{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T10:12:10Z","timestamp":1775124730692,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Dependent older adults experience a high burden of preventable oral conditions, particularly gingivitis, while caregivers\u2019 preventive practices remain insufficiently explained by conventional single-factor models. This study aimed to develop and validate a theory-informed structural equation model (SEM) to explain how oral health literacy and psychosocial determinants shape preventive behaviors for gingivitis among caregivers of dependent older adults in Sisaket Province, Thailand. Methods: A cross-sectional analytical study was conducted among 420 caregivers selected using multistage random sampling. Data were collected using a validated questionnaire based on the Health Belief Model and Social Cognitive Theory, covering knowledge, attitude, perceived severity, perceived benefits, self-efficacy, preventive behaviors, and social support. Reliability was excellent. Descriptive statistics, Pearson\u2019s correlation, and SEM with maximum likelihood estimation were applied. Results: The SEM demonstrated excellent fit (\u03c72\/df = 0.80, p = 1.000; CFI = 1.000; TLI = 1.008; RMSEA = 0.000; SRMR = 0.092). Knowledge directly influenced attitude (\u03b2 = 0.355, p = 0.013) and self-efficacy (\u03b2 = 0.381, p = 0.003). Attitude (\u03b2 = 0.406, p &lt; 0.001), self-efficacy (\u03b2 = 0.384, p &lt; 0.001), and social support (\u03b2 = 0.260, p &lt; 0.001) were significant predictors of preventive behaviors. The model explained 68.3% of variance in behaviors, with knowledge exerting significant total effects through mediated pathways (\u03b2_total = 0.290, p &lt; 0.001). Conclusions: A theory-based SEM effectively explains caregiver preventive oral health behaviors in a rural, resource-limited setting. Interventions should integrate literacy-focused education with strategies that strengthen attitudes, self-efficacy, and social support to achieve sustainable improvements in dependent older adults\u2019 oral health.<\/jats:p>","DOI":"10.3390\/ijerph23040451","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T09:26:12Z","timestamp":1775121972000},"page":"451","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral Health Literacy and Preventive Behaviors Among Caregivers of Dependent Older Adults in Sisaket Province, Thailand: A Structural Equation Modeling Study"],"prefix":"10.3390","volume":"23","author":[{"given":"Kunlachart Wattanavong","family":"Valuvanaluk","sequence":"first","affiliation":[{"name":"College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1388-6970","authenticated-orcid":false,"given":"Aree","family":"Butsorn","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Putthikrai","family":"Pramual","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Sisaket Provincial Health Office, Sisaket 33000, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022). 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