Non-Cochrane · intervention · PM40653471
Health promotion theory-based educational interventions for improving oral health in children and adolescents: a systematic review and meta-analysis.
Nazari Abouzar, Hajihashemi Mina, Safavi Seyyed Roghayeh, et al. · BMC oral health · 2025 · PubMed · doi:10.1186/s12903-025-06549-3
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
8
current version
GRADE rated
8
No studies
0
Included studies
36
linked below
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 6 · 75%Moderate 2 · 25%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents aged 5-18 years | 19 RCTs; 6560 participants; children/adolescents aged 5-18; trials conducted 2012-2024; predominantly Iran |
| Intervention | Theory-based oral health education or promotion interventions (e.g., HBM, TPB, SCT) | Theory-based interventions using HBM, TPB, SCT, HAPA, TTM, PMT, Sense of Coherence, PRECEDE-PROCEED, Motivational Interviewing, Self-Efficacy Theory, Prospect Theory, Authoritative Parenting Model |
| Comparison | Not specified (RCT control/comparison groups) | Waitlist; routine/standard oral health education; conventional one-time instruction; booklets only; plaque-disclosure control |
| Outcomes | At least one oral health outcome (behavior, knowledge, attitudes, self-efficacy, plaque index, gingival index, DMFT) | 8 meta-analyzed outcomes (115 reports): self-efficacy (14 reports), OHRQoL (9), knowledge (14), attitude (14), behavior (29), periodontal health (8), dental plaque (21), DMFT (5) |
| Study designs | Randomized controlled trials (RCTs); English language; up to March 2025 | 19 RCTs (including several cluster RCTs) |
| Timing | Not specified (follow-up duration not prespecified) | Follow-up 1 week to 24 months |
Search date: Up to March 2025 (searches conducted January to March 2025). Databases: PubMed; Web of Science; Scopus; Cochrane Library; plus Google Scholar and reference-list searching (abstract states seven databases, Methods name four)
Questions and results
Theory-based oral health education/promotion interventions (HBM, TPB, SCT, HAPA, TTM, PMT, SOC, PRECEDE-PROCEED, MI) vs Control (waitlist, routine/standard oral health education, or minimal intervention)
Population: Children and adolescents aged 5-18 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self-efficacy related to oral health Post-intervention (follow-up 4 weeks to 12 months, varies by study) · Overall Theory-based educational interventions significantly improved oral health self-efficacy (SMD 1.49; low certainty), though between-study heterogeneity was very high. Source: Results (self-efficacy) and Fig. 3; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD 1.49 [0.99, 2.00] | 10 studies · 4513 participants | Low |
Oral health attitude Post-intervention (follow-up immediately after to 6 months, varies by study) · Overall Theory-based interventions significantly improved oral health attitude (SMD 9.32; low certainty); the very large effect warrants cautious interpretation. Source: Results (attitude) and Fig. 6; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD 9.32 [7.08, 11.55] | 3 studies · 2370 participants | Low |
Periodontal health (gingival/periodontal indices) Post-intervention (follow-up 2 weeks to 6 months, varies by study) · Overall Theory-based interventions significantly improved periodontal health (SMD -1.18; moderate certainty). Source: Results (periodontal health) and Fig. 8; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD -1.18 [-1.83, -0.53] | 4 studies · 3342 participants | Moderate |
Oral health-related quality of life (OHRQoL) Post-intervention (follow-up 0.5 to 12 months, varies by study) · Overall Theory-based interventions significantly improved oral health-related quality of life (SMD 7.38; low certainty), with very high heterogeneity. Source: Results (OHRQoL) and Fig. 4; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD 7.38 [5.57, 9.19] | 4 studies · 4751 participants | Low |
Oral health knowledge Post-intervention (follow-up immediately after to 24 months, varies by study) · Overall Theory-based interventions significantly improved oral health knowledge (SMD 1.09; low certainty). Source: Results (knowledge) and Fig. 5; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD 1.09 [0.80, 1.39] | 7 studies · 10904 participants | Low |
DMFT scores (decayed, missing, filled teeth) Post-intervention (follow-up 3 to 12 months, varies by study) · Overall Theory-based interventions showed no significant effect on DMFT scores (SMD -0.11; low certainty). Source: Results (DMFT) and Fig. 10; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD -0.11 [-0.27, 0.04] | 4 studies · 2556 participants | Low |
Oral health behavior Post-intervention (follow-up 0.5 to 24 months, varies by study) · Overall Theory-based interventions significantly improved oral health behavior (SMD 2.58; low certainty), with very high heterogeneity. Source: Results (behavior) and Fig. 7; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD 2.58 [2.03, 3.12] | 6 studies · 13973 participants | Low |
Dental plaque (plaque index) Post-intervention (follow-up 1 to 24 months, varies by study) · Overall Theory-based interventions significantly reduced dental plaque (SMD -1.92; moderate certainty). Source: Results (dental plaque) and Fig. 9; Certainty of evidence section (Supplementary S3); Abstract · same question in other reviews | SMD -1.92 [-2.42, -1.42] | 9 studies · 12562 participants | Moderate |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | No | no |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | No | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: No | RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 36
