Translation and Validation of Modified Dental Anxiety Scale: The Nepali Version

Adapting a Dental Anxiety Measure to Encourage Empathy

Introduction

The aim of this study was to improve upon the Modified Dental Anxiety Scale (MDAS) by developing the empathy-based International-Modified Dental Anxiety Scale (I-MDAS). This new measure was then utilized to compare the dental anxiety of patients cross-culturally. Methodology. This study was a descriptive cross-sectional study adapting the MDAS into the I-MDAS by adding the International scale. The study surveyed 465 participants from a dental clinic, SurveySwap, and distributed flyers. Data was collected through Qualtrics through the self-administered I-MDAS and analyzed through the SPSS computer software version 28. Participants were categorized into two subgroups where 41.3% received dental care only within the United States and are termed the domestic population, and 58.7% received dental care outside of the United States and are labeled the nondomestic population. Information about demographics, past negative dental experiences, and current dental anxiety was collected. The conducted analyses utilized an independent sample t-test to compare the subgroups' anxiety levels, a bivariate correlation to find the Pearson correlation, a Cronbach's coefficient α, and a one way ANOVA test to compare the genders' I-MDAS scores.

Results

There was no significant difference in dental anxiety levels between the domestic population (M = 12.73, SD = 5.13) and the nondomestic population (M = 12.76, SD = 5.06); t (463) = -0.58, p = 0.95). The I-MDAS shows evidence of validity and reliability. There was a significant and positive relationship between the International scale items and the MDAS scale items (r (463) = 0.60, p < 0.001), indicating the criterion validity of the I-MDAS. Content validity was strengthened by expanding the inquired topics in the new measure. The Cronbach's α value of 0.85 shows that the I-MDAS is reliable for clinical applications.

Conclusions

The I-MDAS improves upon the MDAS by providing dentists with a tool for encouraging empathy. Dental clinicians across nations can use the I-MDAS to combat the vicious cycle of dental anxiety.

Dental Anxiety Among Physicians: Relationship with Oral Problems, Dental Visits, and Socio-Demographic Factors

Purpose

The purpose of study was to investigate dental anxiety (DA) and its relationship with oral health problems, dental visits, and socio-demographic factors among physicians.

Patients and Methods

This cross-sectional study was conducted on physicians working in Dhahran, Khobar, Dammam, and Qatif cities of the kingdom of Saudi Arabia. The study included physicians (general practitioners, residents, specialists, and consultants) working in the public and private sectors. Modified Dental Anxiety Scale and World Health Organization's Oral Health Questionnaire for Adults were used to evaluate DA, oral health problems, and dental attendance.

Results

The study included data from 355 participants with a mean age of 40.13 ± 10.45 years. There were 57.2% of non-Saudi and 42.8% of Saudi participants in the study. Bad dental experience in the previous dental visit was reported by 40% of participants, which was significantly related to DA (P = 0.002). Only 9.60% of participants had no DA, whereas 41.10% demonstrated low DA, 23.4% moderate DA, 18.9% high DA, and 7% extreme DA. Common oral problems included tooth sensitivity (65.40%), tooth cavities (45.90%), bleeding gums (43.10%), and bad breath (36.90%). More than half of participants (58.3%) visited the dentist during the last year and dental pain was the most common reason for dental visits (31.3%). Saudi participants demonstrated significantly increased DA than non-Saudis (P = 0.019). DA was significantly related to tooth sensitivity (P = 0.001), tooth cavities (P = 0.002), dry mouth (P = 0.044), and bad breath (P = 0.005). The participants with difficulty in biting foods (P > 0.001) and feeling embarrassed due to the appearance of teeth (P < 0.001) demonstrated significantly higher DA.

Conclusion

This sample of physicians showed a high prevalence of DA, oral problems, and dental visits due to pain. DA was significantly related to physicians' negative dental experience, tooth sensitivity, dental decay, dry mouth, and bad breath.

To assess the prevalence of dental anxiety among patients visiting a teaching dental hospital in Lucknow, India and their self-perceived treatment needs

Image 1 Patients self assessment was a good predictor of patient dental status.

