Evaluation of a Russian version of the oral health literacy instrument (OHLI)

Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study

Background

In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people's lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population.

Objective

This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces.

Methods

A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed.

Results

A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores.

Conclusions

Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases.

Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French

Background

Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate.

Objective

The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge.

Method

This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F.

Results

A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p < 0.001). Participants with an education level lower than the baccalaureate, and those who never visit the dentist or only in case of pain, had significantly lower OHLI-F scores. Internal consistency was excellent (Cronbach's alpha = 0.881-0.914). Test-retest reliability was very high (intraclass correlation = 0.985 to 0.996).

Conclusion

The OHLI-F has demonstrated adequate psychometric properties and can therefore be used to measure oral health literacy in French-speaking populations.

Predictors of oral health literacy in pregnant women

We determined factors associate with oral health literacy of pregnant women. A total of 203 pregnant women attending Hospital Universiti Sains Malaysia (USM) for antenatal care participated in this cross-sectional study. The Malay version of Oral Health Literacy Instrument (OHLI-M) and a structured self-administered questionnaire were used to obtain variables of interest. The mean OHLI-M score was 73.6 (SD 12.59). Only slightly more than half of our participants had adequate oral health literacy (54.2%), while others were marginal (31.0%) and inadequate (14.8%). Our findings revealed that women with adequate oral health literacy were more likely to be those with higher education qualification and were very satisfied or satisfied with their oral health status. The identification of these predictors highlighted the importance to keep oral health education messages simple and clear for the benefit of individuals with low educational attainment.

Cultural and translation challenges in assessing health literacy among immigrants from the former Soviet Union

Health literacy is an important foundation for health promotion and an under-recognized risk factor for immigrant and refugee groups. Yet measuring health literacy among diverse ethnic and linguistic populations presents complex challenges. We describe cultural and translation challenges encountered in measuring health literacy among Russian-speaking immigrants to the USA and offer a mixed-methods approach to understanding them. The Rx-Health Literacy (RxHL) study used cross-sectional quantitative and qualitative data to examine health literacy and medication adherence among five cultural and four language groups (Latinx, Vietnamese, African-American, Russian-speaking immigrant and White American) who are patients at Caring Health Center, a federally qualified health center in Springfield, MA. We translated an existing health literacy scale into Russian and Vietnamese and examined item difficulty across cultural groups. We conducted qualitative cognitive interviews to learn more about Russian speakers' understandings of the scale. Health literacy scores varied by cultural group, and the range of correct responses was much greater among Russian speakers than in other groups. Percentage correct varied by 69.7% for Russian speakers, compared with 25.0-44.0% for other groups. These findings indicate greater variability in health literacy levels among this group compared with others. Cognitive interviews with Russian-speaking participants revealed multiple interpretations of several items, suggesting that the English version of the scale contained embedded meanings associated with an American health care context that were not captured in the translated instrument. Combining qualitative and quantitative research methods allows for greater insight into contextual and translation factors that may shape the results of translated instruments in unanticipated ways.

Modifiable predictors of health literacy in working-age adults - a rapid review and meta-analysis

Background

Health literacy comprises the ability to identify, obtain, interpret and act upon health information. Low health literacy is a major risk factor for hospitalizations, use of emergency care and premature mortality among others. Known risk factors for low health literacy such as lower educational attainment, migration history and chronic illnesses overlap with those for long-term unemployment – in itself a risk factor for low health literacy. These factors are difficult to address in interventions to support health literacy. Therefore, the objective of this review is to identify potentially modifiable predictors of HL in populations potentially affected by long-term unemployment.

Methods

A rapid review (PROSPERO registration number: 290873) was carried out in Pubmed and SCOPUS including quantitative studies on potentially modifiable predictors of health literacy in working-age populations following PRISMA guidelines for systematic reviews. Where possible, reported effect sizes were transformed into r, and random-effects meta-analyses were conducted where appropriate to pool effect sizes for the association between modifiable predictors and health literacy.

Results

In total, 4765 titles and abstracts were screened, 114 articles were assessed in full-text screening, and 54 were included in the review. Forty-one effect sizes were considered for 9 different meta-analyses. Higher language proficiency, higher frequency of internet use, using the internet as a source of health information more often, being more physically active, more oral health behaviours, watching more health-related TV and a good health status were significantly associated with higher health literacy. Significant heterogeneity suggests between-study differences.

