Validation for Brazilian Portuguese language of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P)

Psychometric Properties of the Portuguese Version of the Quality of Life in Autism Questionnaire (QoLA)

The aim of this study was to cross-culturally adapt and validate of the Brazilian Portuguese version of the Quality of Life in Autism Questionnaire (QoLA) among parents of children ASD. The translated version was administered to 91 parents (Male: 4, Female: 85, other: 2) of individuals diagnosed with ASD. Among these, 22 completed the questionnaire twice, providing data for the assessment of test-retest reliability (ICC). The B-QoLA score ranged from 41 to 122, with a mean (SD) of 74.3 ± 18.5 in Part A and ranged from 22 to 94, with a mean (SD) of 61.6 ± 16.4, in Part B. Cronbach's alpha coefficient was 0.94 for Part A, 0.92 for Part B and 0.94 for total B-QoLA, indicating excellent internal consistency. Test-retest reliability was assessed using the intraclass correlation coefficient, which was 0.96 for the total scale, 0.94 for Part A, and 0.95 for Part B. Part A-X2 (df) = 297, (167), X2/2 = 1.7, CFI = 0.85, TLI = 0.84, GFI = 0.78, AGFI = 0.75, and RMSEA (95%CI) = 0.09 (0.07-0.11); Part B-X2 (df) = 297, (167), X2/2 = 1.7, CFI = 0.85, TLI = 0.84, GFI = 0.78, AGFI = 0.75, and RMSEA (95%CI) = 0.09 (0.07-0.11), thus indicating moderate fit of the model. The Brazilian version of the QoLA shows encouraging psychometric properties on each of the two subscales, showing strong internal consistency and good construct validity.

Reliability and validity of the Turkish version of the Oral Health Literacy Assessment Task: Pathways between parental oral health literacy and oral health consequences in children

BACKGROUND

Parental oral health literacy (OHL) is a determinant of oral health behavior and oral health status of children.

AIM

To delineate the pathways between parental OHL and oral health consequences in children and to validate the Turkish version of the Oral Health Literacy Assessment Task (TOHLAT-P).

DESIGN

This cross-sectional study was conducted with 315 parent-child dyads. The TOHLAT-P was psychometrically evaluated. Item analysis was performed to determine the reliability of the TOHLAT-P. Construct validity was tested by comparing a commonly used instrument using Pearson's product-moment correlation coefficients. A path model was developed to evaluate associations between parental OHL and oral health consequences in children. The model consisted of five endogenous variables (parental oral health behaviors, children's oral health behaviors, children's dental anxiety, dental caries, and oral health-related quality of life [OHRQoL]) and one exogenous variable (parental OHL). A path analysis was used to test the compatibility of the conceptual model, with a statistical significance of p < .001.

RESULTS

There was a statistically significant association between parental oral health behaviors and children's oral health behaviors, and between dental caries and OHRQoL. The variable most directly affected by parental OHL was parental oral health behaviors, whereas the variable most indirectly affected by parental OHL was children's oral health behaviors.

CONCLUSIONS

The path analysis revealed significant associations between parental and children's oral health behaviors, and between dental caries and OHRQoL. Understanding these pathways is necessary to establish strategies to improve children's oral health. The TOHLAT-P will be useful for future assessments of Turkish children.

Influence of digital media in the oral health education of mother-child pairs: study protocol of a parallel double-blind randomized clinical trial

BACKGROUND

Dental caries is the most common non transmissible chronic disease in childhood and the control of dental biofilm in children is one of the greatest challenges in oral disease prevention. Digital media applications can help patients in improving their oral hygiene performance and reducing the number of appointments due to pain and discomfort reasons. This study aims to investigate the use of an smartphone application (WhatsApp) to deliver oral health education to mother-child pairs, with the ultimate goal of controlling dental biofilm and caries through digital activities focused on oral hygiene.

METHODS

This study was designed as a randomized, double-blind, parallel clinical trial involving 100 pairs of mothers and children (6-12 years old). The mothers and children will be randomly allocated to the control group (n = 50 pairs), who will receive a single visit conventional oral health education, or to the experimental group (n = 50 pairs), who will receive both a single visit conventional oral health education and educational videos through WhatsApp Messenger, twice a week. Before randomization of the groups and after the intervention, pairs will be evaluated regarding to plaque index (VPI), gingival bleeding index (GBI), and number of decayed, missing and filled permanent or primary teeth (DMF-T) modified by the inclusion of active non-cavitated carious lesions (Nyvad criteria). Socioeconomic data, dental history, and oral health literacy will obtained using questionnaires (Oral Health Literacy Assessment Task for Paediatric Dentistry; BOHLAT-P). Chi-square, Student's t-test, paired Student's t-test, Mann-Whitney, and Friedman tests will be used with a 5% significance level.

