Parental Knowledge, Attitudes, Practices and Self-Efficacy in Child Oral Health

: A Mixed-Methods Study Using the Health Belief Model in Yaoundé, Cameroon

Abstract

Objectives: To explore the influence of parental oral health knowledge, attitudes and practices and self-efficacy on children's oral health behaviours using the Health Belief Model (HBM).
Methods: A mixed-method study comprised of a cross-sectional assessment of children's oral health status and parental factors, alongside a pilot implementation of a school-based supervised toothbrushing (STB) programme to evaluate feasibility and acceptability. This was conducted among children aged 5–6 years and their parents in three primary schools in Yaoundé, Cameroon. The study included oral health education, supervised toothbrushing and oral health-based SMS messages to parents. Clinical data were obtained through dental screenings, and parents completed a structured questionnaire assessing knowledge, attitudes, practices, and self-efficacy. Acceptability and perceived impact were explored through qualitative interviews with parents, teachers, and dentists. The Health Belief Model guided interpretation.
Results: Among 127 children screened, caries prevalence was 64.6%, with a dmft index of 2.43. No child in the study presented with any form of filled tooth upon examination. Of 91 responding parents, self-efficacy was low, and only a few (3%) supervised their children’s tooth-brushing habits. More than half of the parents (59%) said they had never visited the dentist with their children, and most children visited the dentist only when they had a problem. However, most parents had a positive attitude towards oral health.
Discussion: While causes of tooth decay were well-known to many parents, they often neglected their children's tooth-brushing habits. Although parents generally have confidence in their ability to meet their children's needs, factors such as parental depression, stress, anxiety, and a child's temperament contribute to low parental self-efficacy. The lack of structure or bedtime routine for children in most homes is a major issue in the practice of supervised tooth brushing in homes. Some barriers identified in instituting good oral hygiene were a lack of time, reduced finances and mistrust of health personnel. According to the HBM, perceived severity and barriers were strong influencers of oral health behaviours, while self-efficacy was moderated by perceived barriers. Findings from this study, interpreted through the HBM, suggest that knowledge of caries risk alone does not necessarily lead to preventive action. Providing access to parental training and a supportive environment can improve parents' self-efficacy in improving children’s oral health.

Conclusion: Parents' ability to model good oral health behaviours, not just knowledge, impacts children's oral health habits.

Date of Award	12 May 2026
Original language	English
Awarding Institution	University of Portsmouth
Supervisor	Carolina Machuca Vargas (Supervisor) & Chris Louca (Supervisor)