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Barati M, Bashirian S, Barati M, Khazaei S, Jenabi E, Gholami L et al . Investigating the Effect of Educational Intervention on Oral Health Literacy in Pregnant Women Referring to Comprehensive Health Centers in Arak, 2022. TB 2025; 24 (6) :31-48
URL: http://tbj.ssu.ac.ir/article-1-3882-en.html
URL: http://tbj.ssu.ac.ir/article-1-3882-en.html
Maryam Barati * 
, Saeid Bashirian , Majid Barati , Salman Khazaei , Ensiyeh Jenabi , Leila Gholami , Samane Shirahmadi
, Saeid Bashirian , Majid Barati , Salman Khazaei , Ensiyeh Jenabi , Leila Gholami , Samane Shirahmadi
Arak University Medical Sciences , barati85@gmail.com
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Investigating the Effect of Educational Intervention on Oral Health Literacy in Pregnant Women Referring to Comprehensive Health Centers in Arak, 2022
Maryam Barati (Ph.D)1, Majid Barati (Ph.D)2, Saeed Bashirian (Ph.D)3, Salman Khazaei (Ph.D)4, Ansiyeh Janabi (Ph.D)5, Leila Gholami (Ph.D)6, Samaneh Shir Ahmadi (Ph.D)7
1. Corresponding Author: Assistant Professor of Department of Health Education and Health Promotion, Faculty of Health, Arak University of Medical Sciences, Arak, Iran. Email: barati85@gmail.com
2.Associate Professor of Department of Health Education and Health Promotion, Hamadan University of Medical Sciences, Hamadan, Iran
3.Professor of Department of Health Education and Health Promotion, Hamadan University of Medical Sciences, Hamadan, Iran.
4.Associate Professor of Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
5.Associate Professor of Department of Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran
6.Assistant Professor of Department of Periodontics, Hamadan University of Medical Sciences, Hamadan, Iran
7.Assistant Professor of Department of Community Oral Health, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract
Introduction: Health literacy is a key determinant of health-related behaviors and outcomes. The present study aimed to investigate the effect of an educational intervention on oral health literacy of pregnant women referring to health centers in Arak city in 2022.
Methods: This study was a randomized controlled trial and was conducted among 105 pregnant women (54 in the intervention group and 51 in the control group) who referred to health centers in Arak city. The educational intervention was conducted virtually (from week 12 to 24) and through social networks. The data collection tool was questions related to demographic information and a standard questionnaire, Oral Health Literacy Adults Questionnaire (OHL-AQ), which was completed to measure oral health literacy in two groups before and three months after the end of the educational intervention. The data were collected and analyzed using SPSS version 22 software.
Results:Three months after the educational intervention, there was a significant difference (P=0/022) in the level of oral health literacy between the intervention and control groups. 28% of the participants in the intervention group had adequate health literacy, which increased to 40% three months after the educational intervention. After the intervention, there was a significant difference between the intervention and control groups in the dimension of reading comprehension and decision-making.
Conclusion: Based on the results of the present study, educational intervention regarding oral health literacy in pregnant women was effective on their oral health literacy levels.
Keywords: Pregnancy, Oral health, Randomized controlled trial, Health promotion
Conflict of interest: The authors declared no conflict of interest.
References
1-Tenenbaum A, Azogui-Levy S. Oral health knowledge, attitudes, practices, and literacy of pregnant women: A scoping review. Oral Health Prev Dent. 2023;21:b4100965.
2-Phoosuwan N, Bunnatee P, Lundberg PC. Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand. BMC Oral Health. 2024;24(1):653.
3-Fakheran O, Keyvanara M, Saied-Moallemi Z & et al. The impact of pregnancy on women’s oral health-related quality of life: a qualitative investigation. BMC Oral Health. 2020;20(1):294.