Conclusions

Improving language proficiency and/or providing information in multiple and simplified languages, together with reliable and accessible health information on the internet and in linear media are potentially promising targets to improve health literacy levels in working-age populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13851-0.

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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Gender differences in the association between oral health literacy and oral health-related quality of life in older adults

BACKGROUND

Poor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan.

METHODS

A cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL.

RESULTS

A total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men.

CONCLUSIONS

The relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women's oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

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.

Factors Associated with Health Literacy, Self-Efficacy, Social Support, and Oral Health Care Behaviors Among Elderly in Northern Border Community Thailand

Background

Oral health problems among elderly people are an important public health issues worldwide. Oral healthcare is essential to the health and well-being of elders and is one of the key indicators determining their quality of life. This research aimed to study oral health literacy, self-efficacy, social support, and demographic characteristic factors associated with the oral health care behaviors of elderly people living in the rural areas of northern Thailand.

Methods

This research was a cross-sectional study that recruited 406 elderly participants using convenience and snowball samplings. Participants’ names were obtained from the registration list of the Java Health Center Information System (JHCIS) program, where they received a health service between 2018 and 2020. Data were obtained through face-to-face interviews with participants, while they were waiting to receive a health service or through a phone interview. Linear regression was analyzed to determine the factors associated with oral healthcare behaviors.

Results

The majority of participants (85%) had inadequate functional health literacy, 52% had moderate self-efficacy toward oral health behaviors, 91.9% had moderate social support, and 53% admitted to moderate oral health behaviors. The results from the model show that self-efficacy, social support, and oral health literacy are positively associated with oral health care behaviors among the elderly (p-value < 0.05). The multiple regression model can account for 47.2% of the variance in oral health care behaviors.

Conclusion

Improving oral health care behaviors among elderly people should be considered by health care providers and those who provide social support. Self-esteem, communication skills among service providers and service receivers, and self-management of oral healthcare should receive special attention. Moreover, social support and relevant agencies can help promote oral healthcare by collaborating with other healthcare providers for better oral health outcomes among elderly people.

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

OBJECTIVES

As an important part of health literacy, oral health literacy has been adapted to dental practice and research. The 14-item short version of the Health Literacy in Dentistry (HeLD) scale demonstrated excellent reliability, validity and precision when tested among English-speaking populations. However, an appropriate and reliable assessment of this scale in other language contexts remains lacking. The reliability and validity of the Chinese version of HeLD (HeLD-C) for the Chinese population must therefore be examined.

METHODS

The short version of HeLD was translated into Chinese, and one item was deleted because of its unsuitability for the Chinese healthcare system. The psychometric properties of HeLD-C were evaluated in a sample of 404 Chinese participants aged from 19 to 72 years. The item selection analyses were performed by comparing the difference of each item between the high- and low-score groups. The internal consistency reliability was assessed using the Cronbach's alpha coefficient. Construct validity was assessed using exploratory structural equation modelling. For the criterion validity, correlations between the HeLD-C and the criterion validity scales, including the eHealth Literacy Scale (eHEALS), oral hygiene maintenance habits, and oral health status were tested using Pearson's correlation.

RESULTS

Results of item selection reveal significant differences among all items between the high- and low-score groups (Ps < .001). The internal consistency reliability of HeLD-C was measured using Cronbach's α (0.92), whereas its construct validity was measured using χ² [df] (3.30), comparative fit index (0.95), Tucker-Lewis index (0.94), root mean square error of approximation (0.08), and standardized root mean square residual (0.05). The criterion validity analyses show that HeLD-C is correlated with the criterion validity scales, including eHEALS, oral hygiene maintenance habits and oral health status (Ps < .001).

CONCLUSIONS

Chinese version of HeLD is a reliable and valid instrument for measuring the oral health literacy of the Chinese adult population.

