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

Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka

Nonadherence is a widespread problem among patients receiving hemodialysis, while contributing factors are underexplored due to lack of a validated instrument. The study aimed to develop and validate a new disease-specific instrument determining the factors affecting treatment adherence behaviors among patients receiving hemodialysis in a Sri Lankan hospital. The content validation process using a modified Delphi technique suggested 42-item instrument with an average Item-level Content Validity Index (I-CVI) of 0.94. Subsequent principal component analysis (PCA) revealed 5 components with 17 items (patient-centered psychological and physical factors, factors associated with health care, hemodialysis therapy-related factors, socioeconomic factors, and factors associated with the continuity of the treatment), explaining 67.24% total variance. The reliability estimate based on Mislevy and Bock for each component greater than 0.8 and overall standardized Cronbach's alpha of 0.605, indicated acceptable internal consistency reliability. Root mean square residual (RMSR) and weighted root mean square residual (WRMR) indices of 0.084 and 0.059, respectively, indicated acceptable model fit. The final 17-item instrument provides a valid measure for the factors affecting treatment adherence behaviors of the patients receiving hemodialysis in a Sri Lankan hospital.

Validation of the Short-Test of Functional Health Literacy in Adults for the Samoan Population

BACKGROUND

Health literacy encompasses various levels of communication for an individual, provider, and an organization. Validated and reliable tools have been developed to assess health literacy; however, there is a paucity of tools available to assess health literacy in native languages for indigenous and racial/ethnic minority populations.

OBJECTIVE

This article shares the process taken to translate and evaluate validation and reliability of the Short Test of Functional Health Literacy in Adults for use with the Samoan population.

METHODS

Respondent-driven sampling was used to collect data from 1,543 adults age 45 years and older in American Samoa. A confirmatory factor analysis using a two-factor model for validation was conducted.

KEY RESULTS

The validation results indicated a "good fit" in multiple indices and Cronbach's alpha indicated high internal consistency in both the English and Samoan languages.

CONCLUSIONS

Developing culturally validated and reliable health literacy assessment tools is important to help health care professionals decrease health disparities and address inadequate health literacy in all cultures. [HLRP: Health Literacy Research and Practice. 2022;6(4):e247-e256.] Plain Language Summary: The INSPIRE project studied the Short Test of Functional Health Literacy in Adults (STOFHLA) tested on the American Samoan population age 50 years and older. The results would show if the STOFHLA is a valid tool to measure functional health literacy in American Samoa adults.

The "Reading the Mind in the Eyes" Test Shows Poor Psychometric Properties in a Large, Demographically Representative U.S. Sample

The Reading the Mind in the Eyes test (RMET) is a widely used measure of theory of mind (ToM). Despite its popularity, there are questions regarding the RMET's psychometric properties. In the current study, we examined the RMET in a representative U.S. sample of 1,181 adults. Key analyses included conducting an exploratory factor analysis on the full sample and examining whether there is a different factor structure in individuals with high versus low scores on the 28-item autism spectrum quotient (AQ-28). We identified overlapping, but distinct, three-factor models for the full sample and the two subgroups. In all cases, each of the three models showed inadequate model fit. We also found other limitations of the RMET, including that nearly a quarter of the RMET items did not meet the criteria for inclusion in the RMET that were established in the original validation study. Due to the RMET's weak psychometric properties and the uncertain validity of individual items, as indicated by our study and previous studies, we conclude that significant caution is warranted when using the RMET as a measure of ToM.

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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Plain Language Summary:

Dental vulnerability scale in primary health care: evidence of content and structure internal validity

Background

Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC).

Methods

The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach’s Alpha, McDonald's Omega and Greatest Lower Bound – GBL), with a sample of 1227 individuals.

Results

The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df₍₅₁₎ = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03.