Dental Anxiety and Oral-Health-Related Quality of Life among Rural Community-Dwelling Older Adults

Aim: This study aimed to investigate the association between dental anxiety (DA) and oral-health-related quality of life (OHRQoL) among rural community-dwelling older adults. Methods: A cross-sectional descriptive study was conducted among 390 rural community-dwelling older adults attending outpatient clinics of the Damanhur National Medical Institute during the year 2021. Three instruments were used: a demographic and clinical data structured interview schedule, Modified Dental Anxiety Scale (MDAS), and the Oral Health Impact Profile (OHIP-5) questionnaire. All statistical analyses were considered significant at a p-value of ≤0.001. Results: The main results showed that the prevalence of DA among participants was 90.5%, and 66.9% of the studied elderly population were either extremely (phobic) or very anxious. Moreover, a significant association was found between older adults’ DA and their OHRQoL (p ˂ 0.001). Conclusions: It was concluded that DA represents a common problem among rural community-dwelling older adults and is a predictor for poor OHRQoL. Raising community awareness about the importance of oral health and implementing measures to avoid DA through specialized community campaigns is recommended, particularly in rural areas.

Psychometric Properties of the Hebrew Modified Dental Anxiety Scale in Adult Israeli Population

Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach’s alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.

Patient-reported outcome measures comparing static computer-aided implant surgery and conventional implant surgery for single-tooth replacement: A randomized controlled trial

OBJECTIVE

To compare static computer-aided implant surgery (s-CAIS) and conventional implant surgery (CIS) for single-tooth replacement in posterior sites in terms of patient-reported outcome measures (PROMs).

METHODS

Forty patients were divided into two groups for treatment with s-CAIS (Test) and CIS (Control). Patients' anxiety level was measured using the modified dental anxiety score before implant surgery. After surgery, patients completed two questionnaires for 7 days. The first questionnaire assessed pain level using a visual analog scale (VAS) and the incident rate of pain using a 5-point Likert scale; analgesic intake was also recorded. The second questionnaire investigated patients' oral health-related quality of life (OHRQoL) including postoperative symptoms, oral function, and daily activity. The difference between data was compared at significance level (α = 0.05).

RESULTS

There was no statistically significant difference in pretreatment dental anxiety level, postoperative pain scores, and OHRQoL between treatment groups. Overall, mild or moderate dental anxiety was reported by 70% and 20% of patients, respectively. Pain score was significantly reduced by postoperative Day 3 in the test group and Day 4 in the control group, compared with baseline. Both groups significant reduced analgesic intake by postoperative Day 5. Most OHRQoL-related complaints subsided approximately 3 days after surgery.

CONCLUSIONS

Overall, PROMs between s-CAIS and CIS were not significantly different for the single-tooth implant surgery in the posterior area. Postoperative symptoms after implant surgery still inevitably occurred, reflecting the normal process of oral wound healing.

An Assessment of Dental Anxiety in Patients Before and After Scaling and Polishing Procedures

Introduction As of now, there are not many investigations about the improvement of dental apprehension and dental participation in various populations over time. This investigation includes an examination of emotional appraisals of levels of dental apprehension in patients selected at the AB Shetty Memorial Institute of Dental Sciences. The investigation also aimed to discover the causes of dental apprehension as well as the effect of sexuality on the distinguished dental apprehension.

Materials and Methods The level of dental apprehension was assessed using questionnaires that included 15 questions before and after the scaling and polishing procedures for 78 patients. The typical features were drawn such as gender, age, and oral hygiene habits. The data analysis was analyzed using paired t-test or Wilcoxon signed rank test to assess pre- and postanxiety levels.

Results A total of 78 responses were collected, resulting in a participation rate of 100%. Despite the fact that women had significantly higher overall dental apprehension levels compared with men, the discrepancy among the two genders was substantial and could be clarified.

Conclusion Dental fear was common in females, especially among those with dental problems, and a larger degree of dental fear can contribute to periodontal disease.

Psychometric Testing of the Modified Dental Anxiety Scale among Iranian Adolescents during COVID-19 Pandemic

