Validation of the Chinese version of the Short-Form Health Literacy in Dentistry (HeLD) scale

Validation of an Arabic version of the short form of the health literacy in dentistry scale: a cross-sectional study

BACKGROUND

The Arabic version of the short form of the Health Literacy in Dentistry scale (HeLD) had not yet been developed in previously published studies. This study aims to test the reliability and validity of an Arabic version of the short form of the HeLD questionnaire.

METHODS

The short version of HeLD was translated into Arabic and the psychometric properties were evaluated in a sample of 1,889 female students in their first year of secondary school. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC), and internal consistency reliability was assessed using Cronbach's alpha. Content validity was investigated by creating a correlation matrix between the individual items of the HeLD-14, and criterion validity was determined using Pearson's correlation between the HeLD-14 score and an overall oral health rating. Sensitivity analysis was assessed by testing the associations of the HeLD-14 score with oral health-related behaviours and residential area.

RESULTS

The Arabic version of HeLD-14 (A-HeLD-14) had acceptable ICC (0.54) and excellent internal consistency (Cronbach's alpha: 0.92). The correlations between the items of the A-HeLD-14 varied from 0.3 to 0.9. The A-HeLD-14 showed a statistically significant correlation with the overall oral health rating (r = 0.37, p < 0.001). The median A-HeLD-14 score was significantly higher in participants who brushed their teeth frequently (51.31), visited the dentist regularly (52.00), consumed fresh fruit frequently (51) and consumed soda or energy drinks infrequently (51.00) than participants who brushed their teeth infrequently (41.50), visited the dentist irregularly (49.00), consumed fresh fruit infrequently (47) and consumed soda or energy drinks frequently (48.00).

CONCLUSION

The A-HeLD-14 instrument demonstrates sufficient validity, reliability, and sensitivity for measuring oral health literacy among the Arabic-speaking population.

Psychometric Testing of HeLD-14 in a Colombian Geriatric Population

Introduction

The objective of this study was to test the validity and reliability of the Colombian version of the Health Literacy in Dentistry (HeLD-14) in older adults.

Materials and Methods

A translation and validation study of HeLD-14 was conducted on 384 non-institutionalized older adults attending the Dental Clinic at Universidad Cooperativa from Pasto, Colombia. A cross-cultural adaptation of a multidimensional HeLD-14 was completed, and the psychometric properties of this scale were evaluated through a cross-validation method using an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). Internal consistency was measured with Cronbach's alpha (α) and Omega's McDonald (ɷ). The statistical significance was set at P < 0.05.

Results

The EFA demonstrated that a single-factor structure with 11 items explained a cumulative 59.86% of the overall variance. The CFA confirmed that goodness of fit indices of this questionnaire had optimal adequateness (χ2S-B = 109.047; χ2S-B/(44) = 2.478, P=0.001; non-normed fit index = 0.901; comparative fit index = 0.908; root mean square error of approximation = 0.079 (90% CI (0.075, 0.083)); standardized root mean residual = 0.080). The coefficients indicated a high internal consistency for the total scale (α = 0.94; ɷ = 0.96).

Conclusion

The developed adaptation of HeLD-14 for the Colombian population, HeLD-Col, is a unidimensional, reliable, and valid instrument to assess oral health literacy in older adults in Colombia.

Oral Health Literacy and Tooth Loss and Replacement in Older Adults at a University Dental Clinic in Colombia

BACKGROUND

Oral health literacy (OHL) is the ability of individuals to obtain, process, and understand oral health information and services, allowing them to make appropriate oral health decisions. The association between OHL and tooth loss and replacement have not been well understood.

OBJECTIVES

We aimed to determine the association between OHL and tooth loss and replacement in a Colombia population.

METHODS

A cross-sectional study of 384 older adults age 65 to 89 years from Pasto, Colombia was carried out. The number of lost and replaced teeth was assessed intraorally; sociodemographic and prosthetic characteristics were collected, and the Health Literacy in Dentistry questionnaire was used to evaluate OHL. Generalized linear models were estimated to assess associations between independent variables (including OHL) and the number of lost and replaced teeth.

KEY RESULTS

There were 224 (58.3%) men and 160 (41.7%) women. The mean (standard deviation [SD]) number of lost and replaced teeth was 27.78 (4.03) and 12.53 (9.89), respectively. One hundred fifty five (40.4%) individuals had full removable dental protheses, 122 (31.8%) partial removable dental protheses, 68 (17.7%) fixed prosthetics, and 36 (9.4%) dental implants. OHL was 33.29 (6.59) and significantly positively associated with the number of replaced teeth (β = 0.65, 95% confidence interval [CI]: 0.52-0.78, p < .001), but not with lost teeth.

CONCLUSIONS

OHL may foster individuals' capabilities to replace lost teeth, although we did not find it associated with reduced tooth loss, likely as tooth loss was highly common in this older population. [HLRP: Health Literacy Research and Practice. 2024;8(1):e21-e28.].

Validation of the HeLD-14 functional oral health literacy instrument in a general population

Background

Oral health literacy (OHL) is recognized as an important determinant of oral outcomes. Measuring OHL with a valid and reliable instrument that accurately captures the functional nature of this construct across cultures is needed. The short version of the Health Literacy in Dentistry scale (HeLD-14) shows promise as an appropriate instrument due to its inclusion of comprehensive domains hypothesized to comprise OHL. While studies validating the instrument in several languages have occurred, the number of dimensions in the various analyses range from one to seven. Validation of the HeLD-14 in a general English-speaking population is also lacking. The purpose of this study was to explore and confirm the dimensionality of the HeLD-14 in a general US English-speaking population.

