Bivariate Analysis of a School-based Sense of Coherence Intervention on Oral Health-related Quality of Life of Adolescents in Malaysia
DOI:
https://doi.org/10.24191/cos.v13i2.10179Keywords:
adolescents, oral health-related quality of life, SOC-based intervention, sense of coherence, oral health behaviourAbstract
Objectives: This study aimed to investigate the effect of a school-based SOC intervention on adolescents’ oral health-related quality of life (OHRQoL). Materials and Methods: A quasi-experimental study was conducted among 442 secondary school students aged 14 years from eight schools in Hulu Langat, Selangor, who were assigned to intervention and control groups. Data were collected at baseline and three months post-intervention using validated instruments for SOC (SOC-13) and OHRQoL (CPQ 11-14). Bivariate analyses, including paired and independent t-tests, were performed to assess within-group and between-group differences. Results: Changes in SOC scores were not statistically significant in either group over the study period. However, the intervention group demonstrated significant improvements in OHRQoL domains, particularly functional limitation (p<0.01), emotional wellbeing (p<0.01), and social wellbeing (p<0.01), with a greater magnitude of change compared with the control group. Conclusions: The SOC-based intervention demonstrated early improvement in adolescents’ OHRQoL despite minimal short-term changes in SOC. These findings suggest that psychosocial-based oral health interventions may yield measurable quality-of-life benefits before detectable changes in underlying psychological constructs. A longer intervention period is likely required to strengthen SOC and sustain behavioural outcomes.
References
Ab Mumin, N., Yusof, Z. Y. M., Marhazlinda, J., & Obaidellah, U. (2021). Exploring the opinions of secondary school students on the strengths and weaknesses of the school dental service in Selangor, Malaysia: a qualitative study. BMC Oral Health, 21, 1-9. https://doi.org/10.1186/s12903-021-01741-7.
Alvarez-Azaustre, M. P., Greco, R., & Llena, C. (2021). Oral health-related quality of life in adolescents as measured with the Child-OIDP questionnaire: a systematic review. International journal of environmental research and public health, 18(24), 12995. https://doi.org/10.3390/ijerph182412995.
Antonovsky, A. (1979). Health, stress, and coping. New perspectives on mental and physical well-being, 12-37.Antonovsky, A. (1979). Health, stress, and coping. New perspectives on mental and physical well-being, 12-37. https://doi.org/10.1017/S003329170005371X.
Antonovsky, A. (1987). Health promoting factors at work: The sense of coherence. Psychosocial factors at work and their relation to health, 153-167. https://iris.who.int/bitstream/handle/10665/40996/9241561025_eng.pdf.
Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. Jossey-bass. https://doi.org/10.4135/9781446221129.n9.
Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health promotion international, 11(1), 11-18. https://doi.org/10.1093/heapro/11.1.11.
Baker, S., Mat, A., & Robinson, P. (2010). What psychosocial factors influence adolescents’ oral health? Journal of Dental Research, 89(11), 1230-1235. https://doi.org/10.1177/0022034510376650.
Bandura, A. (2013). Self-Efficacy: The foundation of agency1. In Control of human behavior, mental processes, and consciousness (pp. 16-30). Psychology Press. https://doi.org/10.4324/9781410605412.
Barnett, A. G., Van Der Pols, J. C., & Dobson, A. J. (2005). Regression to the mean: what it is and how to deal with it. International journal of epidemiology, 34(1), 215-220. https://doi.org/10.1093/ije/dyh299.
Chimbinha, Í. G. M., Ferreira, B. N. C., Miranda, G. P., & Guedes, R. S. (2023). Oral-health-related quality of life in adolescents: umbrella review. BMC public health, 23(1), 1603. https://doi.org/10.1186/s12889-023-16241-2.
da-Silva-Domingues, H., del-Pino-Casado, R., Palomino-Moral, P. Á., López Martínez, C., Moreno-Cámara, S., & Frías-Osuna, A. (2022). Relationship between sense of coherence and health-related behaviours in adolescents and young adults: a systematic review. BMC public health, 22(1), 477. https://doi.org/10.1186/s12889-022-12816-7.
Elyasi, M., Abreu, L. G., Badri, P., Saltaji, H., Flores-Mir, C., & Amin, M. (2015). Impact of sense of coherence on oral health behaviors: a systematic review. PloS one, 10(8), e0133918. https://doi.org/10.1371/journal.pone.0133918.
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460.
Eriksson, M., & Lindström, B. (2006). Antonovsky’s sense of coherence scale and the relation with health: a systematic review. Journal of epidemiology & community health, 60(5), 376-381. https://doi.org/10.1136/jech.2005.041616.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175-191. https://doi.org/10.3758/bf03193146.