(1) Background: The present study aimed to examine the psychometric properties of the Persian adaptation of the Modified Dental Anxiety Scale (MDAS) in Iranian adolescents. (2) Methods: Adolescents with a mean age of 15.10 (n = 3197; 47.1% males) were recruited from Qazvin city of Iran using a stratified cluster random sampling technique. All children completed the five-item Persian MDAS and information related to background characteristics. Psychometric testing was conducted using classical test theory (CTT) and Rasch models. For CTT, an item-total correlation of >0.4 was considered satisfactory while for Rasch analysis, infit and outfit mean squares (Mnsq) ranging from 0.5–1.5 were considered satisfactory. Confirmatory Factor Analysis (CFA) was conducted to confirm the unidimensional structure of MDAS using various fit indices. Differential item functioning (DIF) was evaluated based on gender and time since last dental visit. Moreover, latent class analysis (LCA) was used to classify the participants into different levels of dental fear based on their pattern of responses. Both item level reliability using Cronbachs alpha (α) and test-reliability using intraclass correlation coefficients were evaluated. (3) Results: Item-total correlations ranged from 0.69–0.78, infit MnSq ranged from 0.80 to 1.11 and the range of outfit MnSq was 0.84–1.10. The data confirmed a one-factor structure of MDAS with satisfactory fit indices. DIF analysis indicated that the scale was interpreted similarly across the genders and time since dental visit groups. LCA analysis identified three levels, low, moderate and high levels of dental anxiety. The groups with moderate and high levels of dental anxiety had more females (44.6% and 36.7%) than the group with low level of dental anxiety (18.8%; p < 0.001). α of the total scale was 0.89 and item test-retest reliability ranged from 0.72–0.86. (4) Conclusions: The Persian MDAS was unidimensional with satisfactory psychometric properties evaluated using both CTT and Rasch analysis among Iranian adolescents. The scale was stable across the genders and individuals with different dental visiting patterns. The Persian MDAS also demonstrated excellent reliability.

Anxiety/fear of dental treatment during pregnancy: use of the Modified Dental Anxiety Scale (MDAS)

BACKGROUND

Despite advances in the control of anxiety and fear, dental treatment (DT) continues to be a stressful event, especially during pregnancy. There are several instruments to measure anxiety and fear about DT (AFDT). However, few are validated for use in Brazil. Our objective was to validate the Modified Dental Anxiety Scale (MDAS) for use in Brazil and to evaluate the association between AFDT and the use of oral health services (OHS) during pregnancy.

METHODS

This is a cross-sectional study nested in a prospective cohort. We conducted a face, content, and construct validation. The Visual Analogue Scale (VAS) was the comparison instrument with MDAS. Sociodemographic and behavioral characteristics were also assessed. Associations were estimated by odds ratios (OR) and 95% confidence intervals (95%CI) in multiple logistic regression analysis (alpha=5%).

RESULTS

There were no difficulties in the translation/back-translation process. The reproducibility of the instrument was 0.54 (P=0.01). The correlation of MDAS with VAS was 0.71 (P=0.003). The reliability of the instrument was high (Cronbach's alpha: 0.79 to 0.87). After validation, the instrument was administered to 486 women. Mild or moderate AFDT was reported by 81.3% of pregnant women and at higher levels, by 8.2%. There was no association between the use of OHS and AFDT at moderate levels (OR=2.03; 95%CI: 0.45-9.09) or high (OR=1.35; 95%CI: 0.20-9.13).

CONCLUSIONS

MDAS is a valid instrument for measuring AFDT. The prevalence of AFDT among pregnant women is high, but this event does not seem to be associated with the use of OHS.

The Prevalence of Dental Anxiety Associated with Pain among Chinese Adult Patients in Guangzhou

Background

Anxious people appear to exaggerate the severity of aversive experiences such as anxiety and pain. Anxiety towards dental procedures is a common difficulty that may be experienced by dental patients all over the world. The goal of the study is to find out the prevalence of dental anxiety and its associated factors in Chinese adult patients.

Methods

A cross-sectional study was conducted on 183 dental adult patients whose age ranged from 18 to 70 years. Demographic details, first and most recent dental visits with experience, the MDAS, and the Visual Analogue Scale for Anxiety (VAS-A) were obtained. Data were analyzed by frequency analysis, chi-square test, and Spearman correlation test.

Results

Most of the respondents were female (68.9%) and 30-45 years age group. The mean total score for dental anxiety on the MDAS was 13.63 (3.1). 80.3% of participants suffered from moderate or high dental anxiety. Age must show a strong association with dental anxiety among the participants (p=0.011). The first dental visit experience, the frequency of the dental visit, most recent dental experience, length of time since the most recent dental visit, and postponement of the dental visit are strongly associated with the MDAS score (p=0.001).

Conclusions

The MDAS score exhibits that Chinese adult patients have significant dental anxiety and phobia. Identifying patients with dental anxiety as soon as possible is essential to providing better dental care.

Relationship Between Maternal Dental Anxiety and Children's Dental Caries in the Eastern Province of Saudi Arabia

Purpose

Dental anxiety is a barrier to dental care utilization and is associated with poor oral health outcomes. The aim of the study was to assess the relationship between dental anxiety of mothers and dental caries of their children in the Eastern Province, Saudi Arabia.