Impact of School-Based Oral Health Education on Vietnamese Adolescents: A 6-Month Study

We have evaluated the impact of a school-based intervention on oral health knowledge, behaviours, and oral health status of adolescents in Vietnam. This 6-month study included 462 adolescents aged 12 years from four selected schools in Hue City, Vietnam. The intervention group received a 15-min lecture by a dentist and hands-on session on mouth observation and toothbrushing skills. The control group did not engage in any educational activities during the follow-up period. Data were collected at baseline and 6 months through a survey questionnaire and clinical examination. The Debris Index was used for dental plaque; the Papillary, Marginal, Attached gingiva index for gingivitis; and the Decayed, Missing, and Filled Teeth index (World Health Organization modification) for dental caries. Difference-in-difference analysis was used to compare changes between the groups. After 6 months, the control tended to show decreased toothbrushing frequency and increased dental plaque accumulation. The participants in the intervention group showed improved oral health knowledge (p < 0.01), behavior (p < 0.05), and hygiene (p < 0.001) compared to the control group. However, the intervention did not improve dental caries and gingivitis. A single school-based oral health education program can help adolescents improve oral health knowledge and prevent the deterioration of short-term oral health behavior and hygiene.

Cross-Cultural Adaptation and Validation of Oral Health Literacy Instrument (OHLI) for Malaysian Adults

Currently, the availability of a functional oral health literacy instrument in the Malay language is limited. This study aimed to cross-culturally adapt Oral Health Literacy Instrument (OHLI) into the Malay language and to determine its psychometric properties in Malaysian adults. Cross-cultural adaptation of the OHLI into the Malay version (OHLI-M) was conducted according to a guideline, followed by a cross-sectional study among outpatients in a selected health clinic. The psychometric evaluations were the comparison of the OHLI-M scores by education levels and last dental visits, the correlation of the reading comprehension section of OHLI-M with the Malay version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA-M), the correlation of OHLI-M with decayed, missing, and filled teeth (DMFT) and Community Periodontal Index (CPI), and the test-retest reliability of OHLI-M. A total of 195 outpatients participated in this study. The OHLI-M scores were significantly different between participants with different levels of education and timing since last dental visit. Participants with lower secondary school qualification and below, and those whose last dental visit was more than two years ago or never, had significantly lower OHLI-M scores. There was a positive correlation between the reading comprehension scores of the OHLI-M and the S-TOFHLA-M (Spearman’s rho = 0.37, p < 0.001). There was no significant correlation between the OHLI-M scores and the DMFT index scores or the CPI scores. The internal consistency was good (Cronbach’s alpha = 0.83 to 0.88). The test-retest reliability was excellent (intraclass correlation = 0.80 to 0.86). The OHLI-M showed good validity and reliability among adults in Malaysia.

Health Literacy Associations with Periodontal Disease among Slovak Adults

Periodontal disease is inflammation of the gums and without good oral hygiene, it can progress to periodontitis. Oral hygiene might be related to a patient’s health literacy (HL), defined as ability to gain access, understand, and use information to promote and maintain good health. The aim of our study is to examine the associations of HL with indicators of periodontal disease. A cross-sectional study on 1117 adults (36.2% males; mean age = 36.4, SD = 14.2) attending dental hygiene treatment was conducted. Data on demographics, socioeconomic status, and nine domains of HL (Health Literacy Questionnaire, HLQ) were collected by questionnaire, and Community Periodontal Index of Treatment Needs (CPITN) was established by the dental hygienist. Data were analysed using t-tests and logistic regression. Respondents with periodontal disease (N = 152) had statistically significantly lower levels of HL in seven out of nine HLQ domains compared to intact patients (N = 818) (t from 3.03 to 4.75, p < 0.01). Association of higher HL in seven domains with lower chance of diagnosed periodontal disease remain significant even after adjustment for age, gender and educational attainment (adjusted ORs 0.55–0.67, p < 0.05). Our findings confirm that an individual’s lower HL is significantly associated with higher chance of periodontal disease incidence, specifically among Slovak adults attending oral hygiene clinics. HL might be a promising factor in the improvement of oral health in this population, worthy of consideration in intervention and preventive activities.

Survey on the oral health status of community-dwelling older people with visual impairment

AIMS

Little is known about the impact of low vision (LV) on dental care in the elderly population. The present study aimed to clarify the oral health status and oral health behavior of older people with LV.

METHODS AND RESULTS

We surveyed community-dwelling older people (age ≥ 65 years, non-LV = 35, LV = 23); and collected data on sex, age, systemic diseases, oral health status, and oral health behavior. Although there was no difference in dental clinic visits within one year, the LV group received significantly lesser oral health instructions by dental hygienists and dentists than the non-LV (60.9% vs 85.7%, P < 0.05) group. Additionally, the LV group was more than twice as aware of the "8020 Campaign," written by the Ministry of Health, Labor and Welfare in Japan than the non-LV group. The non-LV group had higher awareness of thickening agents and denture cleaners, both of which may require visual input. Although we had assumed that LV would lead to poor results for the oral health status, there were no demonstrable differences between both groups.

