The association between health literacy and treatment cooperation in adolescents undergoing orthodontic treatment

Aim: The aim of this disertation is to examine the relationship between health literacy (HL) levels and cooperation to orthodontic treatment among adolescents undergoing fixed orthodontic treatment. Methods: This prospective and observational study was conducted on 87 adolescents aged between 12 and 18 receiving orthodontic treatment at Çukurova University Dental School, Department of Orthodontics. The data collection tools used in the study included the "Türkiye Health Literacy Scale-32 (TSOY-32)" and the "Health Literacy Scenario Scale (SOY-SEN)"; the "Dental Knowledge Word Recognition Instrument (DKW)" and "Dental Knowledge Picture Recognition Instrument (DKP)" to measure the level of knowledge regarding oral and dental health; and the "Orthodontic Patient Cooperation Scale (OPCS)" and "Clinical Compliance Evaluation (CCE)" to determine adherence to treatment in the fourth month (T0) and the first year (T1) following the start of orthodontic treatment. Statistical analysis of the data was performed using SPSS 25.0 with Shapiro-Wilk, Student t-test, Pearson chi-square, Pearson correlation and Paired Sample t-tests. Findings: The sample group with a mean age of 14.9±1.6, consisted of 63.2% female and 36.8% male patients. According to the TSOY-32 index categories, it was found that 12.64% of the participants had inadequate, 28.74% had problematic-limited, 37.93% had adequate, and 20.69% had excellent health literacy. A weak positive correlation was identified between patients' ages and TSOY-32 scores (r=0.212; p=0.049); however, no significant difference was observed regarding other demographic findings (p>0.05). The mean scores for SOY-SEN Case A and Case B were 3.66 and 3.40 out of 4, respectively. The mean scores for DKW and DKP were 4.85 out of 10 and 4.81 out of 6, respectively. While the mean OPCS scores at T0 and T1 were similar (p=0.983), the mean CCE score at T0 was significantly lower than at T1 (p=0.003). No significant correlation was found between the mean scores TSOY-32, DKW and DKP and the mean scores of the OPCS and the CCE (p>0.05). A weak positive correlation was detected between the mean scores of SOY-SEN Case A and T0 CCE and ∆ CCE scores (r=0.258; r=0.232). Conclusion: The findings of the study indicate that more than half of the adolescents in our sample were in the adequate/excellent health literacy category, and while the level of cooperation to orthodontic treatment was generally good, the level of dental knowledge was inadequate. Furthermore, it is possible to suggest that the "level of health literacy" and "knowledge level regarding oral and dental health" do not directly affect the level of cooperation shown by adolescent patients during the orthodontic treatment process. Key Words: Oral health literacy, Adolescent patient, Orthodontics, Patient cooperation, TSOY-32, Orthodontic Patient Cooperation Scale, Clinical Compliance Evaluation