Methodology

A cross-sectional study was conducted on a sample of mother-child pairs (N= 199) in Dammam, AlKhobar, and Dhahran, Saudi Arabia. Dental caries experience among children was determined using dmft/DMFT indexes following the World Health Organization's guidelines. Maternal dental anxiety was assessed by using the Modified Dental Anxiety Scale (MDAS).

Results

The mean ages of mothers and children were 33.98 ± 5.41 and 6.74 ± 2.29 years, respectively. The mean dmft score was 4.3 ± 3.99 in primary dentition and the mean maternal dental anxiety score was 13.89 ± 5.33. Ninety-two percent of mothers had low to extreme dental anxiety and only 8% reported no dental anxiety. Dental caries experience in primary teeth was higher in children of dentally anxious mothers (mean dmft 4.45 ± 3.92) than the children of mothers who were non-anxious (mean dmft 2.56 ± 4.59) (P=0.07). The mean maternal anxiety score was significantly higher in children with untreated decay in primary dentition (14.49 ± 5.08) than those with sound primary dentition (12.24 ± 5.67) (P = 0.008). The study also found a statistically significant correlation between maternal dental anxiety and untreated decay in the primary dentition (Pearson's r =0.171, P = 0.015).

Conclusion

Dental anxiety was highly prevalent among mothers in the present study. There was a significant relationship between maternal dental anxiety and untreated decay in the primary dentition. Awareness should be raised among dentally anxious mothers to reduce the burden of dental caries in their children.

Magnitude and Determinants of Dental Anxiety among Adult Patients Attending Public Dental Clinics in Dar-Es-Salaam, Tanzania

INTRODUCTION

It is estimated that, about 40% of the population suffer from dental anxiety. Dental anxiety is considered to be complex and multifactorial with a wide range of provoking factors which may be patient, provider, or environment-related.

AIM

This study aimed to assess the magnitude and determinants of dental anxiety among adult patients attending public dental clinics in Dar es Salaam, Tanzania. Methodology. This was a descriptive cross-sectional study carried out in 4 public hospitals in Dar es Salaam, Tanzania. It included 300 adult patients who had dental caries, periodontal diseases, or dental trauma. Data were collected using a self-administered Modified Dental Anxiety Scale (MDAS) questionnaire. Data were analyzed using the SPSS computer software version 23. A one-way Analysis of Variance (ANOVA) was used to assess the association between variables, and the significance level was set at p < 0.05.

RESULTS

The mean age of participants was 32.18 years (±11.06 SD) with a male-to-female ratio of 1 : 1.43. The means MDAS score was 12.84 ± 4.99. Tooth extraction had the highest mean MDAS score. The majority (261, 87%) of participants had mild-to-severe anxiety. The most common (72.2%) anxiety-provoking factor was an unsympathetic dentist; others included unawareness of the procedure to be carried out (58.3%) and the presence of apprehensive patients (52.0%). The level of anxiety was found to be statistically significantly associated (p < 0.05) with young age [p=0.009, AOR 3.06 (95% CI, 1.32, 7.09), female patients [p < 0.001, AOR 4.45 (95% CI, 2.05, 9.70)], and a higher education level [p < 0.05, AOR 2.32 (95% CI, 1.03, 5.25)].

CONCLUSION

The prevalence of dental anxiety was high among the participants of this study. Female gender, young age, and a higher level of education constituted determinants of dental anxiety. An unsympathetic practitioner, unawareness of the procedure, and presence of apprehensive patients were the common anxiety-provoking factors.

Assessment of dental anxiety and dental phobia among adults in Lebanon

Background

Dental anxiety continues to be a widespread problem affecting adult populations. The primary aim of our study was to evaluate the psychometric properties of the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A) and to identify the optimal cut-off for assessing dental anxiety and dental phobia among adults in Lebanon. In addition, we sought to assess dental anxiety and phobia as well as their correlates among Lebanese adult patients.

Methods

A cross-sectional study was carried out on a sample of 451 dental adult patients aged between 18 and 65 years old. Information about demographic characteristics, previous bad dental experience, trauma’s experience period, perception of a periodontal problem, sensation of nausea during dental treatment, the MDAS-A scale, and the Visual Analogue Scale for anxiety (VAS-A) were collected.