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Gholami (2015) A Brief Self-Regulatory Intervention Increases Dental Flossing in Adolescent Girls. PMID:25549910 | 1 other review | not stated | not extracted yet | not extracted yet |
| Haleem (2012) School-based strategies for oral health education of adolescents--a cluster randomized controlled trial. PMID:23249443 | 1 other review | not stated | not extracted yet | not extracted yet |
| Nammontri (2012) Enhancing oral health via sense of coherence: a cluster-randomized trial. PMID:23018820 | 1 other review | not stated | not extracted yet | not extracted yet |
| Shirahmadi (2024) Effectiveness of theory-based educational interventions of promoting oral health among elementary school students. PMID:38195494 | 1 other review | not stated | not extracted yet | not extracted yet |
| Yekaninejad (2012) Effect of a school-based oral health-education program on Iranian children: results from a group randomized trial. PMID:22985001 | 1 other review | not stated | not extracted yet | not extracted yet |
| Aleksejuniene (2015) A theory-guided school-based intervention in order to improve adolescents' oral self-care: a cluster randomized trial. PMID:25877514 | this review only | not stated | not extracted yet | not extracted yet |
| Aleksejuniene 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Brukiene (2012) Is the authoritative parenting model effective in changing oral hygiene behavior in adolescents? PMID:22730491 | this review only | not stated | not extracted yet | not extracted yet |
| Brukiene 2012 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Dziaugyte (2017) Self-efficacy theory-based intervention in adolescents: a cluster randomized trial-focus on oral self-care practice and oral self-care… PMID:26764132 | this review only | not stated | not extracted yet | not extracted yet |
| Dziaugyte 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ghaffari (2021) Design, implementation, and evaluation of a PRECEDE-PROCEED model-based intervention for oral and dental health among primary school… PMID:34479531 | this review only | not stated | not extracted yet | not extracted yet |
| Ghaffari 2021 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Gholami 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ghorbani (2018) Improving Student's Self-Efficacy and Perceived Susceptibility Toward Oral and Dental Health: A Randomized Controlled Trial. PMID:30210722 | this review only | not stated | not extracted yet | not extracted yet |
| Ghorbani 2018 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Haleem 2012 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Marashi (2024) The effect of educational intervention based on self-efficacy theory on promoting adolescent oral health behaviors through mobile… PMID:39448943 | this review only | not stated | not extracted yet | not extracted yet |
| Marashi 2024 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Movaseghi (2022) The Effect of an Educational Intervention on Oral Health Literacy, Knowledge, and Behavior in Iranian Adolescents: A Theory-Based… PMID:35707385 | this review only | not stated | not extracted yet | not extracted yet |
| Movaseghi 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Nammontri 2012 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Naseri-Salahshour (2019) The Effect of Oral Health Promotion Program on Early Dental Decay in Students: a Cluster Randomized Controlled Trial. PMID:31249820 | this review only | not stated | not extracted yet | not extracted yet |
| Naseri-Salahshour 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Pakpour (2013) The effectiveness of gain-versus loss-framed health messages in improving oral health in Iranian secondary schools: a cluster-randomized… PMID:24163187 | this review only | not stated | not extracted yet | not extracted yet |
| Pakpour 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Sanaeinasab (2022) An educational intervention using the health belief model for improvement of oral health behavior in grade-schoolers: a randomized… PMID:35346148 | this review only | not stated | not extracted yet | not extracted yet |
| Sanaeinasab 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Scheerman (2019) A theory-based intervention delivered by an online social media platform to promote oral health among Iranian adolescents: a cluster… PMID:31621423 | this review only | not stated | not extracted yet | not extracted yet |
| Scheerman 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Shirahmadi 2024 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Wu (2017) Motivational Interviewing to Promote Oral Health in Adolescents. PMID:28532895 | this review only | not stated | not extracted yet | not extracted yet |
| Xiang (2022) The efficacy of peer-led oral health programs based on Social Cognitive Theory and Health Belief Model among Hong Kong adolescents: a… PMID:34791503 | this review only | not stated | not extracted yet | not extracted yet |
| Xiang 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Yekaninejad 2012 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Zareban 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).