Gomes, M. C., Dutra, L. C., Costa, E. M. M. B., Paiva, S. M., Granville-Garcia, A. F., & Martins, C. C. (2018). Influence of sense of coherence on oral health-related quality of life: a systematic review. Quality of life research, 27, 1973-1983. https://doi.org/10.1007/s11136-018-1832-5.
Gururatana, O., Baker, S. R., & Robinson, P. G. (2014). Determinants of children's oral‐health‐related quality of life over time. Community dentistry and oral epidemiology, 42(3), 206-215. https://doi.org/10.1111/cdoe.12080.
Gururatana, O. (2015). Assessment of Oral Health-Related Quality of Life among Children Who Received Dental Treatment by Dental Nurse Students at Sirindhorn College of Public Health Chonburi, Thailand. Journal of Health Research, 29(5), 333-340. https://doi.org/10.14456/jhr.2015.23.
Institute for Public Health, National Institute of Health, Ministry of Health Malaysia. (2022). National Health and Morbidity Survey 2022: Adolescent Health Survey. Ministry of Health Malaysia. https://iku.gov.my/images/nhms-2022/Report_Malaysia_nhms_ahs_2022.pdf.
Jevdjevic, M., & Listl, S. (2025). Global, regional, and country-level economic impacts of oral conditions in 2019. Journal of Dental Research, 104(1), 17-21. https://doi.org/10.1177/00220345241281698.
Knorst, J. K., Sfreddo, C. S., de F. Meira, G., Zanatta, F. B., Vettore, M. V., & Ardenghi, T. M. (2021). Socioeconomic status and oral health‐related quality of life: A systematic review and meta‐analysis. Community Dentistry and Oral Epidemiology, 49(2), 95-102. https://doi.org/10.1111/cdoe.12616.
Marmot, M. (2005). Social determinants of health inequalities. The lancet, 365(9464), 1099-1104. https://doi.org/10.1016/s0140-6736(05)71146-6.
Marshman, Z., & Robinson, P. G. (2007, June). Child and adolescent oral health-related quality of life. In Seminars in Orthodontics (Vol. 13, No. 2, pp. 88-95). WB Saunders. https://doi.org/10.1053/j.sodo.2007.03.004.
Ministry of Health Malaysia. (2017). National Health and Morbidity Survey 2017 (NHMS 2017): National Oral Health Survey of Schoolchildren 2017 (NOHSS 2017), Vol. II: Oral health status of 12-year-old schoolchildren. Ministry of Health Malaysia. https://doi.org/10.13140/RG.2.2.25346.76481.
Ministry of Health Malaysia. (2024). National oral health strategic plan 2022-2030. Ministry of Health Malaysia. https://www.moh.gov.my/images/04-penerbitan/pelan-strategik/NOHS-PLAN-22-30-eISBN-Fasa2_compressed.pdf.
Mittelmark, M. B. (2016). Introduction to the Handbook of Salutogenesis. The handbook of salutogenesis, 3-5. Mittelmark, M. B., Eriksson, M., Sagy, S., Pelikan, J. M., Vaandrager, L., Meier Magistretti, C., Lindström, B., & Bauer, G. F. (2022). Salutogenesis for thriving societies. The handbook of salutogenesis, 635-638. https://doi.org/10.1007/978-3-030-79515-3_57.
Mohamad Anuar, M. F., Mohamed, N., Awaluddin, S. M., & Yacob, H. (2025). Inadequate toothbrushing practice and associated factors among in-school adolescents in Malaysia: Findings from Global School Health Survey (GSHS) 2017. PloS one, 20(1), e0317484. https://doi.org/10.1371/journal.pone.0317484.
Nammontri, O., Robinson, P., & Baker, S. (2013). Enhancing oral health via sense of coherence: a cluster-randomized trial. Journal of Dental Research, 92(1), 26-31. https://doi.org/10.1177/0022034512459757.
Navarro-Carrillo, G., Alonso-Ferres, M., Moya, M., & Valor-Segura, I. (2020). Socioeconomic status and psychological well-being: Revisiting the Role of Subjective Socioeconomic Status. Frontiers in Psychology, 11, 1303. https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01303/full.
Nazari, A., Hajihashemi, M., Safavi, S. R., Ataei, R., & Hosseinnia, M. (2025). Health promotion theory-based educational interventions for improving oral health in children and adolescents: a systematic review and meta-analysis. BMC Oral Health, 25(1), 1153. https://doi.org/10.1186/s12903-025-06549-3.
Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., Arora, M., Azzopardi, P., Baldwin, W., Bonell, C., Kakuma, R., Kennedy, E., Mahon, J., Mc Govern, T., Mohdad, A. H., Patel, V., Petroni, S., Reavley, N., Taiwo, K., Waldfogel, J., Wickremarathne, D., Barroso, C., Bhutta, Z., Fatusi, A. O., Mattoo, A., Diers, J., Fang, J., Ferguson, J., Ssewamala, F., & Viner, R. M. (2016). Our future: a Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423-2478. https://doi.org/10.1016/s0140-6736(16)00579-1.