4-Ye C, Kapila Y. Oral microbiome shifts during pregnancy and adverse pregnancy outcomes: Hormonal and Immunologic changes at play. Periodontology 2000. 2021;87(1):276-81.
5-Bi WG, Emami E, Luo Z-C & et al. Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021;34(19):3259-68.
6-De Abreu MHNG, Cruz AJS, Borges-Oliveira AC & et al. Perspectives on social and environmental determinants of oral health. International Journal of Environmental Research and Public Health. 2021;18(24):1-9.
7-Nawabi F, Krebs F, Vennedey V & et al. Health literacy in pregnant women: a systematic review. Int J Environ Res Public Health. 2021;18(7):3847.
8-Berkman ND, Sheridan SL, Donahue KE & et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
9-Yu S, Huang S, Song S & et al. Impact of oral health literacy on oral health behaviors and outcomes among the older adults: a scoping review. BMC geriatrics. 2024;24(1):858.
10-Neves ÉTB, Lima LCMd, Dutra LdC & et al. Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents. International Journal of Paediatric Dentistry. 2021;31(2):204-11.
11-Alzeer ME, AlJameel AH, Øzhayat EB. Exploring the Association Between Oral Health Literacy and Oral Health-Related Quality of Life Among Young Women in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-Sectional Study. J Oral Rehabil. 2025;52(1):100-08.
12-Velasco SRM, Moriyama CM, Bonecker M & et al. Relationship between oral health literacy of caregivers and the oral health-related quality of life of children: a cross-sectional study. Health and Quality of Life Outcomes. 2022;20(1):117.
13-De Araujo G, Rauber ED, Segatto MC & et al. Oral health literacy and its association with oral health-related quality of life amongst pregnant women: a cross-sectional study. Quality of Life Research.2024;33(1):219-27.
14-Zibellini J, Muscat DM, Kizirian N & et al. Effect of health literacy interventions on pregnancy outcomes: A systematic review. Women and Birth. 2021;34(2):180-86.
15-Fazli M, Yazdani R, Mohebbi SZ & et al. Oral health literacy and socio-demographics as determinants of oral health status and preventive behavior measures in participants of a pre-marriage counseling program. PloS one. 2021;16(11):e0258810.
16-Mohammadi TM, Malekmohammadi M, Hajizamani HR & et al. Oral health literacy and its determinants among adults in Southeast Iran. European journal of dentistry. 2018;12(03):439-42.
17-Ghaderi F, Sharif ZAM, Bakhtiar M. The relationship between oral health literacy and oral health behavior in pregnant women referring to health centers in Shiraz. J Mashhad Dent Sch. 2024;48(3):773-85.[Persian].
18-Barati M, Bashirian S, Barati M & et al. The Relationship between oral health literacy and dental caries experience among pregnant women in Arak, Iran in 2021. Journal of Oral Health and Oral Epidemiology. 2023;12(3):123-29.
19-Karimi Afshar M, Torabi M, Raeisi Afshar M & et al. Oral health literacy and oral health behavior in pregnant women referring to health centers in south of Kerman province. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(3):39-49.
20-Haber J, Dolce MC, Hartnett E & et al. Improving Oral Health During Pregnancy: A Call to Action. Journal of Midwifery & Women's Health. 2022;67(2).
21-Balatsoukas P, Kennedy CM, Buchan I & et al. The role of social network technologies in online health promotion: a narrative review of theoretical and empirical factors influencing intervention effectiveness. Journal of medical Internet research. 2015;17(6):e141.
22-Bashirian S, Jenabi E, Barati M & et al. Oral Health Intervention During Pregnancy: A Systematic Review. Curr Womens Health Rev. 2023;19(3):3-12.
23-Shamsi M, Hidarnia A, Niknami S & et al. The Effect of Educational Program on Increasing Oral Health Behavior among Pregnant Women: Applying Health Belief Model. Health Education and Health Promotion. 2013;1(2):21-36.
