Impact of an Oral Health Education Intervention on Informal Caregivers: Validation and Application of the Portuguese Dental Coping Beliefs Scale - DCBS-PT

Impact of an Oral Health Education Intervention on Informal Caregivers: Validation and Application of the Portuguese Dental Coping Beliefs Scale - DCBS-PT | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of an Oral Health Education Intervention on Informal Caregivers: Validation and Application of the Portuguese Dental Coping Beliefs Scale - DCBS-PT Pedro Campos Lopes, Patrícia Couto, Sara Lopes, Joana Janeiro, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8451681/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Oral health literacy among institutional caregivers plays a critical role in maintaining and improving the oral health of dependent older adults. However, training opportunities for caregivers in this field remain limited, and validated instruments to assess their oral health beliefs and practices are scarce. This study aimed to validate the Portuguese version of the Dental Coping Beliefs Scale (DCBS-PT) and to evaluate the impact of an educational intervention on caregivers’ knowledge and beliefs regarding oral health care. Methods A quasi-experimental study was conducted among 44 institutional caregivers of institutionalized elderly from two nursing home facilities in Viseu, in the central region of Portugal. Participants completed the DCBS-PT before and after an oral health educational session. Descriptive and inferential analyses were performed using SPSS 28.0, including reliability analysis (Cronbach’s alpha) and comparison of pre- and post-intervention responses through chi-square and Wilcoxon tests. Statistical significance was set at p < 0.05. Results The study population consisted predominantly of female caregivers (97.7%), with a mean age between 41 and 50 years. Most had more than 10 years of professional experience, and 70.5% reported prior training in healthcare. The DCBS-PT demonstrated high internal consistency (Cronbach’s α = 0.94). Significant improvements were observed in key domains of oral health literacy after the intervention, particularly regarding beliefs about gingival disease control ( p = 0.004), prevention of oral candidiasis ( p = 0.004), and correct response to gingival bleeding during hygiene ( p = 0.03). Conclusions The DCBS-PT showed strong psychometric properties and can be reliably applied among Portuguese-speaking caregivers. The educational intervention effectively improved caregivers’ awareness and understanding of oral health care, highlighting the importance of continuous education for enhancing oral health outcomes in institutionalised populations. Oral health literacy Caregivers Dental Coping Beliefs Scale Education Validation Intervention study Introduction Oral health is an essential component of general health and well-being, particularly among the elderly who are dependent on daily care. In institutional settings, caregivers are primarily responsible for assisting with hygiene routines, including oral hygiene. Therefore, their knowledge, beliefs, and practices are fundamental to ensuring the oral health of residents in long-term care facilities. Poor oral health has been associated with systemic diseases such as cardiovascular disease, diabetes, and respiratory infections, and is recognised as a major determinant of quality of life in older populations ( 1 – 3 ). Despite the recognised importance of oral health care, multiple studies have shown that institutional caregivers often lack adequate training and confidence in providing oral hygiene assistance ( 4 – 6 ). Barriers such as limited education, absence of standardised guidelines, and insufficient institutional support contribute to inconsistent oral care practices and poor outcomes for dependent individuals ( 7 ). As a result, there is a growing need for evidence-based educational interventions that can strengthen caregivers’ knowledge and foster behavioural change regarding oral health maintenance. Health literacy, particularly oral health literacy, is a key determinant of health behaviour. It refers to the ability to access, understand, and apply health information to make appropriate decisions. Low oral health literacy among caregivers can directly affect the quality of preventive care and early disease detection in dependent populations ( 8 ). Therefore, measuring and improving oral health literacy is fundamental to the success of educational programmes in institutional settings. The Dental Coping Beliefs Scale (DCBS), originally developed in English, has been widely used to evaluate individuals’ beliefs and attitudes towards oral health ( 9 ). It assesses psychological constructs such as self-efficacy, locus of control, and perceived importance of oral hygiene practices. However, to the best of our knowledge, no validated Portuguese version had been available for use among caregivers prior to this study. Adapting and validating such an instrument ensures cultural and linguistic relevance, allowing for reliable assessment and comparison across different contexts. Furthermore, educational interventions targeting caregivers have demonstrated positive effects on oral health knowledge and hygiene performance ( 10 – 12 ). Structured training sessions focusing on practical oral care techniques, disease prevention, and motivation can lead to measurable improvements in caregivers’ attitudes and confidence. Nevertheless, few studies have combined the validation of a psychometric tool with the evaluation of a training intervention in the same research design. Therefore, this study aimed to validate the Portuguese version of the Dental Coping Beliefs Scale (DCBS-PT) and assess the impact of an oral health education intervention on the knowledge and beliefs of institutional caregivers. We hypothesised that the DCBS-PT would demonstrate high internal consistency and that participation in the educational intervention would significantly improve caregivers’ oral health literacy and attitudes toward daily care practices. Methods Study design This was a quantitative, quasi-experimental study with a pre- and post-intervention design. It aimed to validate the Portuguese version of the Dental Coping Beliefs Scale (DCBS-PT) and to assess the effectiveness of an oral health education intervention delivered to institutional caregivers. The research followed the ethical principles of the Declaration of Helsinki and received approval by the Health Ethics Committee of the Universidade Católica Portuguesa with the approval number 251 and obtained institutional authorisation from the participating care facilities. Setting and participants The study was conducted between April and May 2024 in two long-term nursing home facilities located in Viseu, central region of Portugal. The target population consisted of institutional caregivers responsible for assisting dependent institutionalized elderly with their daily hygiene routines. The sample was selected through a non-probabilistic convenience sampling method, as recruitment was limited to the two