title: Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial.
abstract: Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia.
  
  
  
  The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on "general intention" of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB).
  
  
  
  A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: "attitude," "subjective norm" (SN), "perceived behavior control" (PBC), "general intention" (GI), and "knowledge" related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention.
  
  
  
  The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (P<.001) and knowledge (P=.001) between the test and control groups. Regression analyses identified that the key factors associated with a change in GI at 6 months were changes in SN (beta=.36, P<.001) and changes in PBC (beta=.23, P<.001).
  
  
  
  The Web-based CPD program based on TPB increased general intention, attitudes, subjective norms, and knowledge to provide oral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care.
  
  
  
  National Medical Research Register, Malaysia NMRR-13-1540-18833 (IIR); https://www.nmrr.gov.my/ fwbLoginPage.jsp.
authors.affiliation: Periodontology and Dental Public Health, The University of Hong Kong, Hong Kong SAR, China.|Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia.
authors.forename: Normaliza
authors.identifier: 0000-0002-0423-0837
authors.initials: N
authors.lastname: Ab Malik
authors.affiliation: Hospital Serdang, Department of Rehabilitation Medicine, Selangor, Malaysia.
authors.forename: Sa'ari
authors.identifier: 0000-0002-3451-7804
authors.initials: S
authors.lastname: Mohamad Yatim
authors.affiliation: Department of Oral Rehabilitation, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Otto Lok Tao
authors.identifier: 0000-0002-7973-3914
authors.initials: OL
authors.lastname: Lam
authors.affiliation: Periodontology and Dental Public Health, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Lijian
authors.identifier: 0000-0003-4305-1337
authors.initials: L
authors.lastname: Jin
authors.affiliation: Periodontology and Dental Public Health, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Colman Patrick Joseph
authors.identifier: 0000-0001-9379-0889
authors.initials: CP
authors.lastname: McGrath
mesh_terms: D003625:Data Collection; D004311:Double-Blind Method; D004506:Education, Nursing / Q000379:methods; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D009910:Oral Hygiene / Q000193:education*; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D017741:Survivors
keywords: cerebrovascular accident; computer-aided learning; health care providers, Internet; oral hygiene; theory of planned behavior