Oral health literacy as a key strategy for managing oral frailty - insights from a mediation model

Q: How was oral health literacy (OHL) examined in relation to oral frailty (OF)?

OHL was measured using the Chinese version of the Health Literacy in Dentistry scale (HeLD-14). Associations with OF were tested, and structural equation modeling assessed the proposed pathways.

Q: Did oral health behavior mediate the relationship between OHL and OF?

No. Although OHL was positively associated with oral health behavior and negatively associated with OF, oral health behavior was not significantly correlated with OF, and the mediation role was not supported.

Sep 28, 2026

Uploaded by jay

Oral frailty (OF) is a progressive decline in oral function closely tied to aging and worsening general health. Oral health literacy (OHL) is a modifiable factor linked to oral outcomes, yet the pathway from OHL to OF remains unclear, especially whether oral health behavior mediates this relationship. A cross-sectional study recruited 425 adults aged 60+ in four Chinese communities and used questionnaires and structural equation modeling with bootstrapping to test the mediation model. OHL showed a negative association with OF, but oral health behavior did not significantly correlate with OF; mediation was not supported. The study reports a significant direct effect of OHL on OF.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Background

Methods

Results

Keywords

Background (Introduction)

Oral frailty concept and need for mechanisms

Yu et al. BMC Geriatrics (2026) 26:2 [https://doi.org/10.1186/s12877-025-06442-2](https://doi.org/10.1186/s12877-025-06442-2) BMC Geriatrics RESEARCH Open Access Oral health literacy as a key strategy for managing oral frailty: insights from a mediation model Shiqi Yu 1, Xin Zeng 1, Shuqi Huang 1, Yi Mao2* and Fan Liu 1* Abstract Background Oral frailty (OF) is a progressive decline in oral function closely linked to aging and general health deterioration. As a modifiable factor, oral health literacy (OHL) is increasingly recognized for its influence on oral health outcomes. However, the mechanism by which OHL affects OF remains unclear, particularly regarding the potential mediating role of oral health behavior. Methods A cross-sectional study was conducted from September to November 2024 in four Chinese communities. A total of 425 older adults (aged ≥ 60 years) were recruited via convenience sampling. Participants completed a structured questionnaire comprising demographic data, the Chinese version of the Health Literacy in Dentistry scale (HeLD-14), an oral health behavior scale, and the Oral Frailty Index-8 (OFI-8) . Descriptive statistics, Pearson’s correlation, And univariate Analyses were conducted using SPSS 22.0. Structural equation modeling (SEM) and bootstrapping (Amos 21 . 0) were used to assess the mediating role of oral health behavior. Results Participants had a mean age of 70.62 ± 7.04 years; 59 . 5% were female, And 77. 9% had at least one chronic condition. The prevalence of high OF risk was 64 . 5% . OHL was negatively associated with OF (r = -0 . 13, p < 0. 01) and positively associated with oral health behavior (r = 0 . 16, p < 0. 01) . However, oral health behavior was not significantly correlated with OF. SEM revealed a significant direct effect of OHL on OF (β = -0 . 32, 95% CI: -0.06 to-0 . 009, p = 0 . 006), while the mediating role of oral health behavior was not supported. Keywords Oral health literacy, Oral frailty, Oral health behavior *Correspondence: Yi Mao Maoyi [1994@126.com](1994@126.com) Fan Liu [samotj@163.com](samotj@163.com) 1State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. Of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China 2National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China Background With rising global life expectancy and demographic expansion, population aging has emerged as one of the most pressing public health challenges. Among health domains affected by aging, oral health has received increasing attention for its integral role in preserving quality of life, functionality, and systemic health in older adults [1]. Geriatric research has increasingly linked poor oral health to a spectrum of age-related conditions, including physical frailty [Slashcheva], sarcopenia [2], cognitive decline [3], and multimorbidity [4]. These associations underscore the emerging concept of oral frailty © The Author(s) 2025, corrected publication 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercialNoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your int

FAQs

What is oral frailty and why is it important?

Oral frailty (OF) is a progressive decline in oral function associated with aging and broader health deterioration. It is linked to adverse outcomes such as functional dependency, nutritional deficits, long-term care needs, and premature mortality.

How was oral health literacy (OHL) examined in relation to oral frailty (OF)?

OHL was measured using the Chinese version of the Health Literacy in Dentistry scale (HeLD-14). Associations with OF were tested, and structural equation modeling assessed the proposed pathways.

Did oral health behavior mediate the relationship between OHL and OF?

No. Although OHL was positively associated with oral health behavior and negatively associated with OF, oral health behavior was not significantly correlated with OF, and the mediation role was not supported.

Sep 28, 2026

Uploaded by jay