Results

MDAS-A exhibited evidence of adequate psychometric properties. The optimal cut-off was 12 for dental anxiety and 14 for dental phobia. Out of the total sample, 31.5% suffered from dental anxiety while 22.4% had a dental phobia. Multivariable analysis showed that the odds of dental anxiety and phobia were higher among females compared to males. Also, patients suffering from periodontal problem perceptions, bad dental experiences during childhood and adolescence, and the sensation of nausea during dental treatment were at a higher risk of developing dental anxiety and phobia compared to their counterparts. However, a higher level of education was found to be a protective factor against dental phobia among Lebanese adult patients.

Conclusion

The MDAS-A scale is a suitable tool for the routine assessment of dental anxiety and phobia among Lebanese adult patients. Identifying patients with dental anxiety at the earliest opportunity is of utmost importance for delivering successful dental care.

The Reliability and Validity of the Japanese Version of the Modified Dental Anxiety Scale among Dental Outpatients

Introduction

A careful assessment of dental anxiety is necessary for its management. The Modified Dental Anxiety Scale (MDAS) is one of the most commonly used questionnaires to measure dental anxiety in the world. The reliability and validity of the Japanese version of MDAS have been demonstrated using undergraduates and a few patients with dental anxiety. The aim of the present study was to examine the reliability and validity of the Japanese version of the MDAS using a wide range of age samples in dental clinics.

Methods

A total of 275 outpatients (145 men and 130 women; 21–87 years) from two dental clinics participated in the present study. Dental anxiety was assessed using the Japanese version of the MDAS and the Dental Fear Survey (DFS). The psychometric evaluation included exploratory factor analysis, and Cronbach's α was used to evaluate for internal consistency. Criterion validity was assessed by correlating the MDAS and DFS scores using Spearman's correlation coefficient. validity was evaluated by examining related factors' differences in the MDAS score (e.g., sex and negative dental experiences).

Results

Six patients (2.2%) reported high levels of dental anxiety (MDAS score ≥ 19). The internal consistency of the MDAS score was high (Cronbach's α = 0.88). Dental anxiety was significantly higher among women (P=0.007), in patients with previous negative dental experiences (P < 0.001), and among those with lower frequencies of dental visits (P < 0.001). The MDAS score was significant and related to age (r = 0.48) and the DFS score (r = 0.87). Factor analysis revealed all items measured only one construct.

Conclusions

The Japanese version of the MDAS score was found to be a reliable and valid measure of dental anxiety among dental outpatients. It could be useful for the Japanese dental practitioner to measure dental anxiety in a clinical setting.

Validation of Arabic version of the Modified Dental Anxiety Scale (MDAS) and Kleinknecht's Dental Fear Survey Scale (DFS) and combined self-modified version of this two scales as Dental Fear Anxiety Scale (DFAS) among 12 to 15 year Saudi school students in Riyadh city

Aims

The aim of this study was to test the reliability and validity of the Arabic version of Modified Dental Anxiety Scale (MDAS), Dental Anxiety Scale (DAS), and a combined self-modified version of these scales and Dental Fear and Anxiety Scale (DFAS). We also aimed to assess the impact of dental fear and anxiety among Arabic-speaking 12-15-year-old Saudi students on their quality of life by correlating MDAS, DAS, and DFAS scores with other demographic data.

Materials and Methods

A cross-sectional study was conducted among 500 individuals (250 male and 250 female) in Riyadh city using a questionnaire. An unpaired t-test was used to check the mean difference between anxiety score among males and females, and one-way analysis of variance was used to check the mean difference between percentage anxiety score among different visit groups. Scheffe post hoc test was used to check the pairwise difference between the groups, and Cronbach's alpha was used to measure internal consistency of the questionnaire.

Results

Overall mean percentage DAS score was 51.1640 + 6.87358 and 55.2080 + 8.52805 for male and females, respectively. The overall mean percentage MDAS score was 51.6640 + 10.9478 and 58.3200 + 11.62990 for males and females, respectively. The overall mean total score was found to be 64.4080 + 11.80776 and 100.4680 + 12.34840 for males and females, respectively. All the above results were statistically significant by 5% (P < 0.001). Cronbach's alpha score for MDAS and DAS was found to be 0.843 and it was 0.960 for DFAS. It was found that removal of any item would have decreased the overall consistency, which indicated a high level of internal consistency for our scales.

Conclusion

Saudi Arabian version of Arabic version of MDAS, DAS and DFAS have shown high validity and reliability, and can be used to assess the dental patient's anxiety and fear.

Dental anxiety in first- and final-year Indian dental students

Objectives

The study aims to investigate dental anxiety in first- and final-year undergraduate dental students in India.

Design

Questionnaire Study Setting: BDS Students in four University dental colleges in India carried-out during 2013 and 2014.