institutions that agreed to participate. The inclusion criteria were: ( 1 ) being employed as a caregiver in one of the selected facilities, ( 2 ) having direct contact with dependent older adults, and ( 3 ) consenting to participate in both the pre- and post-intervention assessments. A total of 44 caregivers participated in the first phase (baseline assessment). The same group was invited to attend the oral health education session and to complete the questionnaire again in the third phase (post-intervention). Participation was voluntary, and all participants provided informed consent. Questionnaire and validation process The Dental Coping Beliefs Scale (DCBS) is a 28-item self-administered instrument designed to assess individuals’ beliefs and attitudes regarding oral health behaviours. It uses a 5-point Likert scale ranging from strongly disagree ( 1 ) to strongly agree ( 5 ). For this study, the original version of the DCBS was translated into Portuguese using a forward–backward translation method by two bilingual experts. A pilot test was performed with a small group of caregivers to ensure semantic and conceptual equivalence. Minor linguistic adjustments were made for clarity and cultural relevance, resulting in the final DCBS-PT version. The psychometric validation included assessment of internal consistency using Cronbach’s alpha, item-total correlations, and construct validity through exploratory analysis of response patterns. Educational intervention Following the initial data collection, an educational session entitled “Oral Health Care for Dependent Patients” was delivered by a dental professional. The session lasted approximately 90 minutes and covered: Basic principles of oral anatomy and physiology; Common oral diseases in dependent older adults; Demonstration of proper oral hygiene techniques (toothbrushing, denture cleaning, use of fluoride products); Recognition of early signs of oral pathology; Practical guidance on communication and motivation strategies. The session combined didactic presentation, visual materials, and hands-on demonstrations using oral care models. Participants were encouraged to share experiences and clarify doubts. Data collection Data were collected in two phases using printed questionnaires: Phase 1 (baseline) — prior to the educational session; Phase 3 (follow-up) — one month after the session, using the same instrument. Sociodemographic and professional data were also collected, including gender, age, years of experience, educational background, area of residence, prior health training and specific oral health education. Data analysis All statistical analyses were performed using IBM SPSS Statistics, version 28.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarise sample characteristics (frequencies, percentages, means, and standard deviations). Internal consistency of the DCBS-PT was evaluated using Cronbach’s alpha coefficient, with values ≥ 0.70 considered acceptable and ≥ 0.90 considered excellent. Comparisons between pre- and post-intervention responses were made using chi-square tests for categorical variables and Wilcoxon signed-rank tests for ordinal data. Statistical significance was set at p < 0.05. Results Sample characteristics A total of 44 institutional caregivers completed the baseline questionnaire. The majority were female (97.7%), aged mainly between 41 and 50 years (34.1%). Most participants lived in rural areas (56.8%) and had a basic education level (52.3%). Over half of the sample (59.1%) reported more than 10 years of professional experience as caregivers (Table 1 ). Table 1 Sociodemographic and professional profile of institutional caregivers (n = 44). Variable Category n % Gender Female 43 97.7 Male 1 2.3 Age (years) 21–30 5 11.4 31–40 9 20.5 41–50 15 34.1 51–60 10 22.7 61–70 5 11.4 Experience as caregiver 10 years 26 59.1 Regarding professional education, 70.5% of the participants had previous training in healthcare fields, primarily in nursing (32.3%) and nutrition (22.6%). Only 29.5% reported specific training in oral health care. Nevertheless, nearly all caregivers (90.9%) considered oral health training essential for their professional duties (Table 2 ). Table 2 Oral health training and hygiene practices applied to residents. Variable Category n % Previous health training Yes 31 70.5 No 13 29.5 Field of training Nursing 10 32.3 Nutrition 7 22.6 Physiotherapy 5 16.1 Medicine 4 12.9 Other 5 16.1 Specific oral health training Yes 13 29.5 No 31 70.5 Considers oral health training important Yes 40 90.9 No 4 9.1 Common oral hygiene practices for residents included the use of family-provided toothbrushes (68.2%), fluoride toothpaste (63.6%), and avoidance of food or drink after night-time cleaning (56.8%). The 28-item DCBS-PT exhibited excellent internal consistency, with a Cronbach’s alpha of 0.942, indicating strong reliability and internal coherence of the instrument. The mean item score was 3.61, ranging from 2.59 to 3.98, reflecting moderately positive beliefs towards oral health care (Table 3 ). Table 3 Reliability and descriptive statistics of the DCBS-PT (n = 44). Parameter Value Number of items 28 Mean item score 3.61 Minimum 2.59 Maximum 3.98 Range 1.39 Variance 0.28 Cronbach’s α 0.942 These findings confirm that the DCBS-PT is a reliable and consistent instrument for assessing oral health beliefs among Portuguese-speaking caregivers. At baseline, caregivers demonstrated generally positive attitudes towards oral health. Most participants strongly agreed that correct toothbrushing prevents dental problems (84.1%) and that oral hygiene training improves care (90.9%). However, misconceptions persisted as 43.2% believed gingival bleeding should stop toothbrushing, and 38.6% were unsure about the impact of systemic diseases on oral health (Table 4 ). Table 4 Selected baseline beliefs and attitudes regarding oral health (n = 44). Statement Strongly disagree (%) Neutral (%) Strongly agree (%) Proper toothbrushing reduces dental problems 0.0 0.0 84.1 Oral health training improves care quality 0.0 2.3 90.9 Gingival bleeding should stop toothbrushing 15.9 20.5 43.2 Diseases and medications do not affect teeth 36.4 15.9 2.3 Oral diseases can be prevented 2.3 11.4 59.1 Following the educational session, improvements were observed across several domains of oral health literacy. Statistically significant differences ( p < 0.05) were found in beliefs related to: The need to assist residents with oral hygiene (Q01, p = 0.005); The controllability of gingival disease (Q14, p = 0.004); Prevention of oral candidiasis (Q15, p = 0.004); Correct management of gingival bleeding (Q26, p = 0.03). These changes indicate a more informed and proactive attitude towards oral health care after the intervention. Table 5 Comparison of key beliefs before and after the educational intervention. Item Belief statement (simplified) p-value Change observed Q01 Recognising need for help with oral hygiene 0.005 Improved awareness Q14 Gingival disease is impossible to control 0.004 Shift towards positive belief Q15 Knows how to prevent oral candidiasis 0.004 Increased