24-Naghibi Sistani MM, Montazeri A, Yazdani R & et al. New oral health literacy instrument for public health: development and pilot testing. J Investig Clin Dent. 2014;5(4):313-21.
25-Ho MH, Montayre J, Chang HC & et al. Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan. Public Health Nurs. 2020;37(2):303-09.
26-Cordero MJA, Leon-Rios XA, Rivero-Blanco T & et al. Quality of life during pregnancy and its influence on oral health: a systematic review. Journal of Oral Research. 2019;8(1):74-81.
27-Movaseghi Ardekani F, Ghaderi F, Kaveh MH & et al. The Effect of an Educational Intervention on Oral Health Literacy, Knowledge, and Behavior in Iranian Adolescents: A Theory‐Based Randomized Controlled Trial. BioMed research international. 2022;2022(1):5421799.
28-Hosseini MS, Rakhshanderou S, Safari-Moradabadi A & et al. Effectiveness of a school-based oral health literacy promotion intervention: a randomized controlled trial (RCT) among adolescents. BMC Public Health. 2025;25(1):1982.
29-Dudovitz R, Teutsch C, Holt K & et al. Improving parent oral health literacy in Head Start programs. Journal of Public Health Dentistry. 2020;80(2):150-58.
30-Kaur N, Kandelman D, Potvin L. Effectiveness of “safeguard your smile,” an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants: a randomized controlled trial. Canadian Journal of Dental Hygiene. 2019;53(1):23.
31-Koo FK, Chen R, Fethney J & et al. Evaluating pre‐and post‐oral health literacy of undergraduate nursing students on an oral‐systemic health learning intervention. Journal of Dental Education. 2024;88(10):1358-66.
32-Roozbeh B, Pourmovahed Z, Zare Chahooky S & et al. The Effect of Educational Intervention on Self-efficacy Related to the Oral and Dental Hygiene of Pregnant Mothers. Tolooebehdasht. 2021;20(5):90-101.[Persian]
33-zare mirok abad f, Dehghani-Tafti A-A, Rashidy meybo f & et al. Developing and Evaluating a Health Belief Model-based Educational Program on Oral Hygiene Behaviors among Child-wanting Women in Mehriz, Yazd. Tolooebehdasht. 2018;17(3):52-63.[Persian]
34-Nawabi F, Krebs F, Lorenz L & et al. Health Literacy among Pregnant Women in a Lifestyle Intervention Trial. Int J Environ Res Public Health. 2022;19(10).
35-Panahi R, Ramezankhani A, Dashtbani F & et al. Effect of Health Belief Model based education on health literacy and smoking prevention among students. Journal of Health in the Field. 2020;7(4):47-58[Persian]
36-Abdolmaleki N, Bahmani A, Nili S & et al. The Effect of the Theory of Planned Behavior on Health Literacy and Diabetes Testing Among Individuals at Risk of Diabetes. Iranian Journal of Health Education and Health Promotion. 2025;13(3):31-45.[Persian]
37-Balbaa NM, Hamza MA, Abdelaziz WE & et al. Effectiveness of mobile oral health intervention on orthodontic patients’ oral hygiene and oral health literacy: a randomised controlled clinical trial. BMC Oral Health. 2025;26(5):113.
38-Meldgaard M, Gamborg M, Maindal HT. Health literacy levels among women in the prenatal period: A systematic review. Sexual & Reproductive Healthcare. 2022;34:100796.
39-Sørensen K, Van den Broucke S, Fullam J & et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC public health. 2012;12(1):80.
40-Thirasupa N, Intarakamhang U, Kasevayuth K. A Comparative Evaluation of Oral Health Behavior and Plaque Index Between an Innovative Oral Health Literacy Enhancement Program and Traditional Oral Health Education in Adult Orthodontic Patients: A Single-Center, Randomized Controlled Trial. Journal of International Oral Health. 2025;17(6):493-502.