DISCUSSION

This intervention proposal is designed to motivate behavioral change in mother-child pairs. We hypothesize that adding digital media to traditional oral health programs will provoke improvements in oral hygiene behavior and health outcomes. To our knowledge, this is the first study evaluating the effect of educational videos communicated by digital media (WhatsApp) on the oral health of mother-child pairs evaluated by long-term dental examinations. In addition, we will assess the maternal level of comprehension of the provided information via a literacy assessment tool. The clinical trial is registered at the Brazilian Registry of Clinical Trials (No. RBR-7s8bw6m).

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

Validation of the Brazilian Oral Health Literacy-Adults Questionnaire

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Development and validation of a short form of the BOHLAT-P

The authors developed and validated a short form of the Brazilian Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P). Data included responses from 200 parents of preschoolers to sociodemographic and oral health service access questions on the BOHLAT-P, the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), and the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). Data on the preschoolers' dental caries experience (ICDAS-II) were also included. An item response theory-based approach was employed to develop the short form, while confirmatory factor analysis evaluated the instrument dimensionality. The validity and reliability of the short form were tested by statistical analysis using BREALD-30, B-ECOHIS, and sociodemographic and dental caries experience data. The short form (BOHLAT-P-30) comprises 30 items, is unidimensional, and presents better model fit estimates (TLI = 0.94; CFI = 0.94; RMSEA = 0.05) than those of the BOHLAT-P. Moreover, BOHLAT-P-30 demonstrated excellent reliability (Cronbach's alpha = 0.91; intraclass correlation coefficient [ICC] = 0.95). BOHLAT-P-30 scores were positively correlated with BREALD-30 scores (r = 0.71), with the number of years of schooling (r = 0.60), and with the number of hours spent reading (r = 0.33). BOHLAT-P-30 scores were negatively correlated with B-ECOHIS scores (r = -0.21), and with the number of teeth with cavitated caries (r = -0.18). After controlling for confounding factors, BOHLAT-P-30 scores were not found to be associated with caries presence, or with the number of teeth with cavitated caries. The BOHLAT-P-30 had properties similar to those of the BOHLAT-P, and proved to be a valid measure to assess the OHL of Brazilian parents.

Validation of the Brazilian Version of the RMS Tactile Scale (B-RMS-TS)

This study aimed to validate the Brazilian version of the RMS Tactile Scale (B-RMS-TS) in children and adolescents with visual impairment. Ten visually impaired children and adolescents between 10 and 17 years old of an Educational Center for Visually Impaired People answered the verbalized Dental Anxiety Scale (DAS), and the DAS in Braille to evaluate their dental anxiety levels. B-RMS-TS construct validity was assessed by convergent and discriminant validity. Convergent validity was tested in two ways: Pearson's correlation between the B-RMS-TS and the overall anxiety question; Pearson's correlation between B-RMS-TS and verbalized DAS and DAS in Braille. B-RMS-TS reliability was measured by internal consistency (Cronbach's alfa and McDonald's omega) and test-retest reliability (ICC). B-RMS-TS was moderately correlated to the overall anxiety question (r=0.493;p=0.147). B-RMS-TS showed excellent correlation with verbalized DAS (r=0.971;p<0.001) and DAS in Braille (r=0.934;p<0.011). B-RMS-TS was able to discriminate dental anxiety levels between male and female (p=0.008). The B-RMS-TS demonstrated excellent reliability (Cronbach's alpha=0.661, McDonald's omega=0.700 and ICC=0.987; 95%CI=0.817-0.999). B-RMS-TS is valid and reliable to measure dental anxiety levels in Brazilian children and adolescents with visual impairment.

A Systematic Review of Cross-Cultural Adaptation and Psychometric Properties of Oral Health Literacy Tools

The aims of this systematic review were to critically appraise the quality of the cross-cultural adaptation and the psychometric properties of the translated versions of oral health literacy assessment tools. CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), and ProQuest Dissertation and Thesis were searched systematically. Studies focusing on cross-cultural adaptation and psychometric properties of oral health literacy tools were included. The methodological quality of included studies was assessed according to the COSMIN Risk of Bias checklist. Sixteen oral health literacy instruments in 11 different languages were included in this systematic review. However, only seven instruments met the criteria for an accurate cross-cultural adaptation process, while the remaining tools failed to meet at least one criterion for suitable quality of cross-cultural adaptation process. None of the studies evaluated all the aspects of psychometric properties. Most of the studies reported internal consistency, reliability, structural validity, and construct validity. Despite adequate ratings for some reported psychometric properties, the methodological quality of studies on translated versions of oral health literacy tools was mostly doubtful to inadequate. Researchers and clinicians should follow standard guidelines for cross-cultural adaptation and assess all aspects of psychometric properties for using oral health literacy tools in cross-cultural settings.