Subjects (materials and methods)

The students (n = 614) were assessed using a pre-tested questionnaire. We estimated the level of dental anxiety by using the Modified-Dental-Anxiety-Scale (MDAS). ANCOVA and Mann–Whitney U, and Chi-squared contingency tests were employed to analyze the extensive dataset acquired. Univariate clustering analysis and principal component regression were also applied. Students had similar demographic and lifestyle patterns.

Interventions

Assessments of the level of dental anxiety amongst undergraduate dental students.

Main outcome measures

Mean ± SD MDAS scores for first- and final-year Bachelor of Dental Surgery (BDS) students were 12.96 ± 4.00 and 10.54 ± 3.41, respectively.

Results

Six hundred and fourteen (n = 614) students from four dental colleges were included in this study. In total 77% were female (n = 478) and 23% were male (n = 136). The mean age of the first- and final-year students were 18.31 and 21.54 years, respectively. First-year BDS students had dental anxiety score (Mean ± SD 12.96 ± 4.00) compared to that of the final year (10.54 ± 3.41), a difference which was very highly statistically significant (p < 0.0001).

Conclusion(s)

Dental anxiety was moderately higher amongst first year BDS students over that of final-year students but it is lesser than the dental phobic threshold level.

Why some mothers overestimate birth size and length of pregnancy in rural Nepal

Background

Quantitative validation studies alone may not be able to distinguish between instances when participants did not accurately report an event vs when participants did not understand a question. We used an explanatory qualitative study design to acquire an in-depth understanding of why some mothers in rural Nepal overestimate birth size of their newborn and their length of pregnancy.

Methods

We conducted two focus group discussions (FGDs) with study staff who administered a quantitative questionnaire and 12 in-depth interviews (IDIs) with mothers who had participated in a quantitative validation study. Transcripts were coded and analyzed for themes in patterns of meaning within and across FGDs and IDIs. Using this thematic map, we synthesized our data into common and divergent responses from participants to facilitate our interpretation of the quantitative findings.

Results

We identified five themes specific to this analysis: difficulties with the length of pregnancy question, challenges in administering the birth size question, the perceived effect of time since birth on mothers' ability to remember information, the language and style differences specific to this setting, and the study context shaping the relationship between study staff and mothers who participated and how this may have influenced mothers' responses. Visual aids may help to scale the question about birth size within a cultural frame of reference for maternal reports to be more interpretable. Among both study staff and mothers, a longer period of time since the birth of a child was thought to be associated with diminished accuracy of maternal reports, a perception not supported by our previously published quantitative findings.

Conclusions

Poor validity of low birth weight (LBW) and preterm birth indicators based on maternal reports may be partly attributed to challenges in maternal understanding of questions assessing birth size and length of pregnancy. Additional research is needed to confirm these findings regarding maternal comprehension and to further evaluate the utility of visual aids developed for this study.

Cross-Cultural adaption, validity and reliability of a Hindi version of the Corah's Dental Anxiety Scale

Background: An appropriate scale to assess the dental anxiety of Hindi speaking population is lacking. This study, therefore, aims to evaluate the psychometric properties of Hindi version of one of the oldest dental anxiety scale, Corah’s Dental Anxiety Scale (CDAS) in Hindi speaking Indian adults.

Methods: A total of 348 subjects from the outpatient department of a dental hospital in India participated in this cross-sectional study. The scale was cross-culturally adapted by forward and backward translation, committee review and pretesting method. The construct validity of the translated scale was explored with exploratory factor analysis. The correlation of the Hindi version of CDAS with visual analogue scale (VAS) was used to measure the convergent validity. Reliability was assessed through calculations of Cronbach’s alpha and intra class correlation 48 forms were completed for test-retest.

Results: Prevalence of dental anxiety in the sample within the age range of 18-80 years was 85.63% [95% CI: 0.815-0.891]. The response rate was 100 %. Kaiser-Meyer-Olkin (KMO) test value was 0.776. After factor analysis, a single factor (dental anxiety) was obtained with 4 items.The single factor model explained 61% variance. Pearson correlation coefficient between CDASand VAS was 0.494. Test-retest showed the Cronbach’s alpha value of 0.814. The test-retest intraclass correlation coefficient of the total CDAS score was 0.881 [95% CI: 0.318-0.554].

Conclusion: Hindi version of CDAS is a valid and reliable scale to assess dental anxiety in Hindi speaking population. Convergent validity is well recognized but discriminant validity is limited and requires further study.