confidence Q16 Stop flossing if gums bleed 0.004 Reduction in incorrect belief Q26 Stop brushing if gums bleed 0.03 Significant behavioural correction Q19 Visit dentist only when in pain > 0.05 No significant change Overall, post-intervention responses reflected improved understanding of preventive care and stronger belief in self-efficacy and professional responsibility in maintaining residents’ oral health. The results presented in Table 5 demonstrate a positive impact of the educational intervention on most of the beliefs assessed. A statistically significant improvement was observed in recognising the need for help with oral hygiene (p = 0.005), as well as a favourable shift in the belief that gingival disease is impossible to control (p = 0.004). Participants also showed a significant increase in confidence regarding their knowledge of how to prevent oral candidiasis (p = 0.004). In addition, there was a significant reduction in incorrect beliefs related to discontinuing flossing (p = 0.004) and toothbrushing (p = 0.03) in the presence of gingival bleeding, indicating meaningful behavioural correction. In contrast, the belief that dental visits are only necessary when experiencing pain did not show a statistically significant change following the intervention (p > 0.05) (Table 5 ). Discussion This study validated the Portuguese version of the Dental Coping Beliefs Scale (DCBS-PT) and assessed the impact of an oral health education intervention for institutional caregivers. The results confirmed that the DCBS-PT is a psychometrically robust instrument, and that educational training significantly improved caregivers’ oral health knowledge and beliefs. These findings align with international evidence underscoring the importance of structured training to enhance oral health literacy among healthcare professionals and caregivers ( 1 – 3 ). The DCBS-PT exhibited excellent internal consistency (Cronbach’s α = 0.94), exceeding the thresholds typically accepted for psychological and behavioural measurement tools ( 4 ). This level of reliability suggests that the instrument provides a stable and coherent measure of caregivers’ beliefs across multiple dimensions, such as self-efficacy, perceived control, and attitudes towards preventive care. Similar results have been reported in adaptations of the DCBS in other languages, including Spanish and Japanese versions, supporting the cross-cultural stability of the scale ( 5 , 6 ). The mean item scores indicated a moderately positive baseline orientation towards oral health, which reflects that caregivers already possessed some awareness of the importance of oral hygiene. Nevertheless, the persistence of misconceptions, for instance, regarding the management of gingival bleeding and the role of systemic conditions highlights the need for ongoing professional education. The intervention effectively enhanced participants’ beliefs in key areas of oral health literacy. Notably, significant improvements were observed in understanding disease prevention, controlling gingival inflammation, and recognising the need to assist residents in their oral hygiene. These findings reinforce previous research showing that targeted educational programmes can significantly influence caregivers’ oral health-related attitudes and practices ( 7 – 10 ). Similar interventions conducted in nursing homes have demonstrated that practical, hands-on training coupled with theoretical explanations leads to better oral care practices and increased confidence among staff ( 11 , 12 ). In this study, the combination of visual materials, live demonstrations, and interactive discussion proved particularly effective. Participants reported feeling more capable of identifying oral health problems and implementing preventive strategies, which is consistent with the concept of self-efficacy proposed by Bandura ( 13 ). The results also suggest a positive behavioural shift concerning misconceptions. Prior to the intervention, a considerable proportion of caregivers believed that toothbrushing or flossing should be stopped in case of gingival bleeding. Following the session, these incorrect beliefs decreased significantly ( p = 0.03), demonstrating that short, focused educational actions can achieve measurable cognitive and attitudinal changes. Improved oral health literacy among caregivers is directly associated with better quality of care for dependent older adults ( 14 ). By increasing their knowledge, caregivers are more likely to perform routine oral hygiene procedures correctly, identify early signs of disease, and promote preventive habits. This has broader implications for the overall health of institutionalised populations, as poor oral hygiene has been linked to aspiration pneumonia, malnutrition, and reduced quality of life ( 15 – 17 ). In addition, promoting oral health within care institutions contributes to interdisciplinary collaboration. The findings of this study support the integration of dental professionals into the training and supervision of caregiving teams. This aligns with the World Health Organization’s recommendations on the inclusion of oral health promotion in long-term care strategies ( 18 ). While this study corroborates existing evidence on the positive effects of educational interventions, it also adds value by simultaneously validating a measurement instrument and applying it within a real-world intervention context. Previous studies have often focused solely on knowledge improvement, without ensuring the reliability of the assessment tools used ( 19 ). The present study’s dual approach strengthens the robustness of the findings and provides a reliable framework for future research in Portuguese-speaking contexts. Furthermore, the observed effect sizes and statistical significance (notably in Q14, Q15, and Q26) are comparable to those reported in similar interventions in Scandinavian and Asian populations ( 20 , 21 ). This suggests that the benefits of caregiver education are culturally transferable and not confined to specific healthcare systems. This study presents certain limitations. First, the sample size was relatively small (n = 44) and restricted to two care facilities, which may limit generalisability. Future studies should include a larger and more diverse sample. Second, the follow-up period was short (one month after the intervention), preventing assessment of long-term behavioural changes. Third, the study relied on self-reported data, which are susceptible to social desirability bias. Direct observation or longitudinal monitoring would provide a more objective evaluation of care practices. Despite these limitations, the study’s methodological rigour, use of validated tools, and significant pre-post differences strengthen the reliability of its conclusions. The findings underscore the need for continuous, structured oral health training for institutional caregivers. Educational interventions should be embedded in staff induction and continuing education programmes. Collaboration between dental professionals and long-term care institutions could further improve