Peres, M. A., Macpherson, L. M., Weyant, R. J., Daly, B., Venturelli, R., Mathur, M. R., Listl, S., Celeste, R. K., Guarnizo-Herreno, C. C., Kearns, C., Benzian, H., Allison, P., & Watt, R. G. (2019). Oral diseases: a global public health challenge. The Lancet, 394(10194), 249-260. https://doi.org/10.1016/s0140-6736(19)31146-8.
Petersen, P. E. (2003). The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dentistry and oral epidemiology, 31, 3-24. https://doi.org/10.1046/j..2003.com122.x.
Rauber, E. D., Menegazzo, G. R., Knorst, J. K., Bolsson, G. B., & Ardenghi, T. M. (2021). Pathways between toothache and children's oral health‐related quality of life. International journal of paediatric dentistry, 31(5), 558-564. https://doi.org/10.1111/ipd.12692.
Reiss, F., Meyrose, A. K., Otto, C., Lampert, T., Klasen, F., & Ravens-Sieberer, U. (2019). Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study. PloS one, 14(3), e0213700. https://doi.org/10.1371/journal.pone.0213700.
Reynolds-Salmon, R., Samms-Vaughan, M., Coore-Desai, C., Reece, J., & Pellington, S. (2024). Does household size matter? Crowding and its effects on child development. Psychology, Health & Medicine, 29(6), 1165-1178. https://doi.org/10.1080/13548506.2024.2326867.
Rincón, T., Gómez-Polo, C., Montero, J., Curto, D., & Curto, A. (2025). An Assessment of Oral-Health-Related Quality of Life and Anxiety in Early Adolescents (11–14 Years) at Their First Dental Visit: A Cross-Sectional Study. Children, 12(4), 428. https://doi.org/10.3390/children12040428.
Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S.-J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012). Adolescence: a foundation for future health. The lancet, 379(9826), 1630-1640. https://doi.org/10.1016/s0140-6736(12)60072-5.
Sischo, L., & Broder, H. (2011). Oral health-related quality of life: what, why, how, and future implications. Journal of Dental Research, 90(11), 1264-1270. https://doi.org/10.1177/0022034511399918.
Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. WHO Document Production Services. https://www.who.int/publications/i/item/9789241500852.
Thomson, W. M., & Broder, H. L. (2018). Oral Health-Related Quality of Life in children and adolescents. Pediatric Clinics, 65(5), 1073-1084. https://doi.org/10.1016/j.pcl.2018.05.015.
Tomazoni, F., Vettore, M., Baker, S., & Ardenghi, T. (2019). Can a school-based intervention improve the oral health-related quality of life of Brazilian children? JDR Clinical & Translational Research, 4(3), 229-238. https://doi.org/10.1177/2380084418816984.
Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. The lancet, 379(9826), 1641-1652. https://doi.org/10.1016/s0140-6736(12)60149-4.
Watt, R. G. (2005). Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World Health Organization, 83, 711-718. https://pubmed.ncbi.nlm.nih.gov/16211164/.
Watt, R. G. (2012). Social determinants of oral health inequalities: implications for action. Community dentistry and oral epidemiology, 40, 44-48. http://dx.doi.org/10.1001/jama.1995.03520250075037.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. Jama, 273(1), 59-65. http://dx.doi.org/10.1001/jama.1995.03520250075037.
World Health Organization. (2021). Report of the Multistakeholder Consultation on Programming to Promote Adolescent Well-Being in the WHO South-East Asia Region (No. SEA-CAH-42). World Health Organization. Regional Office for South-East Asia. https://iris.who.int/handle/10665/351073.
World Health Organization. (2022). Global oral health status report: Towards universal health coverage for oral health by 2030. World Health Organization. https://www.who.int/publications/i/item/9789240061484.
World Health Organization. (2025). Tracking progress on the implementation of the Global oral health action plan 2023–2030: baseline report. World Health Organization. https://www.who.int/publications/i/item/9789240106031.
Wuollet, E., Laisi, S., Alaluusua, S., & Waltimo-Sirén, J. (2018). The association between molar-incisor hypomineralization and dental caries with socioeconomic status as an explanatory variable in a group of Finnish children. International journal of environmental research and public health, 15(7), 1324. https://www.mdpi.com/1660-4601/15/7/1324.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Compendium of Oral Science
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Materials contained in the journal may be reproduced for educational purposes provided that both the author(s) and the journal are appropriately recognised; otherwise duplication is not permitted. No articles, reports, or portions there of may be translated into other languages, published in books, journals, magazines, or any other print form without written permission from the authors and from the journal.
Disclaimer: The statements, opinions and data expressed in the articles and reports herein are those of the author(s) and not of the publisher and the editor(s). The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any schemes, methods, instructions or ideas referred to in the content.
