado na estratégia saúde da família em um município do estado do Ceará. Rev Bras Promoc Saude 2016; 29(1):132-138.
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3Beraldi MIR, Pio MSM, Codasski MD, Portugal MEG, Bettega PVS. Cárie na primeira infância: uma revisão de literatura. RGS 2020; 22(2):29-42.
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4Dias TKS, Ferreira GC, Almeida LHS. Cárie na primeira infância e qualidade de vida de pacientes de zero a 3 anos. Rev Uningá 2019; 56(S3):192-201.
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5Lopes MVO, Silva VM, Araújo TL. Validação de diagnósticos de enfermagem: desafios e alternativas. Rev Bras Enferm 2013; 66(5):649-655.
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6Essvein S, Baumgarten A, Rech RS, Hilgert JB, Neves M. Dental care for early childhood in Brazil: from the public policy to evidence. Rev Saude Publica 2019; 53(15):1-12.
-
7Phantumvanit P, Makino Y, Ogawa H, Rugg-Gunn A, Moynihan P, Petersen PE, Evans W, Feldens CA, Lo E, Khoshnevisan MH, Baez R, Varenne B, Vichayanrat T, Songpaisan Y, Woodward M, Nakornchai S, Ungchusak C. WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol 2018; 46(1):280-287.
-
8Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, Perez-Escamilla R, Rao N, Ip P, Fernald LCH, MacMillan H, Hanson M, Wachs TD, Yao H, Yoshikawa H, Cerezo A, Leckman JF, Bhutta ZA; Early Childhood Development Interventions Review Group, for the Lancet Early Childhood Development Series Steering Committee. Nurturing care: promoting early childhood development. Lancet 2017; 389(10064):91-102.
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9Bartsch L, Loronha MF, Pioczkoski NP, Cavalheiro VS, Arrue AM, Jantsch LB. Influência da extensão universitária nos atributos da atenção primária a saúde no contexto da puericultura. Rev Soc Bras Enferm Ped 2021; 21(2):166-172.
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10Nagarajappa R, Kakatkar G, Sharda AJ, Asawa K, Ramesh G, Sandesh N. Infant oral health: Knowledge, attitude and practices of parents in Udaipur, India. Dent Res J 2013; 10(5):659-665,
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11Macambira DSC, Chaves ES, Costa EC. Conhecimento De Pais/Cuidadores Sobre Saúde Bucal Na Infância. Saude Pesq 2017; 10(3):463-472.
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Chief editors:
Publication Dates
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Publication in this collection
31 July 2023 -
Date of issue
Aug 2023
History
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Received
20 Oct 2022 -
Accepted
28 Mar 2023 -
Accepted
10 May 2023