Oral Health Service Utilization Behavior among Older Adults: Development and Validation of a Composite Behavioral Model-Based Questionnaire

Background Effective oral health service utilization is critical for healthy aging, yet elderly populations in China underutilize dental care. This study aimed to develop and validate a theoretically grounded questionnaire assessing oral health service utilization behavior and its determinants among community-dwelling older adults. Methods We integrated the health belief model (HBM) and theory of planned behavior (TPB) to construct a composite theoretical framework. The 20-item questionnaire was developed through (1) literature synthesis of validated HBM/TPB instruments; (2) expert consultations (n = 8) for content validity; (3) pilot testing (n = 30) to assess questionnaire comprehensibility, structural validity, and logical coherence; and (4) psychometric validation via a cross-sectional study. A convenience sample of 352 older adults (60 + years) from Guangdong Province communities completed the survey between July and September 2023. Item analysis, exploratory factor analysis (EFA), and reliability testing were performed via SPSS. Results EFA revealed a 5-factor structure (behavior, perceived benefits, perceived threats, subjective norms, and behavioral intentions/controls) explaining 62.6% of the total variance, with factor loadings ranging from 0.517–0.829. The instrument demonstrated strong internal consistency (Cronbach’s α = 0.864) and acceptable split-half reliability (Spearman-Brown coefficient = 0.712). ​All the subscales exhibited satisfactory Cronbach’s α values (range: 0.793–0.864), exceeding the 0.700 threshold for internal consistency.Initial validation confirmed structural alignment with the composite theoretical model. Conclusion This psychometrically robust tool bridges a critical gap in geriatric oral health research by integrating HBM/TPB constructs. It enables systematic assessment of modifiable behavioral determinants, informing targeted interventions to improve dental service utilization among aging populations. Further multiregional validation is recommended to increase generalizability.