The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review

BACKGROUND

Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties.

METHODS

This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines.

RESULTS

Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria.

CONCLUSIONS

None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.

Psychometric properties of the Urdu version of the Geriatric Oral Health Assessment Index (GOHAI) and oral health-related quality of life in the elder Pakistani population

OBJECTIVE

The study aimed to translate the English version of the Geriatric Oral Health Assessment Index, assess its reliability and validity, and demonstrate its psychometric properties with regard to OHRQoL in the elder Pakistani population.

MATERIAL AND METHODS

In this cross-sectional study, 408 elder people were randomly recruited from three day-care centres. In the translation process, the translated Urdu version was reviewed by a committee of experts, followed by back-translation into English and re-reviewed by the same committee of experts. The questionnaire sought information about socio-demographic characteristics information and self-perception of oral, general health and treatment needs. OHRQoL was examined using GOHAI-U, and intraoral examination recorded the decayed, missing, and filled teeth. Reliability, internal consistency, convergent and discriminant validity of GOHAI-U were examined.

RESULTS

The mean GOHAI-U score was 40.2 (SD = 5.7, range = 20-55). The Cronbach's alpha for GOHAI score was 0.71, item-scale correlation coefficients ranged from 0.63 to 0.76, and test-retest correlation ranged from 0.59 to 0.74. Three factors supported the theoretical construction in the component factor analysis of the index. For convergent validity, there was a significant relationship between the GOHAI score and self-perceived oral, general health and treatment needs (P < .05). For discriminant validity, a significant correlation was found between the GOHAI score and clinical measures of dental health status except with the carious teeth.

CONCLUSION

The GOHAI-U has sufficient reliability and constructs validity to be used as an efficient measure of oral health-related quality of life in the Pakistani elder population.

Validation of a modified version of the Spanish Geriatric Oral Health Assessment Index (GOHAI-SP) for adults and elder people

Background

The Geriatric Oral Health Assessment Index (GOHAI) was developed and validated in 1990 and translated into Spanish in 1999. Since then, the original version has been used in numerous studies, but it has not been re-evaluated in terms of language in the new generations of older adults. The purpose of this study is to confirm the validity of the Spanish version of the Geriatric Oral Health Assessment Index (GOHAI-SP) after three decades to be used as part of an ongoing field trial.

Methods

The GOHAI-SP was pilot tested in a focus group to confirm linguistic comprehension. A version with minor language changes was administered to individuals with metabolic syndrome aged 55–75 years from one health care district in southern Spain as part of an ongoing field trial (PREDIMED-Plus). Clinical evaluation included assessment of dental and periodontal status. The psychometric properties of the GOHAI-SP were evaluated through stability and internal consistency measures, and concurrent and discriminant validity were assessed.

Results

The new version of the GOHAI-SP was administered to 100 individuals. The application time was reduced by 7 min. The alpha value for reliability was 0.87. The item-scale correlation coefficients ranged from 0.54 to 0.75, and the test–re-test correlation for the total score was 0.75. There were inverse correlations between GOHAI-SP scores and the number of lost teeth and the decayed-missing-filled teeth index (p < 0.001).

Conclusions

The GOHAI-SP questionnaire remains a valid and useful tool to assess oral health-related quality of life in primary health care settings. A linguistic update of the questionnaire brought improvements to the instrument application.

Trial registration

The PREDIMED-Plus trial is registered in the ISRCTN registry with reference number ISRCTN89898870. Registration date: 4th July 2014.

General Oral Health Assessment Index: A new evaluation proposal

OBJECTIVES

To validity the General Oral Health Assessment Index (GOHAI) among adults who sought dental care and to present a new proposal for calculating scores on self-perception of oral health.

BACKGROUND

There is no study that presents a GOHAI scores using weight of the items.

MATERIALS AND METHODS

The one-factor model, the three-factor model (physical function, psychosocial/psychological function and pain/discomfort) and the second-order hierarchical model (SOHM) were evaluated from confirmatory factor analysis (λ, χ² /df, CFI,GFI and RMSEA). The reliability (CR,α) was estimated. Concurrent validity was assessed using the Oral Health Impact Profile (OHIP-14). The invariance of the models was estimated in independent samples. The calculation of an overall score using the factor scores was proposed to obtain the overall weighted scores. These overall weighted scores were compared to the scores estimated as the simple arithmetic mean (overall unweighted scores) using a repeated measures analysis of variance.