oral care outcomes, reduce preventable oral diseases, and enhance the well-being of dependent older adults. Conclusions This study successfully validated the Portuguese version of the Dental Coping Beliefs Scale (DCBS-PT) and demonstrated the positive impact of an oral health education intervention on institutional caregivers’ knowledge and beliefs. The DCBS-PT proved to be a reliable and valid tool for assessing oral health literacy in Portuguese-speaking contexts, with excellent internal consistency (Cronbach’s α = 0.94). The educational intervention effectively improved caregivers’ understanding of oral hygiene practices, disease prevention, and professional responsibility in promoting oral health among dependent older adults. Significant post-intervention improvements were observed in key domains of belief and behaviour, such as controlling gingival disease and recognising the need for active oral care support. These results reinforce the value of integrating oral health education into the training of institutional caregivers. Ongoing, structured programmes can enhance care quality, reduce preventable oral diseases, and improve the well-being and dignity of residents in long-term care facilities. Declarations Acknowledgements The authors would like to acknowledge the institutional caregivers in the study and the professionals and responsibles that helped in the data collection. Authors contributions NV, PC MJC and PCL were responsible for the conceptualization and design of the project. NV, PC, KP and RA were responsible for the data collection. NV, HC, SL, IA, KP and RA were responsible for the statistical analysis and contributions to the various analytical approaches and interpretations of data. PCL, PC, SL and JJ drafted the main manuscript and made major contributions to the revising of the manuscript. All authors read and approved the final manuscript submitted. Funding This work is financially supported by National Funds through FCT– Fundação para a Ciência e a Tecnologia, I.P., under the projects UID/04279. Availability of data and materials The data used to generate and support the findings of this study are available from the corresponding author upon request. Human ethics and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research was approved by the Health Ethics Committee of the Universidade Católica Portuguesa (Approval number 251). Written informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The author declares that they have no competing interests. Author details 1 Faculty of Dental Medicine, Universidade Católica Portuguesa, Center of Interdisciplinary Research in Health (CIIS), Viseu, Portugal, 2 Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal. References Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol . 2005;33(2):81–92. Kiyak HA, Reichmuth M. Barriers to and enablers of older adults’ oral health. Gerodontology . 2005;22(1):3–8. Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health . 2012;102(3):411–8. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ . 2011;2:53–5. Bravo M, Cortés FJ, Casals E, Llena C. 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De Visschere LMJ, Vanobbergen JN, Van der Putten GJ, de Baat C, Schols JMGA. An oral health care guideline for institutionalised older people. Gerodontology . 2011;28(4):307–10. Delgado AJ, Prieto L, Herrera D, Sanz M. The impact of educational interventions on caregivers’ oral health knowledge: a systematic review. Int J Dent Hyg . 2021;19(2):121–30. Bandura A. Self-efficacy: Toward a unifying theory of behavioural change. Psychol Rev . 1977;84(2):191–215. Dickson M, Smith K, Hall A. Oral health literacy and its impact on elderly care: a cross-sectional study. BMC Oral Health . 2019;19(1):286. Terpenning MS. Geriatric oral health and pneumonia risk. Clin Infect Dis . 2005;40(12):1807–10. Scannapieco FA, Shay K. Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia. Dent Clin North Am . 2014;58(4):771–82. Watt RG, Daly B, Allison P. Ending the neglect of global oral health: time for radical action. Lancet . 2019;394(10194):261–72. World Health Organization. Oral health: action plan for promotion and integrated disease prevention . Geneva: WHO; 2022. Harada S, Hirano H, Saito T, et al. Effects of an oral health education program on caregivers’ knowledge and practices in long-term care institutions. Gerodontology . 2018;35(4):348–55. Wong FMF, Ng YTY, Leung WK. Oral health and its associated factors among older institutionalised residents – a systematic review. Int J Environ Res Public Health . 2019;16(21):4132. Naito M, Ozeki M, Ogawa H, et al. The impact of a caregiver training program on oral health care of elderly residents: a cluster randomised trial. Community Dent Oral Epidemiol . 2018;46(6):610–7. Additional Declarations No competing interests reported. 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In institutional settings, caregivers are primarily responsible for assisting with hygiene routines, including oral hygiene. Therefore, their knowledge, beliefs, and practices are fundamental to ensuring the oral health of residents in long-term care facilities. Poor oral health has been associated with systemic diseases such as cardiovascular disease, diabetes, and respiratory infections, and is recognised as a major determinant of quality of life in older populations (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the recognised importance of oral health care, multiple studies have shown that institutional caregivers often lack adequate training and confidence in providing oral hygiene assistance (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Barriers such as limited education, absence of standardised guidelines, and insufficient institutional support contribute to inconsistent oral care practices and poor outcomes for dependent individuals (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). As a result, there is a growing need for evidence-based educational interventions that can strengthen caregivers\u0026rsquo; knowledge and foster behavioural change regarding oral health maintenance.\u003c/p\u003e \u003cp\u003eHealth literacy, particularly oral health literacy, is a key determinant of health behaviour. It refers to the ability to access, understand, and apply health information to make appropriate decisions. Low oral health literacy among caregivers can directly affect the quality of preventive care and early disease detection in dependent populations (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Therefore, measuring and improving oral health literacy is fundamental to the success of educational programmes in institutional settings.\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS), originally developed in English, has been widely used to evaluate individuals\u0026rsquo; beliefs and attitudes towards oral health (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It assesses psychological constructs such as self-efficacy, locus of control, and perceived importance of oral hygiene practices. However, to the best of our knowledge, no validated Portuguese version had been available for use among caregivers prior to this study. Adapting and validating such an instrument ensures cultural and linguistic relevance, allowing for reliable assessment and comparison across different contexts.