CONCLUSION

Older individuals with LV require suitable forms of nonvisual communication to receive oral health instruction and literacy.

Evaluation of the psychometric properties of the Brazilian version of the Oral Health Literacy Assessment in Spanish and development of a shortened form of the instrument

OBJECTIVE

The objective of this study was to investigate the psychometric properties of the Oral Health Literacy Assessment in Spanish (OHLA-S) for the Brazilian-Portuguese language using robust analysis and with the results disclose possibilities to develop a shorter and more valid instrument.

METHODS

OHLA-S is an oral health literacy instrument comprising a word recognition section and a comprehension section. It consists of 24 dental words. It was translated into the Brazilian-Portuguese language (OHLA-B) and its psychometric properties were evaluated in a random sample of 250 adults aged 20-59 years. To assess the dimensionality and factor structure were tested by means of Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Reliability was assessed using two indicators: Cronbach's alpha and McDonald's Omega.

RESULTS

EFA and CFA demonstrated that the OHLA-B with 24 items did not present an adequate adjustment of the model, compromising its validity. In addition, reliability values at 0.50 for Cronbach's alpha and 0.67 for McDonald's omega were below the minimum acceptable rate of 0.70. As no support was found for the original structure, we decided to proceed with the withdrawal of individual items and successive reanalysis of the model until the indicators were adjusted in a shorter instrument. A new structure with 15 items produced an instrument with two dimensions and a better goodness of fit than the original instrument. The Alpha and Omega reliability index values increased to 0.83 and 0.80, respectively, and all scores were better in the OLHA-B with 15 items than in the instrument with 24 items.

CONCLUSION

OLHA-B with the original structure composed by 24 items did not show acceptable construct validity. The shorter version with 15 items showed more promising results for assessing oral health literacy levels in the Brazilian population.

Validation of three Arabic health literacy assessment tools in Lebanon

Health literacy is an important predictor of health status, health behaviours, and other health outcomes. However, research on health literacy in the Arab world is scarce and no health literacy tool has been validated to test the health literacy level of the Lebanese population so far. The aim of this study was to validate Arabic translations of three commonly used health literacy assessment tools, the S-TOFHLA, the REALM-R, and the Brief Health Literacy Screening items. The tools were linguistically and culturally adapted to the Lebanese context, and 250 face-to-face interviews were conducted in an outpatient clinic in Beirut, Lebanon, between April and June 2015. The General Self-Efficacy Scale and socio-demographic questions such as gender, age, origin, education and chronic condition were included to assess predictive validity. Reliability of the instruments was found to be low to high (Cronbach's α =0 .94 for the S-TOFHLA, Cronbach's α = 0.46 for the REALM-R). Younger and highly educated participants scored higher on the S-TOFHLA. The Brief Health Literacy Screening items were significantly correlated with age, education, self-efficacy and the S-TOFHLA, reinforcing the convergent and predictive validity of the two tools. Results indicate that the S-TOFHLA and the three screening questions are a valuable tool to measure health literacy in Lebanon and, allowing for minimal adaptations according to each country's healthcare system, in the entire Arabic-speaking area.

Disparities between English and Spanish in readability of online endodontic information for laypeople

BACKGROUND

In this study, the authors assessed the readability of online endodontic information in English and Spanish.

METHODS

The authors performed a systematic search in Google in May 2016. Search queries were "root canal treatment" and "¿Qué es una endodoncia?" without limits or filters. The authors assessed English readability by using Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, Gunning Fog Index, Coleman-Liau index, automated readability index, and Simple Measure of Gobbledygook (SMOG) index. The authors calculated readability for Spanish by using the Fernández-Huerta index and INFLESZ (Ines-Barrio).