RESULTS

A total of 1000 individuals participated (74.1% female; age: 40.7 (SD=14.3) years). Three items of the GOHAI were excluded (λ<0.40). The one-factor model (λ=0.40-0.77; χ² /df=6.291; CFI=0.947; GFI=0.960; RMSEA=0.073) and the three-factor model (λ=0.40-0.78; χ² /df=8.321; CFI=0.932; GFI=0.954; RMSEA=0.086) each presented an adequate fit. Reliability was adequate (one-factor: CR=0.83/α=0.83; three-factor: CR=0.53-0.76/α=0.53-0.73), with the exception of the pain/discomfort factor. The GOHAI was invariant in independent samples, and the concurrent validity was adequate. The overall unweighted scores overestimated self-perceptions of oral health when compared with the weighted scores.

CONCLUSION

Both the one-factor and three-factor models of the GOHAI were found to be valid, reliable and invariant for the sample after the exclusion of three items. The use of overall weighted scores is recommended for calculating the score of self-perception of oral health.

Psychometric characteristics of the "General Oral Health Assessment Index (GOHAI) » in a French representative sample of patients with schizophrenia

BACKGROUND

The "General Oral Health Assessment Index" (GOHAI) was widely used in clinical or epidemiological studies worldwide, as it was available for use in different languages. Therefore, the aim of this study was to evaluate the psychometric characteristics of the GOHAI in a representative sample of patients with schizophrenia.

METHODS

A total of 90 schizophrenic patients (in-patients and out-patients) were recruited from the participants of the "buccodor study" (NCT02167724) between March and September 2015. They were selected using a random stratified sampling method according to their age, sex, or residential area (urban/rural area). GOHAI validity (construct, predictive, concurrent and known group validity) and internal consistency (reliability) were tested. Test-retest reliability was evaluated in 32 subjects.

RESULTS

The mean age was 47.34 (SD = 12.17). Internal consistency indicated excellent agreement, with a Cronbach's α value of 0.82 and average inter-item correlation of 0.65. Intraclass correlation coefficients for test-retest reliability with 95% confidence intervals were not significantly different (p > 0.05). Construct validity was supported by three factor that accounted for 60.94% of the variance observed. Predictive validity was corroborated as statistically significant differences were observed between a high GOHAI score, which was associated with self-perceived satisfaction with oral health, lower age and high frequency of toothbrushing. Concurrent validity was corroborated as statistically significant relationships were observed between the GOHAI scores and most objective measures of dental status. For known group validity, they was no significant difference of the mean GOHAI score between out or in-patients (p > 0.05).

CONCLUSION

Acceptable psychometric characteristics of the GOHAI could help caregivers to develop ways to improve the Oral Health related Quality Of Life of schizophrenic patients.

TRIAL REGISTRATION

Clinical Trials Gov NCT02167724 . Date registered 17 June, 2014.

Validation of a Dutch version of the Geriatric Oral Health Assessment Index (GOHAI-NL) in care-dependent and care-independent older people

BACKGROUND

The GOHAI is a frequently used instrument to measure oral health-related quality of life (OHRQoL) of adults, in particular older people. The aim of this study was to translate the original English version of the GOHAI into a Dutch version (GOHAI-NL), and to test the validity and reliability of the GOHAI-NL in care-independent and care-dependent older people.

METHODS

The GOHAI questionnaire was translated into Dutch, discussed by an expert panel, back-translated to the original, pilot-tested and assessed for cognitive and conceptual equivalence. The resulting GOHAI-NL was tested in a groups of care-independent (Group A, n = 109, mean age 73.1 ± 5.4 years) and care-dependent (Group B, n = 118, mean age 85.6 ± 7.0. years) cognitively alert people of 65 years and over. Psychometric properties including reliability (internal consistency, item-total, item-dimension, dimension-total, inter-item correlation, and test-retest stability), and validity (convergent, discriminant, known-group), and floor and ceiling effects were assessed.