Methods

The psychometric properties of HeLD-14 were evaluated in a sample of 631 participants attending the Minnesota State Fair. Construct validity was assessed using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) on the data set split into two groups. Internal consistency reliability was assessed using the Cronbach's alpha coefficient. Concurrent validity was established between the HeLD-14 and the Oral Health Inventory Profile (OHIP-5) using Pearson's correlation.

Results

EFA found, and CFA reinforced, a unidimensional structure of the HeLD-14. Cronbach's alpha was acceptable at 0.92. Fit assessment also supported a unidimensional structure, comparative fit index = 0.992, Tucker-Lewis index = 0.991, root mean square error of approximation = 0.065, and standardized root mean square residual = 0.074. Concurrent validity analyses showed that the HeLD-14 correlated with the OHIP-5.

Conclusions

The HeLD-14 is a unidimensional reliable and valid instrument for measuring the oral health literacy in the general US English-speaking adult population.

A psychometric network perspective to oral health literacy: Examining the replicability of network properties across the general community and older adults from Brazil

Objectives

To evaluate the replicability of oral health literacy (OHL) network models across the general community and a sample of older adults from Brazil.

Methods

Data were obtained from two oral health surveys conducted with a total of 1138 participants. OHL was measured using the short form Health Literacy in Dentistry scale (HeLD‐14). A regularized partial correlation network was estimated for each sample. Dimensionality and structural stability were examined via exploratory graph analysis. Network properties compared included global strength, edge weights, and centrality estimates. Model replicability was examined fitting the general community model to the older participants' data.

Results

Six dimensions with the exact same item composition were detected in both network models. Only the Receptivity domain in the older adults sample yielded low structural stability. Strong correlations were observed between edge weights (τ: 0.68; 95% CI: 0.62–0.74) and between node strength estimates (τ: 0.63; 95% CI: 0.36–0.89). No statistically significant differences were found for global strength. The fit of the older adults sample to the HeLD‐14 network structure of the general community sample was satisfactory.

Conclusion

Network models OHL replicated across the general community and a sample of older adults. The psychometric network approach is a useful tool to evaluate the measurement equivalence of OHL instruments across populations.

Effects of Dental Implants and Nutrition on Elderly Edentulous Subjects: Protocol for a Factorial Randomized Clinical Trial

Background

Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed dental prosthesis with brief dietary advice. The relative contribution and the potential synergy of the components of such interventions need to be determined as it has major public health implications for the community-dwelling aging population that continues to disproportionately suffer from tooth loss and its consequences.

Objective

To assess the effect of rehabilitation of masticatory function with fixed implant supported dentures and nutrition education in older subjects with terminal dentition (stage IV periodontitis) or full edentulism.

Methods

A 2 × 2 factorial randomized controlled trial with 16-month follow-up of eligible adults (≥60 years) with loss of masticatory function consequent to full arch edentulism or terminal dentition (n = 120) will be conducted to test whether the rehabilitation of masticatory function with fixed implant supported dentures, nutrition education and/or their combination improves intake of fresh fruits and vegetables for aging subjects. The study has been designed to detect changes in fresh fruits and fresh vegetables intake at 4 months using the 24-h dietary recall method. Changes in protein as percentage of total energy, nutritional biomarkers, plasma metabolomics, oral and gut microbiome, quality of life and masticatory function will also be assessed.

Discussion

We hypothesize that receiving rehabilitation of masticatory function with fixed implant dentures together with nutrition education is the most effective intervention for improving nutrient intake in aging community-dwelling subjects with extensive tooth loss. The results of this study will assist in designing better treatment regimens, guide medical care for individual subjects, and inform public health and policy.

Clinical Trials Registration

NCT05334407.

Effect of oral health literacy on self-reported tooth loss: A multiple mediation analysis

BACKGROUND

This study aims to investigate the mediating pathways of oral health literacy (OHL) and oral health-related behaviours on the relationship between education and self-reported tooth loss among Australian adults.

METHODS

Data used for studying the effects of mediating pathways are from the National Dental Telephone Interview Survey 2013, a random sample survey of Australian adults aged 18+ years. To study the mediating effects, we use counterfactual-based analysis. To decompose the effect of multiple mediator's alternate, to natural effect, methods such as interventional effects have been proposed. In this paper, we use these approaches to decompose the effect between education, OHL and oral health-related behaviours on self-reported tooth loss. Sensitivity analysis was performed for unmeasured confounding with multiple mediators.

RESULTS

Data were available for 2936 Australian adults. The prevalence of persons with ≥12 self-reported tooth loss was approximately 15%. The average total causal effect from the low education group was nearly 150%, and the interventional indirect effect through OHL and the dependence of oral health-related behaviours on OHL to more than 12 missing teeth were 20% and 120%, respectively, higher than in the high education group. Sensitivity analysis indicated if the difference in the prevalence of unmeasured confounder is as big as 6% the direct effect and the indirect effect remains as observed.

CONCLUSIONS

An additional two-fifths reduction on having more than 12 missing teeth for Australian adults with lower education level could be achieved if the proportion of lower OHL was decreased and optimal dental behaviours were increased.