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Carrouel F, du Sartz de Vigneulles B, Clément C, Lvovschi VE, Verot E, Tantardini V, Lamure M, Bourgeois D, Lan R, Dussart C. Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e58942. [PMID: 39149854 PMCID: PMC11337139 DOI: 10.2196/58942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/26/2024] [Indexed: 08/17/2024] Open
Abstract
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.
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Affiliation(s)
- Florence Carrouel
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | | | - Céline Clément
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Interpsy Laboratory (INSERM UR4432), University of Lorraine, Nancy, France
| | - Virginie-Eve Lvovschi
- Research on Healthcare Performance Laboratory (INSERM U1290), University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Elise Verot
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- PRESAGE Institute, University Jean Monnet, Saint-Etienne, France
- Centre Hospitalier Universitaire de Saint-Étienne (CIC 1408 INSERM), Saint-Étienne, France
| | - Valeria Tantardini
- Geriatric Rehabilitation and Follow-up Care Service, Centre Hospitalier Universitaire of Rouen, Oissel site, Rouen, France
| | - Michel Lamure
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Denis Bourgeois
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Romain Lan
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Anthropologie bio-culturelle, droit, éthique et santé Laboratory (ADES, UMR7268), Centre National de la Recherche Scientifique, Etablissement Français du Sang, Aix Marseille University, Marseille, France
| | - Claude Dussart
- Health Systemic Process Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Hospices Civils of Lyon, Lyon, France
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Clément C, Lvovschi VE, Verot E, du Sartz de Vigneulles B, Darlington-Bernard A, Bourgeois D, Lamure M, Vitiello F, Dussart C, Carrouel F. Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French. Front Public Health 2023; 11:1326771. [PMID: 38179573 PMCID: PMC10764472 DOI: 10.3389/fpubh.2023.1326771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
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.
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Affiliation(s)
- Céline Clément
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Laboratory “Interpsy”, UR 4432, University of Lorraine, Nancy, France
| | - Virginie-Eve Lvovschi
- Laboratory “Research on Healthcare Performance” (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Elise Verot
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- PRESAGE Institute, University Jean Monnet, Saint-Etienne, France
- CIC 1408 Inserm, CHU of Saint-Etienne, Saint-Etienne, France
| | - Benjamin du Sartz de Vigneulles
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Adeline Darlington-Bernard
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Denis Bourgeois
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Michel Lamure
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Flavia Vitiello
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- PRESAGE Institute, University Jean Monnet, Saint-Etienne, France
| | - Claude Dussart
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Florence Carrouel
- Laboratory “Health, Systemic, Process” Laboratory (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
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Niazi S, Eusufzai SZ, Saddki N. Predictors of oral health literacy in pregnant women. Health Care Women Int 2023; 44:1466-1480. [PMID: 35302903 DOI: 10.1080/07399332.2022.2046751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Sarah Niazi
- Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Malaysia
| | - Sumaiya Zabin Eusufzai
- Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Malaysia
| | - Norkhafizah Saddki
- Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Malaysia
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Lim FY, Goo CL, Leung WK, Goh V. Validation of the Malay Oral Impacts on Daily Performances and Evaluation of Oral Health-Related Quality of Life in a Multi-Ethnic Urban Malaysian Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16944. [PMID: 36554823 PMCID: PMC9779849 DOI: 10.3390/ijerph192416944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Oral Impacts on Daily Performances (OIDP) can be used as a generic or condition-specific oral health-related quality of life (OHRQoL) instrument. It offers different contexts on how dental conditions affect OHRQoL. This cross-sectional study aimed to validate a newly translated Malay OIDP (OIDP-M), compare OHRQoL, decayed, missing, or filled teeth (DMFT) in Malaysians, and investigate factors associated with OHRQoL. A total of 368 Malaysians were surveyed and examined for DMFT. Short-form oral health impact profile-Malaysia [S-OHIP(M)] and OIDP-M were used to measure OHRQoL. The OIDP-M was tested for reliability and validity. DMFT, S-OHIP(M), and OIDP-M between ethnicities were compared. Associations between ethnicity, DMFT, S-OHIP(M), and OIDP-M of Malays and Chinese were evaluated through partial correlation. Malays and Chinese had more filled teeth and DMFT compared with Indians. Malays reported worse OHRQoL through S-OHIP(M). Decayed teeth were positively associated with S-OHIP(M), physical, psychological, social disabilities, and handicap. For OIDP-M, decayed teeth were positively associated with OIDP-M, working, and sleeping. Missing teeth and ethnicity were positively associated with eating and speaking. Filled teeth were negatively associated with cleaning teeth. The OIDP-M was reliable and valid for evaluating OHRQoL. There were differences in DMFT and OHRQoL between ethnicities. Ethnicity affects OHRQoL, where Malays experienced worse OHRQoL due to dental problems.
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Affiliation(s)
- Fei Yee Lim
- Oral Health Division, Ministry of Health, Putrajaya 62590, Malaysia
| | - Chui Ling Goo
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur 50300, Malaysia
| | - Wai Keung Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Victor Goh
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur 50300, Malaysia
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Singh H, Kolschen J, Samkange-Zeeb F, Brand T, Zeeb H, Schüz B. Modifiable predictors of health literacy in working-age adults - a rapid review and meta-analysis. BMC Public Health 2022; 22:1450. [PMID: 35906567 PMCID: PMC9338662 DOI: 10.1186/s12889-022-13851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Hunny Singh
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
| | - Jonathan Kolschen
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Benjamin Schüz
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bremen, Germany.
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Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One 2022; 17:e0271524. [PMID: 35839272 PMCID: PMC9286266 DOI: 10.1371/journal.pone.0271524] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Ramin Mozafari Kermani
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Rahele Rostami
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
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Saddki N, Hashim MIBM, Mohamad N. Factors Associated with Oral Health Literacy among Patients with Type 2 Diabetes Mellitus Attending Hospital Universiti Sains Malaysia. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] Open
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Praveen S, Parmar J, Chandio N, Arora A. A Systematic Review of Cross-Cultural Adaptation and Psychometric Properties of Oral Health Literacy Tools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10422. [PMID: 34639729 PMCID: PMC8508111 DOI: 10.3390/ijerph181910422] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Sobiya Praveen
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (S.P.); (J.P.); (N.C.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
| | - Jinal Parmar
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (S.P.); (J.P.); (N.C.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
| | - Navira Chandio
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (S.P.); (J.P.); (N.C.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (S.P.); (J.P.); (N.C.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
- Clinical School Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
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