41-Ebrahimi N, Sargeran K, Yazdani R & et al. Does the transition from face-to-face to face-to-screen improve oral health literacy? A non-inferiority randomized controlled trial. BMC Oral Health. 2025;25(1):182.
42-Saini RS, Chopra S, Assiri YA & et al. Impact of mHealth and eHealth on oral health literacy: A systematic review. Digital Health. 2025;11:1-15.
Maryam Barati (Ph.D)1, Majid Barati (Ph.D)2, Saeed Bashirian (Ph.D)3, Salman Khazaei (Ph.D)4, Ansiyeh Janabi (Ph.D)5, Leila Gholami (Ph.D)6, Samaneh Shir Ahmadi (Ph.D)7
1. Corresponding Author: Assistant Professor of Department of Health Education and Health Promotion, Faculty of Health, Arak University of Medical Sciences, Arak, Iran. Email: barati85@gmail.com
2.Associate Professor of Department of Health Education and Health Promotion, Hamadan University of Medical Sciences, Hamadan, Iran
3.Professor of Department of Health Education and Health Promotion, Hamadan University of Medical Sciences, Hamadan, Iran.
4.Associate Professor of Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
5.Associate Professor of Department of Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran
6.Assistant Professor of Department of Periodontics, Hamadan University of Medical Sciences, Hamadan, Iran
7.Assistant Professor of Department of Community Oral Health, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract
Introduction: Health literacy is a key determinant of health-related behaviors and outcomes. The present study aimed to investigate the effect of an educational intervention on oral health literacy of pregnant women referring to health centers in Arak city in 2022.
Methods: This study was a randomized controlled trial and was conducted among 105 pregnant women (54 in the intervention group and 51 in the control group) who referred to health centers in Arak city. The educational intervention was conducted virtually (from week 12 to 24) and through social networks. The data collection tool was questions related to demographic information and a standard questionnaire, Oral Health Literacy Adults Questionnaire (OHL-AQ), which was completed to measure oral health literacy in two groups before and three months after the end of the educational intervention. The data were collected and analyzed using SPSS version 22 software.
Results:Three months after the educational intervention, there was a significant difference (P=0/022) in the level of oral health literacy between the intervention and control groups. 28% of the participants in the intervention group had adequate health literacy, which increased to 40% three months after the educational intervention. After the intervention, there was a significant difference between the intervention and control groups in the dimension of reading comprehension and decision-making.
Conclusion: Based on the results of the present study, educational intervention regarding oral health literacy in pregnant women was effective on their oral health literacy levels.
Keywords: Pregnancy, Oral health, Randomized controlled trial, Health promotion
Conflict of interest: The authors declared no conflict of interest.
References
1-Tenenbaum A, Azogui-Levy S. Oral health knowledge, attitudes, practices, and literacy of pregnant women: A scoping review. Oral Health Prev Dent. 2023;21:b4100965.
2-Phoosuwan N, Bunnatee P, Lundberg PC. Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand. BMC Oral Health. 2024;24(1):653.
3-Fakheran O, Keyvanara M, Saied-Moallemi Z & et al. The impact of pregnancy on women’s oral health-related quality of life: a qualitative investigation. BMC Oral Health. 2020;20(1):294.
4-Ye C, Kapila Y. Oral microbiome shifts during pregnancy and adverse pregnancy outcomes: Hormonal and Immunologic changes at play. Periodontology 2000. 2021;87(1):276-81.
5-Bi WG, Emami E, Luo Z-C & et al. Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021;34(19):3259-68.
6-De Abreu MHNG, Cruz AJS, Borges-Oliveira AC & et al. Perspectives on social and environmental determinants of oral health. International Journal of Environmental Research and Public Health. 2021;18(24):1-9.
7-Nawabi F, Krebs F, Vennedey V & et al. Health literacy in pregnant women: a systematic review. Int J Environ Res Public Health. 2021;18(7):3847.
