Oral Health Service Utilization Behavior among Older Adults: Development and Validation of a Composite Behavioral Model-Based Questionnaire

Oral Health Service Utilization Behavior among Older Adults: Development and Validation of a Composite Behavioral Model-Based Questionnaire | 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 Oral Health Service Utilization Behavior among Older Adults: Development and Validation of a Composite Behavioral Model-Based Questionnaire Xiaoyuan Pan, Shuwen Su, Jianli Li, Leyi Han, Xinyue Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6875885/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Effective oral health service utilization is critical for healthy aging, yet elderly populations in China underutilize dental care. This study aimed to develop and validate a theoretically grounded questionnaire assessing oral health service utilization behavior and its determinants among community-dwelling older adults. Methods We integrated the health belief model (HBM) and theory of planned behavior (TPB) to construct a composite theoretical framework. The 20-item questionnaire was developed through (1) literature synthesis of validated HBM/TPB instruments; (2) expert consultations (n = 8) for content validity; (3) pilot testing (n = 30) to assess questionnaire comprehensibility, structural validity, and logical coherence; and (4) psychometric validation via a cross-sectional study. A convenience sample of 352 older adults (60 + years) from Guangdong Province communities completed the survey between July and September 2023. Item analysis, exploratory factor analysis (EFA), and reliability testing were performed via SPSS. Results EFA revealed a 5-factor structure (behavior, perceived benefits, perceived threats, subjective norms, and behavioral intentions/controls) explaining 62.6% of the total variance, with factor loadings ranging from 0.517–0.829. The instrument demonstrated strong internal consistency (Cronbach’s α = 0.864) and acceptable split-half reliability (Spearman-Brown coefficient = 0.712). ​All the subscales exhibited satisfactory Cronbach’s α values (range: 0.793–0.864), exceeding the 0.700 threshold for internal consistency.Initial validation confirmed structural alignment with the composite theoretical model. Conclusion This psychometrically robust tool bridges a critical gap in geriatric oral health research by integrating HBM/TPB constructs. It enables systematic assessment of modifiable behavioral determinants, informing targeted interventions to improve dental service utilization among aging populations. Further multiregional validation is recommended to increase generalizability. Elderly oral health Health service utilization Questionnaire validation Health belief model Theory of planned behavior Composite behavioral model Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialS1EnglishVersionofOralHealthServiceUtilizationBehaviorQuestionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Editor invited by journal 26 Nov, 2025 Reviews received at journal 06 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers invited by journal 28 Sep, 2025 Editor assigned by journal 26 Jun, 2025 Submission checks completed at journal 25 Jun, 2025 First submitted to journal 25 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6875885","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526701938,"identity":"892c6e55-7602-4882-8dd9-cd4f1dd236f1","order_by":0,"name":"Xiaoyuan Pan","email":"","orcid":"","institution":"Foshan Universit","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyuan","middleName":"","lastName":"Pan","suffix":""},{"id":526701940,"identity":"704fff9e-d0a9-4541-a942-91c311f32d8a","order_by":1,"name":"Shuwen 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Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Elderly oral health, Health service utilization, Questionnaire validation, Health belief model, Theory of planned behavior, Composite behavioral model","lastPublishedDoi":"10.21203/rs.3.rs-6875885/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6875885/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEffective oral health service utilization is critical for healthy aging, yet elderly populations in China underutilize dental care. This study aimed to develop and validate a theoretically grounded questionnaire assessing oral health service utilization behavior and its determinants among community-dwelling older adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe integrated the health belief model (HBM) and theory of planned behavior (TPB) to construct a composite theoretical framework. The 20-item questionnaire was developed through (1) literature synthesis of validated HBM/TPB instruments; (2) expert consultations (n\u0026thinsp;=\u0026thinsp;8) for content validity; (3) pilot testing (n\u0026thinsp;=\u0026thinsp;30) to assess questionnaire comprehensibility, structural validity, and logical coherence; and (4) psychometric validation via a cross-sectional study. A convenience sample of 352 older adults (60\u0026thinsp;+\u0026thinsp;years) from Guangdong Province communities completed the survey between July and September 2023. Item analysis, exploratory factor analysis (EFA), and reliability testing were performed via SPSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEFA revealed a 5-factor structure (behavior, perceived benefits, perceived threats, subjective norms, and behavioral intentions/controls) explaining 62.6% of the total variance, with factor loadings ranging from 0.517\u0026ndash;0.829. The instrument demonstrated strong internal consistency (Cronbach\u0026rsquo;s \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.864) and acceptable split-half reliability (Spearman-Brown coefficient\u0026thinsp;=\u0026thinsp;0.712). ​All the subscales exhibited satisfactory Cronbach\u0026rsquo;s \u003cem\u003eα\u003c/em\u003e values (range: 0.793\u0026ndash;0.864), exceeding the 0.700 threshold for internal consistency.Initial validation confirmed structural alignment with the composite theoretical model.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis psychometrically robust tool bridges a critical gap in geriatric oral health research by integrating HBM/TPB constructs. It enables systematic assessment of modifiable behavioral determinants, informing targeted interventions to improve dental service utilization among aging populations. 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