Knowledge, Attitude, and Practice (KAP)-based health education programme for parents of adolescent fixed orthodontic patients: a two-phase intervention development and assessor-blinded randomized controlled trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Malocclusion is highly prevalent among Chinese adolescents and represents a prominent oral public health concern. Orthodontic treatment outcomes rely not only on clinical expertise but also on parental oral health knowledge, health attitudes, and daily supervision. Many parents lack targeted orthodontic care knowledge, hold biased perceptions, and fail to develop standardized supervision habits, leading to poor adolescent treatment compliance, aggravated gingival and plaque problems, and increased treatment complications. This study aimed to develop and evaluate a standardized parent-oriented health education programme based on the knowledge–attitude–practice framework for adolescents receiving fixed orthodontic treatment. A two-phase intervention development and assessor-blinded randomized controlled trial was conducted. The educational framework was established via systematic literature review and two-round Delphi consultation with 22 multidisciplinary experts. Subsequently, a single-centre, assessor-blinded, parallel-group randomized controlled trial was performed. A total of 212 parent–adolescent dyads were assigned at a 1:1 ratio to either the intervention group receiving framework-based health education plus standard care or the control group receiving routine orthodontic care. The 7-month intervention comprised offline face-to-face sessions and online follow-up support. The primary outcome was the Gingival Index (GI) score at 7 months; secondary outcomes included the Plaque Index, parental knowledge-attitude-practice scores, and treatment compliance. Based on an a priori power analysis for the primary outcome, 55 participants per group were required after accounting for 20% dropout; however, 106 participants per group were pragmatically randomized to enhance precision for secondary outcomes. Analysis of covariance (ANCOVA) with the 7-month outcome as dependent variable and baseline as covariate was used for between-group comparisons, and all analyses followed the intention-to-treat principle. After 7 months of intervention, ANCOVA adjusting for baseline showed that the intervention group had significantly better outcomes than controls: lower Gingival Index (adjusted mean difference − 0.58, 95% CI − 0.67 to − 0.49, p < 0.001), lower Plaque Index (− 0.62, 95% CI − 0.75 to − 0.49, p < 0.001), higher parental KAP scores (all p < 0.001), and better treatment compliance (total score adjusted mean difference − 9.15, 95% CI − 10.23 to − 8.07, p < 0.001). Session attendance exceeded 95% across all face-to-face and digital sessions, indicating good feasibility and acceptance. The programme was associated with better clinical outcomes and lower observed costs over the 7-month study period. The theory-guided, family-centred health education programme effectively improves parental oral health literacy, optimizes adolescent periodontal conditions, and enhances orthodontic treatment compliance. This online–offline integrated intervention provides a scalable strategy for adolescent oral health promotion and can be incorporated into routine orthodontic care and public health management. Retrospective registration submitted to the Chinese Clinical Trial Registry (ChiCTR), currently under audit (Submission ID: 345914). The final registration number will be provided upon acceptance.
Source: BMC Public Health
Authors: Xiaona Sui, Wei Zhang, Sheng Zhai, Jiale Zhu, Xin Liu
Language: English
Subfield: Orthodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
OpenAlex ID: W7166449253