8-Berkman ND, Sheridan SL, Donahue KE & et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
9-Yu S, Huang S, Song S & et al. Impact of oral health literacy on oral health behaviors and outcomes among the older adults: a scoping review. BMC geriatrics. 2024;24(1):858.
10-Neves ÉTB, Lima LCMd, Dutra LdC & et al. Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents. International Journal of Paediatric Dentistry. 2021;31(2):204-11.
11-Alzeer ME, AlJameel AH, Øzhayat EB. Exploring the Association Between Oral Health Literacy and Oral Health-Related Quality of Life Among Young Women in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-Sectional Study. J Oral Rehabil. 2025;52(1):100-08.
12-Velasco SRM, Moriyama CM, Bonecker M & et al. Relationship between oral health literacy of caregivers and the oral health-related quality of life of children: a cross-sectional study. Health and Quality of Life Outcomes. 2022;20(1):117.
13-De Araujo G, Rauber ED, Segatto MC & et al. Oral health literacy and its association with oral health-related quality of life amongst pregnant women: a cross-sectional study. Quality of Life Research.2024;33(1):219-27.
14-Zibellini J, Muscat DM, Kizirian N & et al. Effect of health literacy interventions on pregnancy outcomes: A systematic review. Women and Birth. 2021;34(2):180-86.
15-Fazli M, Yazdani R, Mohebbi SZ & et al. Oral health literacy and socio-demographics as determinants of oral health status and preventive behavior measures in participants of a pre-marriage counseling program. PloS one. 2021;16(11):e0258810.
16-Mohammadi TM, Malekmohammadi M, Hajizamani HR & et al. Oral health literacy and its determinants among adults in Southeast Iran. European journal of dentistry. 2018;12(03):439-42.
17-Ghaderi F, Sharif ZAM, Bakhtiar M. The relationship between oral health literacy and oral health behavior in pregnant women referring to health centers in Shiraz. J Mashhad Dent Sch. 2024;48(3):773-85.[Persian].
18-Barati M, Bashirian S, Barati M & et al. The Relationship between oral health literacy and dental caries experience among pregnant women in Arak, Iran in 2021. Journal of Oral Health and Oral Epidemiology. 2023;12(3):123-29.
19-Karimi Afshar M, Torabi M, Raeisi Afshar M & et al. Oral health literacy and oral health behavior in pregnant women referring to health centers in south of Kerman province. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020;23(3):39-49.
20-Haber J, Dolce MC, Hartnett E & et al. Improving Oral Health During Pregnancy: A Call to Action. Journal of Midwifery & Women's Health. 2022;67(2).
21-Balatsoukas P, Kennedy CM, Buchan I & et al. The role of social network technologies in online health promotion: a narrative review of theoretical and empirical factors influencing intervention effectiveness. Journal of medical Internet research. 2015;17(6):e141.
22-Bashirian S, Jenabi E, Barati M & et al. Oral Health Intervention During Pregnancy: A Systematic Review. Curr Womens Health Rev. 2023;19(3):3-12.
23-Shamsi M, Hidarnia A, Niknami S & et al. The Effect of Educational Program on Increasing Oral Health Behavior among Pregnant Women: Applying Health Belief Model. Health Education and Health Promotion. 2013;1(2):21-36.
24-Naghibi Sistani MM, Montazeri A, Yazdani R & et al. New oral health literacy instrument for public health: development and pilot testing. J Investig Clin Dent. 2014;5(4):313-21.
25-Ho MH, Montayre J, Chang HC & et al. Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan. Public Health Nurs. 2020;37(2):303-09.
26-Cordero MJA, Leon-Rios XA, Rivero-Blanco T & et al. Quality of life during pregnancy and its influence on oral health: a systematic review. Journal of Oral Research. 2019;8(1):74-81.