\u003c/p\u003e \u003cp\u003eFurthermore, educational interventions targeting caregivers have demonstrated positive effects on oral health knowledge and hygiene performance (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Structured training sessions focusing on practical oral care techniques, disease prevention, and motivation can lead to measurable improvements in caregivers\u0026rsquo; attitudes and confidence. Nevertheless, few studies have combined the validation of a psychometric tool with the evaluation of a training intervention in the same research design.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to validate the Portuguese version of the \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS-PT) and assess the impact of an oral health education intervention on the knowledge and beliefs of institutional caregivers. We hypothesised that the DCBS-PT would demonstrate high internal consistency and that participation in the educational intervention would significantly improve caregivers\u0026rsquo; oral health literacy and attitudes toward daily care practices.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis was a quantitative, quasi-experimental study with a pre- and post-intervention design. It aimed to validate the Portuguese version of the \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS-PT) and to assess the effectiveness of an oral health education intervention delivered to institutional caregivers. The research followed the ethical principles of the Declaration of Helsinki and received approval by the Health Ethics Committee of the Universidade Cat\u0026oacute;lica Portuguesa with the approval number 251 and obtained institutional authorisation from the participating care facilities.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted between April and May 2024 in two long-term nursing home facilities located in Viseu, central region of Portugal. The target population consisted of institutional caregivers responsible for assisting dependent institutionalized elderly with their daily hygiene routines.\u003c/p\u003e \u003cp\u003e The sample was selected through a non-probabilistic convenience sampling method, as recruitment was limited to the two institutions that agreed to participate. The inclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) being employed as a caregiver in one of the selected facilities, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) having direct contact with dependent older adults, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) consenting to participate in both the pre- and post-intervention assessments.\u003c/p\u003e \u003cp\u003eA total of 44 caregivers participated in the first phase (baseline assessment). The same group was invited to attend the oral health education session and to complete the questionnaire again in the third phase (post-intervention). Participation was voluntary, and all participants provided informed consent.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire and validation process\u003c/h3\u003e\n\u003cp\u003eThe \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS) is a 28-item self-administered instrument designed to assess individuals\u0026rsquo; beliefs and attitudes regarding oral health behaviours. It uses a 5-point Likert scale ranging from \u003cem\u003estrongly disagree\u003c/em\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) to \u003cem\u003estrongly agree\u003c/em\u003e (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor this study, the original version of the DCBS was translated into Portuguese using a forward\u0026ndash;backward translation method by two bilingual experts. A pilot test was performed with a small group of caregivers to ensure semantic and conceptual equivalence. Minor linguistic adjustments were made for clarity and cultural relevance, resulting in the final DCBS-PT version.\u003c/p\u003e \u003cp\u003eThe psychometric validation included assessment of internal consistency using Cronbach\u0026rsquo;s alpha, item-total correlations, and construct validity through exploratory analysis of response patterns.\u003c/p\u003e\n\u003ch3\u003eEducational intervention\u003c/h3\u003e\n\u003cp\u003eFollowing the initial data collection, an educational session entitled \u003cem\u003e\u0026ldquo;Oral Health Care for Dependent Patients\u0026rdquo;\u003c/em\u003e was delivered by a dental professional. The session lasted approximately 90 minutes and covered:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBasic principles of oral anatomy and physiology;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCommon oral diseases in dependent older adults;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDemonstration of proper oral hygiene techniques (toothbrushing, denture cleaning, use of fluoride products);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRecognition of early signs of oral pathology;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePractical guidance on communication and motivation strategies.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e The session combined didactic presentation, visual materials, and hands-on demonstrations using oral care models. Participants were encouraged to share experiences and clarify doubts.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected in two phases using printed questionnaires:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePhase 1 (baseline) \u0026mdash; prior to the educational session;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePhase 3 (follow-up) \u0026mdash; one month after the session, using the same instrument.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSociodemographic and professional data were also collected, including gender, age, years of experience, educational background, area of residence, prior health training and specific oral health education.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics, version 28.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarise sample characteristics (frequencies, percentages, means, and standard deviations).\u003c/p\u003e \u003cp\u003eInternal consistency of the DCBS-PT was evaluated using Cronbach\u0026rsquo;s alpha coefficient, with values\u0026thinsp;\u0026ge;\u0026thinsp;0.70 considered acceptable and \u0026ge;\u0026thinsp;0.90 considered excellent.\u003c/p\u003e \u003cp\u003eComparisons between pre- and post-intervention responses were made using chi-square tests for categorical variables and Wilcoxon signed-rank tests for ordinal data. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eA total of 44 institutional caregivers completed the baseline questionnaire. The majority were female (97.7%), aged mainly between 41 and 50 years (34.1%). Most participants lived in rural areas (56.8%) and had a basic education level (52.3%). Over half of the sample (59.1%) reported more than 10 years of professional experience as caregivers (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and professional profile of institutional caregivers (n\u0026thinsp;=\u0026thinsp;44).