RESULTS

Internal consistency was confirmed by Cronbach's alphas of 0.86 (group A) and 0.80 (group B). Item-total score correlations were between 0.4 and 0.7 except for item 3 in group A (0.34) and B (0.08) and for item 12 in group A (0.20). Item-dimension and dimension-total correlations were between 0.30 and 0.78 and around 0.7 respectively for the dimensions 'physical functioning' and 'psychosocial functioning', but lower for the dimension 'pain and discomfort' with item-dimension correlations between 0.13 and 0.44. Average inter-item correlations were 0.34 ± 0.11 (group A) and 0.33 ± 0.08 (group B). Test-retest correlation of the total score (GOHAI-ADD) was 0.88 in group A (ICCs: 0.62 - 0.88) and 0.93 in group B (ICCs: 0.64 - 0.91). Significant correlations in the expected direction were found between GOHAI and most oral health-related variables except for presence of caries in group A, and perceived general health, prosthodontic status and number of natural teeth in group B. No floor or ceiling effects were detected at GOHAI-ADD level; however ceiling effects did occur at dimension level.

CONCLUSION

The GOHAI-NL has satisfactory reliability and validity and can be used to measure OHRQoL in Dutch care-dependent and care-independent older people.

Validation of the Geriatric Oral Health Assessment Index in complete denture wearers

To perform a validation of the Geriatric Oral Health Assessment Index (GOHAI) for complete denture wearers and present a proposal for estimation of perceived oral health. This is a cross-sectional study with non-probabilistic sampling. A total of 211 subjects with a mean age of 62·5 (s.d. = 11·4) years participated, being 169 female. The GOHAI was applied in a personal interview. The construct/convergent/discriminant validity was tested using structural equation modelling. Confirmatory factor analysis was used to verify the fit of three proposals of the GOHAI: three-factor, one-factor and second-order hierarchical models. The stability of the models was evaluated in independent samples. The three-factor model presented an inadequate fit, and items 3, 4 and 9 were removed. The new structure presented an acceptable fit and strong invariance in independent samples. The convergent, discriminant validity and internal consistency were below adequate. The one-factor model presented an adequate fit to the sample. Convergent validity was compromised. A strong invariance of the one-factor model was observed. To calculate the overall scores of the GOHAI factors (three-factor model) or of the oral health perception (one-factor model), a matrix of regression weights for each item in the model was presented as a suggestion. We found an adequate fit of the both structures of the GOHAI for denture wearers, but the three-factor structure was more parsimonious. We suggested considering the weights of the regression model to calculate the overall score of perceived oral health or of its factors in different samples.

Oral health-related quality of life and periodontal and dental health status in Iranian hemodialysis patients

AIM

The aim of this study was to evaluate oral health status and oral health related quality of life (OHRQoL) in Iranian patients undergoing hemodialysis.

MATERIALS AND METHODS

In this cross-sectional study 145 (95 dentate and 50 edentulous) patients undergoing hemodialysis participated. Demographic information, laboratory findings and dental health status was recorded by a standard form. Oral hygiene status was obtained by simplifed oral hygiene index (OHI-S) and oral health was evaluated by decay missing flling teeth (DMFT) index, plaque index (PLI) and periodontal disease index. Oral health related quality of life was determined by means of short form oral health impact profle (OHIP-14) and general oral health assessment index (GOHAI).

RESULTS

The mean (± SD) DMFT, PLI and PDI were 15.47 ± 7.85, 2.03 ± 0.95, 4.09 ± 1.31 respectively. OHI-S was good in 7 (7.4%), fair 25 (26.6%) and poor in 38 (26.6%) of patients. The mean OHIP-14 and GOHAI scores were 31.32 ± 12.53 and 29.07 ± 8.5 respectively. The self-perceived oral health of 58 (40%) was good, 49(33.8%) was fair and 38 (26.2%) was poor. Patients with higher scores for the questionnaires had significantly worst self-rated oral health. Besides, there was a significant positive correlation between dental and periodontal variables with OHIP-14 and GOHAI scores.

CONCLUSION

Hemodialysis patients had a poor oral hygiene and periodontal status, weak attitudes and negligence toward oral health but they were satisfed of their oral health condition and their OHRQoL was approximately good. Therefor it should be communications between nephrologists and oral health care professionals for promoting the oral health status of the patients.

CLINICAL SIGNIFICANCE

The findings high light the need of comprehensive oral examinations including periodontal therapy, restorative treatment, preventive dental treatment and follow-up care in the hemodialysis patients.