The utility of network analysis in the context of Indigenous Australian oral health literacy

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Understanding juveniles' problematic smartphone use and related influencing factors: A network perspective

BACKGROUND AND AIMS

To understand the interaction between problematic smartphone use (PSU) and related influencing factors (individual variables, family environment, and school environment) and to determine the most influential factors affecting the use of smartphones by juveniles to implement effective interventions in the future.

METHODS

A total of 3,442 children and adolescents (3,248 actual participants (males = 1,638, average age = 12.27 ± 2.36)) were included in the study. This study measured juveniles' PSU and its influencing factors: individual variables (4 factors), family environments (13 factors), and school environments (5 factors). This study employed a network analysis approach for data assessment.

RESULTS

This study found that there were several central influencing factors (such as self-control ability, loss of control, parent-child relationship, and peer attitudes towards smartphone use) and bridge factors (such as peer attitudes towards smartphone use, peer pressure for smartphone use, and fear of missing out).

DISCUSSION AND CONCLUSIONS

Juveniles' PSU included several core symptoms and critical influencing factors. Intervention based on these factors may be effective, timely, and inexpensive.

Exploratory Graph Analysis of the Strengths and Difficulties Questionnaire for Aboriginal and/or Torres Strait Islander Children

In Australia, one of the most frequently used measures for assessing social and emotional well-being (SEWB) of Aboriginal and/or Torres Strait Islander children is the Strengths and Difficulties Questionnaire (SDQ). Previous studies on state-level validations have indicated the problems associated with the original five-factor SDQ structure, especially in the dimension of Peer Problems. The aim of this study was to use a novel psychometric methodology, namely Exploratory Graph Analysis (EGA), to evaluate the dimensionality of caregiver-informant SDQ version 4-10 years at a national level in Australia. Data for this study were retrospectively collected from two independent longitudinal studies: the Longitudinal Study of Indigenous Children (LSIC) and South Australian Aboriginal Birth Cohort (SAABC). The caregiver-informed SDQ version 4-10 years was applied across several study waves, including more than 4,000 responses. To conduct EGA, Gaussian graphical models (GGMs) were estimated using the Least Absolute Shrinkage and Selection Operator. About 2,500 bootstrap samples were also employed to investigate dimensions and item stability. The findings indicated robust evidence against the construct validity of the original five-factor SDQ structure. Future studies should conduct a direct external validation of the findings with Aboriginal and/or Torres Strait Islander parents/carers and community groups to develop the guidelines for future use of the instrument among Aboriginal and/or Torres Strait Islander children in Australia.

Chronic disease health literacy in First Nations people: A mixed methods study

AIM

To explore chronic disease education, self-management and health literacy abilities from First Nations Australian adults with chronic disease through the integration of qualitative and quantitative findings.

BACKGROUND

Chronic disease management requires good health literacy abilities to manage long-term health needs. First Nations people have a higher burden of chronic disease although little is known regarding chronic disease health literacy of First Nations people.

DESIGN

A concurrent embedded mixed methods study reported using the Consolidated Criteria for Reporting Qualitative Research guidelines.

METHODS

Data were collected from First Nations people with one or more chronic diseases living in remote Australia between February-November 2017. Quantitative data (n = 200) were collected using the Health Literacy Questionnaire along with demographic and health data. Qualitative data (n = 20) were collected via face-to-face interviews to examine chronic disease education and self-management experiences. Data were analysed separately then integrated to develop meta-inferences.

RESULTS

Poor communication from healthcare providers coupled with low health literacy abilities is a major barrier to both active and successful management of chronic disease. Communicating in medical jargon resulted in individuals being placed in a power differential causing lack of trust and relationship breakdowns with healthcare providers affecting active chronic disease self-management. The perception of inevitability and ambivalence towards chronic disease and the notion of futility towards self-management were concurred with the low level of active engagement in health care.

CONCLUSIONS

Yarning is an important strategy used by First Nations people for communication. For nurses, understanding and developing skills in yarning will facilitate cultural safety, communication and understanding about chronic disease self-management in contexts where health literacy abilities are challenged.

RELEVANCE TO CLINICAL PRACTICE

Using yarning, and plain language visual aids, and teach-back will readdress the power differential experienced by First Nations people and may also improve understanding of chronic disease self-management.