SOCIAL NETWORK ANALYSIS: A NOVEL APPROACH FOR ORAL HEALTH KNOWLEDGE AND BEHAVIORS MODELING
Authors: Sadeghipour M. , Shariatpanahi P. , Namdari M. , Khoshnevisan M.H. , Foroughmand H. 
Published: February 2025

The purpose of this study was to explore the correlation between oral health behaviors and knowledge of school children as well as in friendship social networks. Methods: To assess the relationship between social network structure and oral health knowledge and behaviors among primary school students, a valid and reliable questionnaire was developed in multiple steps. (a) A pool of items was developed from literature for expert evaluation. (b) Content validity was performed in two phases: In a qualitative phase, 10 experts, assessed each question determining the scale of each for calculation of the content validity index. In the quantitative phase, the content validity index (CVI) and content validity ratio (CVR) were assessed. (c) Qualitative face validity phase was performed using the impact score. (d) 10 students were asked to assess the questionnaire and to indicate difficulty or ambiguity in responding. (e) Test-retest reliability was assessed by Kappa statistics excluding, social network part. For evaluating the reliability of social network section, the proportions of agreement for the responses between two responses were calculated. The medical and health system is governed by two medical science universities in Tehran, Iran. In order to have a representative sample of the whole population, one primary school was selected randomly from the list of schools covered by each of medical science universities. All qualified students were given a self-administered questionnaire and consent was completed by parents. The questionnaire was developed to assess the relationship between oral health knowledge and behavior as well as their social network structure. Results: A total of 421 (228 male and 193 female late primary school students) participated in the study with age range of 12-13 years old. Ordinal regression analyses was used to identify correlation between social network and oral health status. The response rate was 91%.The frequency of daily tooth brushing showed 24.2% (102) of the students brushed their teeth two or more times daily. 196 students (46.6%) brushed once a day and the rest (29.2%) reported no brushing. Daily dental flossing was reported by 97 students (23%:), 28.4% of participants (120 students) floss more than once a week. 48.4% reported that they did not floss at all. The reported oral health knowledge scores ranged between 0 - 9 and were distributed with median 6 and interquartile range (IQR) 5 to 7. A significantly better oral health knowledge was reported by girls compared with boys (p<0.01). Girls demonstrated a meaningfully higher level of flossing (p=0.006) and brushing behavior (p<0.0001). A significant difference was detected in levels of socioeconomic status between groups with different tooth brushing behaviors (p<0.01) while it was not significantly different with flossing levels (p=0.25). There was a positive relationship between a child’s daily brushing frequency and the average of his/her friends’ daily tooth brushing (p<0.001). Flossing frequency was also positively correlated with friends flossing habit (rs=0.25, p=0.008). In addition, child’s daily tooth brushing was significantly related with average tooth brushing of his/her friends of friends (level 2); while for flossing such a relationship, was not detected. No correlation was found among friends’ oral health knowledge. Conclusion: This paper has highlighted the importance of friends’ social network effect on oral health behavior. Understanding the relation between oral health behavior and social network will help policy makers to use this instrument for oral health promotion programs among adolescents. For instance educating hubs (popular students), may be a cost effective promotion program.