Assessment of oral health literacy and oral health related quality of life in Saudi university students: A cross sectional study

BACKGROUND

Oral health literacy was recognized as important to encouraging oral health and avoiding oral health diseases. Therefore, this study was conducted to assess oral health literacy (OHL) and oral health-related quality of life (OHRQoL) among undergraduate students studying at university.

MATERIALS & METHODS

A prospective cross-sectional study was carried out from November to February 2023 among the students of King Khalid University. OHL and OHRQoL were assessed using a Rapid estimate of adult literacy in dentistry-30 (REALD-30) and oral health impact profile (OHIP-14). Further, Pearson's correlation tests were used to measure the correlation between REALD-30 and OHIP-14.

RESULTS

Among the 394 completed respondents, the majority were Aged>20 years (n=221; 56.09%), Aged <20 years (n=173 43.91%), female (n=324; 82.23%), male (n=70; 17.7%). Participants from health-related colleges were (n=343; 87.06%), and other colleges were (n=51; 12.94%) *P<0.04. Participants brushing frequency once daily were (n=165; 41.88%) twice or more per day (n=229; 58.12%) *P<0.018. The overall mean REALD-30 score of the participants was 11.76 ±0.17 indicating Low OHL. The higher mean score of OHIP-14 for the following domains physical pain 12.93±0.56, physical disability 12.05±0.72, and psychological disability 12.71±0.76. Oral health impact profile-14 and REALD showed a positive correlation for health-related colleges (r = 0.314; *P<0.002) and other colleges (r = 0.09; P<0.072). However, a significant correlation was observed between REALD-30 and OHIP-14 scores among health-related colleges (P < 0.05).

CONCLUSION

The current study concluded that self-rated poor oral health is significantly linked with OHIP-14 scores. Furthermore, systematic health education programs such as regular dental checkups for college students must be arranged to assist in changing the student's everyday life and oral health behaviors.

Validity and reliability of the Portuguese version of the rapid estimate of adult literacy in dentistry: REALD-29 PT

BACKGROUND

Health literacy is a main factor in health for its improvement, allowing the individuals to have a greater capacity to engage and participate in collective health promotion actions. The evaluation of functional health literacy is essential to determine the ability that each individual has to understand basic health information. The present study aimed to perform the translation and cross-cultural adaptation of the Rapid Estimate of Adult Literacy in Dentistry-30 to the Portuguese language and test the reliability and validity of this version.

METHODS

After translation and cultural adaptation, the instrument was applied to a group of individuals that participate in the program Atividade Senior, developed by the municipality of Viseu, Portugal. The final sample was composed by 206 participants that accepted responding to the translated version of the instrument. Statistical validation was accomplished to complete the process and obtain the final instrument. One question was removed for the creation of the final instrument with 29 questions, therefore being named Rapid Estimate of Adult Literacy in Dentistry-29 PT.

RESULTS

The Rapid Estimate of Adult Literacy in Dentistry-29 PT presented good internal reliability. Cronbach's alpha ranged from 0.89 to 0.90 when words were deleted individually. The analysis of test-retest reliability revealed excellent reproducibility. We can verify that the Rapid Estimate of Adult Literacy in Dentistry-29 PT scale for assessment of oral health literacy among older adults presents an acceptable internal consistency, with a global Cronbach´s alpha of 0.894.

CONCLUSIONS

The new scale can be applied to assess oral health literacy among older Portuguese adults, presenting an acceptable internal consistency and is validated to assess oral health literacy and is crucial in epidemiological studies.

Cross-cultural adaptation and validation of Malay version of Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) among Orang Asli population in Malaysia

BACKGROUND

The aim of this study was to adapt, translate and validate the Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) instrument for the Orang Asli population in Malaysia.

METHODS

After translation and cross-cultural adaptation, interviews were conducted with 326 participants of the Temuan tribe from village Kampung Tering in Johol, Negeri Sembilan, Malaysia. The instrument's validity was assessed using the scores of MREALD-30, which were compared based on occupation, monthly household income, educational attainment, general literacy, use of dental services, and three dental outcomes. A questionnaire containing socio-behavioral information and validated Malay Oral Health Impact Profile (M-OHIP-14) was also administered. The reliability of the MREALD-30 was assessed by re-administering it to 30 subjects after two weeks. Its correlations evaluated convergent and discriminative validity of MREALD-30 with the level of education and dental visiting habits, monthly household income, respectively. Predictive validity was assessed with M-OHIP-14, while construct validity was evaluated by exploratory factor analysis using the Rasch model.

