title: Does self-efficacy mediate the effect of oral health literacy on self-rated oral health in an Indigenous population?
abstract: Mediation analyses are critical to understanding why behavioral interventions work. Health literacy is a known mediator between socio-economic factors, health behavior and oral health outcomes in various populations, explaining gradients in oral health status and outcomes. We explore whether self-efficacy (SE) mediates the association between oral health literacy (OHL) and self-rated oral health (SROH) in an Indigenous population.
  
  
  
  Cross-sectional data collected from 278 rural-dwelling Indigenous Australians evaluated OHL, SE, SROH, socio-demographic and behavioral characteristics. OHL was measured using a validated OHL scale (HeLD-14), SE was measured using a validated SE scale and SROH was measured using a global, one-item statement. Theoretically-driven multivariable models, adjusted for age, sex, income, education, and dental service use estimated the prevalence ratios (PR) and 95 percent confidence intervals for poor SROH.
  
  
  
  The overall prevalence of poor SROH was 78.8 percent. The prevalence of low OHL was 46.0 percent, while the prevalence of low SE was 56.8 percent. Analysis showed a significant main effect of SE (PR = 2.5, 95 percent CI 1.3-4.6). SE attenuated the effects of OHL on poor SROH (from PR = 2.4 to PR = 2.0), supporting its associated role in the Indigenous population under study. Sobel and bootstrap testing confirmed the significance of the mediating effect (z = 2.2, SE 0.30, P < 0.05) and 95 percent CI (0.11-0.07) (P < 0.05) respectively.
  
  
  
  Given that SE is a construct amenable to change, our results suggest that interventions that aim to improve SE may have positive impacts on SROH among this vulnerable population.
authors.affiliation: Dental School, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Jones
authors.affiliation: Dental School, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: David S
authors.initials: DS
authors.lastname: Brennan
authors.affiliation: Dental School, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Eleanor Jane
authors.initials: EJ
authors.lastname: Parker
authors.affiliation: Dental School, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Mills
authors.affiliation: Dental School, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D020377:Self Efficacy; D013021:South Australia
keywords: indigenous; oral health; oral health literacy; self-efficacy