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperience as caregiver\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding professional education, 70.5% of the participants had previous training in healthcare fields, primarily in nursing (32.3%) and nutrition (22.6%). Only 29.5% reported specific training in oral health care. Nevertheless, nearly all caregivers (90.9%) considered oral health training essential for their professional duties (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOral health training and hygiene practices applied to residents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious health training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eField of training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecific oral health training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsiders oral health training important\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCommon oral hygiene practices for residents included the use of family-provided toothbrushes (68.2%), fluoride toothpaste (63.6%), and avoidance of food or drink after night-time cleaning (56.8%).\u003c/p\u003e \u003cp\u003eThe 28-item DCBS-PT exhibited excellent internal consistency, with a Cronbach\u0026rsquo;s alpha of 0.942, indicating strong reliability and internal coherence of the instrument. The mean item score was 3.61, ranging from 2.59 to 3.98, reflecting moderately positive beliefs towards oral health care (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReliability and descriptive statistics of the DCBS-PT (n\u0026thinsp;=\u0026thinsp;44).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of items\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean item score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.942\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThese findings confirm that the DCBS-PT is a reliable and consistent instrument for assessing oral health beliefs among Portuguese-speaking caregivers.\u003c/p\u003e \u003cp\u003e At baseline, caregivers demonstrated generally positive attitudes towards oral health. Most participants strongly agreed that correct toothbrushing prevents dental problems (84.1%) and that oral hygiene training improves care (90.9%). However, misconceptions persisted as 43.2% believed gingival bleeding should stop toothbrushing, and 38.6% were unsure about the impact of systemic diseases on oral health (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSelected baseline beliefs and attitudes regarding oral health (n\u0026thinsp;=\u0026thinsp;44).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly disagree (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeutral (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStrongly agree (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProper toothbrushing reduces dental problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral health training improves care quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGingival bleeding should stop toothbrushing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiseases and medications do not affect teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral diseases can be prevented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFollowing the educational session, improvements were observed across several domains of oral health literacy. Statistically significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were found in beliefs related to:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe need to assist residents with oral hygiene (Q01, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe controllability of gingival disease (Q14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePrevention of oral candidiasis (Q15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCorrect management of gingival bleeding (Q26, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eThese changes indicate a more informed and proactive attitude towards oral health care after the intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of key beliefs before and after the educational intervention.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelief statement (simplified)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChange observed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecognising need for help with oral hygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImproved awareness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGingival disease is impossible to control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eShift towards positive belief\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnows how to prevent oral candidiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased confidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStop flossing if gums bleed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReduction in incorrect belief\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStop brushing if gums bleed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant behavioural correction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVisit dentist only when in pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo significant change\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOverall, post-intervention responses reflected improved understanding of preventive care and stronger belief in self-efficacy and professional responsibility in maintaining residents\u0026rsquo; oral health. The results presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e demonstrate a positive impact of the educational intervention on most of the beliefs assessed. A statistically significant improvement was observed in recognising the need for help with oral hygiene (p\u0026thinsp;=\u0026thinsp;0.005), as well as a favourable shift in the belief that gingival disease is impossible to control (p\u0026thinsp;=\u0026thinsp;0.004). Participants also showed a significant increase in confidence regarding their knowledge of how to prevent oral candidiasis (p\u0026thinsp;=\u0026thinsp;0.004). In addition, there was a significant reduction in incorrect beliefs related to discontinuing flossing (p\u0026thinsp;=\u0026thinsp;0.004) and toothbrushing (p\u0026thinsp;=\u0026thinsp;0.03) in the presence of gingival bleeding, indicating meaningful behavioural correction. In contrast, the belief that dental visits are only necessary when experiencing pain did not show a statistically significant change following the intervention (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study validated the Portuguese version of the \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS-PT) and assessed the impact of an oral health education intervention for institutional caregivers. The results confirmed that the DCBS-PT is a psychometrically robust instrument, and that educational training