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

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.