27-Movaseghi Ardekani F, Ghaderi F, Kaveh MH & et al. The Effect of an Educational Intervention on Oral Health Literacy, Knowledge, and Behavior in Iranian Adolescents: A Theory‐Based Randomized Controlled Trial. BioMed research international. 2022;2022(1):5421799.
28-Hosseini MS, Rakhshanderou S, Safari-Moradabadi A & et al. Effectiveness of a school-based oral health literacy promotion intervention: a randomized controlled trial (RCT) among adolescents. BMC Public Health. 2025;25(1):1982.
29-Dudovitz R, Teutsch C, Holt K & et al. Improving parent oral health literacy in Head Start programs. Journal of Public Health Dentistry. 2020;80(2):150-58.
30-Kaur N, Kandelman D, Potvin L. Effectiveness of “safeguard your smile,” an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants: a randomized controlled trial. Canadian Journal of Dental Hygiene. 2019;53(1):23.
31-Koo FK, Chen R, Fethney J & et al. Evaluating pre‐and post‐oral health literacy of undergraduate nursing students on an oral‐systemic health learning intervention. Journal of Dental Education. 2024;88(10):1358-66.
32-Roozbeh B, Pourmovahed Z, Zare Chahooky S & et al. The Effect of Educational Intervention on Self-efficacy Related to the Oral and Dental Hygiene of Pregnant Mothers. Tolooebehdasht. 2021;20(5):90-101.[Persian]
33-zare mirok abad f, Dehghani-Tafti A-A, Rashidy meybo f & et al. Developing and Evaluating a Health Belief Model-based Educational Program on Oral Hygiene Behaviors among Child-wanting Women in Mehriz, Yazd. Tolooebehdasht. 2018;17(3):52-63.[Persian]
34-Nawabi F, Krebs F, Lorenz L & et al. Health Literacy among Pregnant Women in a Lifestyle Intervention Trial. Int J Environ Res Public Health. 2022;19(10).
35-Panahi R, Ramezankhani A, Dashtbani F & et al. Effect of Health Belief Model based education on health literacy and smoking prevention among students. Journal of Health in the Field. 2020;7(4):47-58[Persian]
36-Abdolmaleki N, Bahmani A, Nili S & et al. The Effect of the Theory of Planned Behavior on Health Literacy and Diabetes Testing Among Individuals at Risk of Diabetes. Iranian Journal of Health Education and Health Promotion. 2025;13(3):31-45.[Persian]
37-Balbaa NM, Hamza MA, Abdelaziz WE & et al. Effectiveness of mobile oral health intervention on orthodontic patients’ oral hygiene and oral health literacy: a randomised controlled clinical trial. BMC Oral Health. 2025;26(5):113.
38-Meldgaard M, Gamborg M, Maindal HT. Health literacy levels among women in the prenatal period: A systematic review. Sexual & Reproductive Healthcare. 2022;34:100796.
39-Sørensen K, Van den Broucke S, Fullam J & et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC public health. 2012;12(1):80.
40-Thirasupa N, Intarakamhang U, Kasevayuth K. A Comparative Evaluation of Oral Health Behavior and Plaque Index Between an Innovative Oral Health Literacy Enhancement Program and Traditional Oral Health Education in Adult Orthodontic Patients: A Single-Center, Randomized Controlled Trial. Journal of International Oral Health. 2025;17(6):493-502.
41-Ebrahimi N, Sargeran K, Yazdani R & et al. Does the transition from face-to-face to face-to-screen improve oral health literacy? A non-inferiority randomized controlled trial. BMC Oral Health. 2025;25(1):182.
42-Saini RS, Chopra S, Assiri YA & et al. Impact of mHealth and eHealth on oral health literacy: A systematic review. Digital Health. 2025;11:1-15.
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Received: 2026/02/17 | Accepted: 2026/03/16 | Published: 2025/09/1
Received: 2026/02/17 | Accepted: 2026/03/16 | Published: 2025/09/1
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