significantly improved caregivers\u0026rsquo; oral health knowledge and beliefs. These findings align with international evidence underscoring the importance of structured training to enhance oral health literacy among healthcare professionals and caregivers (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe DCBS-PT exhibited excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.94), exceeding the thresholds typically accepted for psychological and behavioural measurement tools (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This level of reliability suggests that the instrument provides a stable and coherent measure of caregivers\u0026rsquo; beliefs across multiple dimensions, such as self-efficacy, perceived control, and attitudes towards preventive care. Similar results have been reported in adaptations of the DCBS in other languages, including Spanish and Japanese versions, supporting the cross-cultural stability of the scale (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The mean item scores indicated a moderately positive baseline orientation towards oral health, which reflects that caregivers already possessed some awareness of the importance of oral hygiene. Nevertheless, the persistence of misconceptions, for instance, regarding the management of gingival bleeding and the role of systemic conditions highlights the need for ongoing professional education.\u003c/p\u003e \u003cp\u003eThe intervention effectively enhanced participants\u0026rsquo; beliefs in key areas of oral health literacy. Notably, significant improvements were observed in understanding disease prevention, controlling gingival inflammation, and recognising the need to assist residents in their oral hygiene. These findings reinforce previous research showing that targeted educational programmes can significantly influence caregivers\u0026rsquo; oral health-related attitudes and practices (\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilar interventions conducted in nursing homes have demonstrated that practical, hands-on training coupled with theoretical explanations leads to better oral care practices and increased confidence among staff (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the combination of visual materials, live demonstrations, and interactive discussion proved particularly effective. Participants reported feeling more capable of identifying oral health problems and implementing preventive strategies, which is consistent with the concept of self-efficacy proposed by Bandura (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results also suggest a positive behavioural shift concerning misconceptions. Prior to the intervention, a considerable proportion of caregivers believed that toothbrushing or flossing should be stopped in case of gingival bleeding. Following the session, these incorrect beliefs decreased significantly (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03), demonstrating that short, focused educational actions can achieve measurable cognitive and attitudinal changes.\u003c/p\u003e \u003cp\u003eImproved oral health literacy among caregivers is directly associated with better quality of care for dependent older adults (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). By increasing their knowledge, caregivers are more likely to perform routine oral hygiene procedures correctly, identify early signs of disease, and promote preventive habits. This has broader implications for the overall health of institutionalised populations, as poor oral hygiene has been linked to aspiration pneumonia, malnutrition, and reduced quality of life (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, promoting oral health within care institutions contributes to interdisciplinary collaboration. The findings of this study support the integration of dental professionals into the training and supervision of caregiving teams. This aligns with the World Health Organization\u0026rsquo;s recommendations on the inclusion of oral health promotion in long-term care strategies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile this study corroborates existing evidence on the positive effects of educational interventions, it also adds value by simultaneously validating a measurement instrument and applying it within a real-world intervention context. Previous studies have often focused solely on knowledge improvement, without ensuring the reliability of the assessment tools used (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The present study\u0026rsquo;s dual approach strengthens the robustness of the findings and provides a reliable framework for future research in Portuguese-speaking contexts.\u003c/p\u003e \u003cp\u003eFurthermore, the observed effect sizes and statistical significance (notably in Q14, Q15, and Q26) are comparable to those reported in similar interventions in Scandinavian and Asian populations (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This suggests that the benefits of caregiver education are culturally transferable and not confined to specific healthcare systems.\u003c/p\u003e \u003cp\u003eThis study presents certain limitations. First, the sample size was relatively small (n\u0026thinsp;=\u0026thinsp;44) and restricted to two care facilities, which may limit generalisability. Future studies should include a larger and more diverse sample. Second, the follow-up period was short (one month after the intervention), preventing assessment of long-term behavioural changes. Third, the study relied on self-reported data, which are susceptible to social desirability bias. Direct observation or longitudinal monitoring would provide a more objective evaluation of care practices.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study\u0026rsquo;s methodological rigour, use of validated tools, and significant pre-post differences strengthen the reliability of its conclusions.\u003c/p\u003e \u003cp\u003eThe findings underscore the need for continuous, structured oral health training for institutional caregivers. Educational interventions should be embedded in staff induction and continuing education programmes. Collaboration between dental professionals and long-term care institutions could further improve oral care outcomes, reduce preventable oral diseases, and enhance the well-being of dependent older adults.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study successfully validated the Portuguese version of the \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS-PT) and demonstrated the positive impact of an oral health education intervention on institutional caregivers\u0026rsquo; knowledge and beliefs. The DCBS-PT proved to be a reliable and valid tool for assessing oral health literacy in Portuguese-speaking contexts, with excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.94).\u003c/p\u003e \u003cp\u003e The educational intervention effectively improved caregivers\u0026rsquo; understanding of oral hygiene practices, disease prevention, and professional responsibility in promoting oral health among dependent older adults. Significant post-intervention improvements were observed in key domains of belief and behaviour, such as controlling gingival disease and recognising the need for active oral care support.