Conclusion

DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

Initial Validation of the Mindful Presence Scale: The Issue of the Construal Level of Scale Items

Our research has two main aims. It undertakes the validation of a six-item trait mindfulness scale called Mindful Presence Scale (MPS), which measures central aspects of mindfulness. For the first time in mindfulness literature, the construal level of scale items is also examined. Four questionnaire-based online studies were conducted. Study 1 drew three samples (n n = 391, n p = 215, and n b = 235) from the students at the University of Debrecen. It examined the factor structure, reliability, and internal consistency of the three differently worded scale versions. The positively worded scale version (MPSp) yielded a stable two-factor structure and demonstrated the best psychometric properties. Study 2 performed a confirmatory factor analysis on a sample drawn from public employees across the country (n cfa = 420). The two-factor solution in Study 1 was confirmed. χ2 tests were not significant, and fit indices were excellent. There was no significant difference between the high-level construal subscale (Fhlc) and the low-level construal subscale (Fllc) in terms of factorial stability. Participant of Study 3 were students who did not take part in Study 1. The sample (n inv = 250) was tested for measurement invariance across gender. The scaled results supported strong/threshold invariance. Study 4 tested concurrent validity with 10 concurrent instruments. A sample of secondary school teachers (n con = 128) was tested by examining Spearman's rank order correlations. There was a significant difference in how the Fhlc and Fllc subscales predicted scores of some of the concurrent instruments. Further research is warranted into how the construal level of mindfulness scale items affects the recollection of the mindful experience. Overall, MPSp proved to be a valid short mindfulness measure.

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.

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

BACKGROUND

Oral health literacy (OHL) is associated with oral health outcomes.

AIM

To validate the Brazilian Portuguese version of the Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT-P).

DESIGN

We performed cross-cultural adaptation of the HKOHLAT-P. A sample of 200 pre-schoolers and caregivers from Campina Grande, Brazil completed the Brazilian HKOHLAT-P (BOHLAT-P), sociodemographic questionnaire, the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Child dental caries was assessed. Instrument reliability was measured by internal consistency (Cronbach's alpha) and test-retest (ICC). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) evaluated dimensionality. Regression models tested associations between BOHLAT-P and exploratory variables (P < .05).

RESULTS

BOHLAT-P demonstrated excellent reliability (Cronbach's alpha = 0.92; ICC = 0.95). BOHLAT-P and BREALD-30 scores (r = .71), number of schooling years (r = .60), and reading hours (r = .34) were positively correlated. BOHLAT-P and B-ECOHIS scores (r = -.22), and BOHLAT-P scores and number of cavitated teeth (r = -.15) were negatively correlated. After controlling for confounding variables, BOHLAT-P scores were not associated with caries or number of teeth with cavitated caries.

CONCLUSION

BOHLAT-P is a valid and reliable instrument to assess the OHL of Brazilian parents.

Validation of the Health Literacy in Dentistry scale in Brazilian adults

OBJECTIVES

To perform cross-cultural adaptation and validation of the Health Literacy Dental scale (HeLD) in Brazilian adults.

METHODS

The HeLD instrument was translated and cross-culturally adapted to the Brazilian Portuguese language to create longer (HeLD-29) and shorter (HeLD-14) versions. The reliability and validity of these versions were assessed in a sample of 603 adults living near six primary care units in the city of Piracicaba, São Paulo, Brazil.

RESULTS

Both versions of HeLD demonstrated high internal reliability, acceptable convergent validity and discriminant validity. However, the confirmatory factor analysis showed that only HeLD-14 demonstrated satisfactory goodness of fit. There were associations between HeLD-14 scores and social demographic characteristics, general and oral health and oral health-related behaviours. Higher scores were observed for the total HeLD-14 and/or individual components of HeLD-14 among women, ethnic white subjects, those with high educational attainment, those with higher income, those reporting toothbrushing twice or more daily, regular dental attenders, those who usually attended for dental care for a check-up, those with excellent or very good self-ratings of general health, those with excellent or very good self-ratings of oral health, and those without tooth extraction and oral health impact.

CONCLUSION

The Brazilian version of HeLD-14 was demonstrated to be a reliable and valid instrument for measuring broad aspects of oral health literacy in the adult Brazilian population.