RESULTS

The authors assessed the first 100 consecutive sites identified with each search strategy and selected 117 sites. Readability scores for English-language sites were in the category of normal to read, easily understood by 13- through 15-year-old students (Flesch Reading Ease Score, 63, interquartile range (IQR) [53.9-66.2]; Gunning Fog Index, 10.4, IQR [8.8-12]; Coleman-Liau index, 12.5, IQR [11.6-13.3]; and automated readability index, 8.6, IQR [6.7-9.8]). SMOG results led to the estimation that only 7 years of education would be needed to understand these contents (SMOG, 7.6, IQR [6.5-8.8]). Spanish-language sites had a readability index normal for an adult, equivalent to a seventh or eighth school year (Fernandez-Huerta, 62.3, IQR [59.7-66.6]; INFLESZ, 57.5, IQR [55.1-62.1]). The authors found that 36.6% of English-language sites had some degree of difficulty for readers to understand their contents, whereas 23% of Spanish-language sites had some degree of difficulty (14.46; 95% confidence interval, -3.16 to 30.08).

CONCLUSIONS

Spanish- and English-language electronic health information about endodontic treatment is acceptable to read, but-particularly for English-language sites-there is an important proportion of sites scoring difficulty levels well above the recommendations.

PRACTICAL IMPLICATIONS

The internet is a useful tool for communicating with patients, but available endodontic information is difficult for laypeople to understand. Endodontists should produce relevant materials in plain language to overcome this problem.

Associations of multidimensional health literacy with reported oral health promoting behaviour among Slovak adults: a cross-sectional study

BACKGROUND

Modification of health literacy (HL) is an important factor for improving and maintaining oral health. The aim of the study is to examine the association of HL with oral health-promoting behaviour (OHPB) and assess possible mediating effects of HL on the impact of socioeconomic status on OHPB.

METHODS

A cross-sectional questionnaire survey on the Slovak general adult population (N = 360, mean age 39) was conducted in 2014 and 2015. The association of HL (9 domains of the Health Literacy Questionnaire) and OHPB was analysed using logistic regression models adjusted for gender, age and educational level. Testing the mediating effect of HL domains between education attainment and OHPB was performed using the Sobel test.

RESULTS

Women and respondents with higher education reported better OHPB. Regular tooth-brushing is associated with better HL in five domains: Feeling understood and supported by healthcare provider, Having sufficient information to manage my health, Activelymanaging my health, Social support for health, Appraisal of health information (Odds ratios (ORs) from 1.64 to 2.33, p < 0.05). Using interdental tools is in association with better HL in two domains: Feeling understood and supported by a healthcare provider and Having sufficient information to manage my health (ORs 1.71 to 1.80, p < 0.05). Respondents who visited a dentist for prevention score higher in Social support for health (OR 1.79, p < 0.05). Using a tongue scraper and single brush and reporting gums bleeding is notstatistically significantly associated with HL. Mediation was confirmed between the effect of respondents' education on using fluoride toothpaste - mediated respondent's ability to find good health information. Frequency of tooth-brushing and using interdental hygiene aids were both mediated by patient's sufficient information to manage health.

CONCLUSIONS

Our results indicate HL to be an important factor related to good oral health, and HL should be considered when planning oral health interventions.

Comprehension of Japanese oral care-related terms among caregivers and nurses, as assessed using a newly developed instrument

OBJECTIVES

(i) To assess comprehension of oral care-related terms among caregivers and nurses working at long-term care facilities, using a newly developed test; (ii) to analyse the effect of participant characteristics on their comprehension.

BACKGROUND

Effective mutual communication between dental professionals and caregivers/nurses is essential for providing information on daily oral care for institutionalised elders.

METHODS

A 36-item word-knowledge test in Japanese was developed to assess comprehension of oral care-related terms. The test was administered to a convenience sample of 236 nursing staff (198 caregivers and 38 nurses) at six long-term care facilities in Niigata City, Japan, and its reliability and validity were verified. Associations of participant characteristics with their responses were investigated by multiple regression analysis.

RESULTS

Mean percentage of correct responses (accuracy rate) for nursing staff was approximately 62% (highest for oral care products and lowest for prosthodontic terms). Test internal reliability was high (Cronbach's alpha >0.8). Concurrent validity (test ability to distinguish between characteristically different groups) was confirmed. Mean accuracy rate was significantly higher among nurses (78.5 ± 19.3%) than among caregivers (58.7 ± 22.8%), and among respondents with interest in oral care (64.2 ± 21.1%) than among those with no such interest (51.5 ± 28.9%).

CONCLUSION

The word-knowledge test was valid and reliable for nursing staff of six long-term care facilities in Niigata City. Their comprehension was low for perioral and intraoral structures, related symptom and disease names, and prosthodontics terms related to oral care. Understanding of oral care-related terms among the nursing staff was related to their occupation and interest in oral care.