\u003c/p\u003e \u003cp\u003eThese results reinforce the value of integrating oral health education into the training of institutional caregivers. Ongoing, structured programmes can enhance care quality, reduce preventable oral diseases, and improve the well-being and dignity of residents in long-term care facilities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the institutional caregivers in the study and the professionals and responsibles that helped in the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNV, PC MJC and PCL were responsible for the conceptualization and design of the project. NV, PC, KP and RA were responsible for the data collection. NV, HC, SL, IA, KP and RA were responsible for the statistical analysis and contributions to the various analytical approaches and interpretations of data. PCL, PC, SL and JJ drafted the main manuscript and made major contributions to the revising of the manuscript. All authors read and approved the final manuscript submitted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is financially supported by National Funds through FCT– Fundação para a Ciência e a Tecnologia, I.P., under the projects UID/04279.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to generate and support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research was approved by the Health Ethics Committee of the Universidade Católica Portuguesa (Approval number 251). Written informed consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eFaculty of Dental Medicine, Universidade Católica Portuguesa, Center of Interdisciplinary Research in Health (CIIS), Viseu, Portugal, \u003csup\u003e2\u003c/sup\u003eFaculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePetersen PE, Yamamoto T. 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Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia.\u0026nbsp;\u003cem\u003eDent Clin North Am\u003c/em\u003e. 2014;58(4):771\u0026ndash;82.\u003c/li\u003e\n \u003cli\u003eWatt RG, Daly B, Allison P. Ending the neglect of global oral health: time for radical action.\u0026nbsp;\u003cem\u003eLancet\u003c/em\u003e. 2019;394(10194):261\u0026ndash;72.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. \u003cem\u003eOral health: action plan for promotion and integrated disease prevention\u003c/em\u003e.\u0026nbsp;Geneva: WHO; 2022.\u003c/li\u003e\n \u003cli\u003eHarada S, Hirano H, Saito T, et al. Effects of an oral health education program on caregivers\u0026rsquo; knowledge and practices in long-term care institutions.\u0026nbsp;\u003cem\u003eGerodontology\u003c/em\u003e. 2018;35(4):348\u0026ndash;55.\u003c/li\u003e\n \u003cli\u003eWong FMF, Ng YTY, Leung WK. Oral health and its associated factors among older institutionalised residents \u0026ndash; a systematic review. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e. 2019;16(21):4132.\u003c/li\u003e\n \u003cli\u003eNaito M, Ozeki M, Ogawa H, et al. The impact of a caregiver training program on oral health care of elderly residents: a cluster randomised trial. \u003cem\u003eCommunity Dent Oral Epidemiol\u003c/em\u003e. 2018;46(6):610\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oral health literacy, Caregivers, Dental Coping Beliefs Scale, Education, Validation, Intervention study","lastPublishedDoi":"10.21203/rs.3.rs-8451681/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8451681/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOral health literacy among institutional caregivers plays a critical role in maintaining and improving the oral health of dependent older adults. However, training opportunities for caregivers in this field remain limited, and validated instruments to assess their oral health beliefs and practices are scarce. This study aimed to validate the Portuguese version of the \u003cem\u003eDental Coping Beliefs Scale\u003c/em\u003e (DCBS-PT) and to evaluate the impact of an educational intervention on caregivers\u0026rsquo; knowledge and beliefs regarding oral health care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quasi-experimental study was conducted among 44 institutional caregivers of institutionalized elderly from two nursing home facilities in Viseu, in the central region of Portugal. Participants completed the DCBS-PT before and after an oral health educational session. Descriptive and inferential analyses were performed using SPSS 28.0, including reliability analysis (Cronbach\u0026rsquo;s alpha) and comparison of pre- and post-intervention responses through chi-square and Wilcoxon tests. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study population consisted predominantly of female caregivers (97.7%), with a mean age between 41 and 50 years. Most had more than 10 years of professional experience, and 70.5% reported prior training in healthcare. The DCBS-PT demonstrated high internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.94). Significant improvements were observed in key domains of oral health literacy after the intervention, particularly regarding beliefs about gingival disease control (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), prevention of oral candidiasis (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), and correct response to gingival bleeding during hygiene (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe DCBS-PT showed strong psychometric properties and can be reliably applied among Portuguese-speaking caregivers. The educational intervention effectively improved caregivers\u0026rsquo; awareness and understanding of oral health care, highlighting the importance of continuous education for enhancing oral health outcomes in institutionalised populations.\u003c/p\u003e","manuscriptTitle":"Impact of an Oral Health Education Intervention on Informal Caregivers: Validation and Application of the Portuguese Dental Coping Beliefs Scale - DCBS-PT","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 08:39:40","doi":"10.21203/rs.3.rs-8451681/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-28T20:24:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120553892693094365714054252263885711693","date":"2026-01-17T11:13:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13344993888072906187726284319401930740","date":"2026-01-14T16:46:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T11:27:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-02T05:32:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-02T05:30:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-12-26T02:54:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"612e07ad-8f83-4199-b10e-1244e4022a06","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T08:39:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 08:39:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8451681","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8451681","identity":"rs-8451681","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}