RESULTS

The internal consistency of the MREALD-30 measured by Cronbach's alpha was 0.89. The test-retest reliability was excellent (ICC 0.95, k = 0.85). MREALD-30 exhibited good construct validity. Rasch analysis showed two factors, and infit mean-square statistics for MREALD-30 were all within the desired range of 0.50-2.0. The discriminant validity and predictive validity were statistically significant (p < 0.05).

CONCLUSIONS

MREALD-30 showed very strong reliability, good construct, discriminant, and predictive validity, but poor convergent validity. Overall, it showed good psychometric properties and can be used in these community settings.

Development of a Greek Oral health literacy measurement instrument: GROHL

Background

Oral health literacy is an important construct for both clinical and public health outcomes research. The need to quantify and test OHL has led to the development of measurement instruments and has generated a substantial body of recent literature. A commonly used OHL instrument is REALD-30, a word recognition scale that has been adapted for use in several languages. The objective of this study was the development and testing of the Greek language oral health literacy measurement instrument (GROHL).

Methods

Data from 282 adult patients of two private dental clinics in Athens, Greece were collected via in-person interviews. Forty-four words were initially considered and tested for inclusion. Item response theory analysis (IRT) and 2-parameter logistic models assessing difficulty and discriminatory ability were used to identify an optimal scale composition. Internal consistency was examined using Cronbach’s alpha and test-retest reliability was measured using intraclass correlation coefficient (ICC) in a subset of 20 participants over a two-week period. Convergent validity was tested against functional health literacy screening (HLS) items, dental knowledge (DK), oral health behaviors (OHBs), oral health-related quality of life (OHRQoL; OHIP-14 index), as well as self-reported oral and general health status.

Results

From an initial item pool of 44 items that were carried forward to IRT, 12 were excluded due to no or little variance, 10 were excluded due to low item-test correlation, and 2 due to insignificant contribution to the scale, i.e., difficulty parameter estimate with p > 0.05. The twenty remaining items composed the final index which showed favorable internal consistency (alpha = 0.80) and test-retest reliability (ICC = 0.95). The summary score distribution did not depart from normality (p = 0.32; mean = 11.5; median = 12; range = 1–20). GROHL scores were positively correlated with favorable oral hygiene behaviors and dental attendance, as well as HLS, DK and education level.

Conclusion

The GROHL demonstrated good psychometric properties and can be used for outcomes research in clinical and public health settings.

Reliability and validity of the Turkish version of the Rapid Estimate of Adult Literacy in Dentistry (TREALD-30)

OBJECTIVE

To culturally adapt the Turkish version of Rapid Estimate of Adult Literacy in Dentistry (TREALD-30) for Turkish-speaking adult dental patients and to evaluate its psychometric properties.

MATERIAL AND METHODS

After translation and cross-cultural adaptation, TREALD-30 was tested in a sample of 127 adult patients who attended a dental school clinic in Istanbul. Data were collected through clinical examinations and self-completed questionnaires, including TREALD-30, the Oral Health Impact Profile (OHIP), the Rapid Estimate of Adult Literacy in Medicine (REALM), two health literacy screening questions, and socio-behavioral characteristics. Psychometric properties were examined using Classical Test Theory (CTT) and Rasch analysis.

RESULTS

Internal consistency (Cronbach's Alpha = 0.91) and test-retest reliability (Intraclass correlation coefficient = 0.99) were satisfactory for TREALD-30. It exhibited good convergent and predictive validity. Monthly family income, years of education, dental flossing, health literacy, and health literacy skills were found as stronger predictors of patients'oral health literacy (OHL). Confirmatory factor analysis (CFA) confirmed a two-factor model. The Rasch model explained 37.9% of the total variance in this dataset. In addition, TREALD-30 had eleven misfitting items, which indicated evidence of multidimensionality. The reliability indeces provided in Rasch analysis (person separation reliability = 0.91 and expected-a-posteriori/plausible reliability = 0.94) indicated that TREALD-30 had acceptable reliability.

CONCLUSION

TREALD-30 showed satisfactory psychometric properties. It may be used to identify patients with low OHL. Socio-demographic factors, oral health behaviors and health literacy skills should be taken into account when planning future studies to assess the OHL in both clinical and community settings.