Dental hygiene therapy oral health literacy concordance and periodontal maintenance adherence in Ethiopian antenatal cohorts: a multilevel mediation analysis of language-matched counselling

The study uses a multilevel mediation framework applied to a conceptual cohort of antenatal attendees, with language concordance between provider and patient treated as the exposure, literacy concordance as the mediator, and periodontal maintenance adherence as the outcome. The analysis is specified as a two-level model with patients nested within health facilities, allowing for facility-level random intercepts and cross-level interaction terms. Language matching operates not merely through comprehension but through the construction of shared explanatory models of periodontal disease, which in turn sustain adherence behaviours across the antenatal period. The contribution is a formal specification of the literacy-concordance mechanism and a set of testable propositions for dental hygiene therapy practice in linguistically fragmented antenatal care systems. The paper concludes that language-matched counselling should be treated as a structural feature of dental hygiene service design rather than a communication courtesy, and that literacy concordance is the operative pathway through which language matching affects periodontal maintenance adherence.