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OBJECTIVE: This article aims to provide an evaluation of the psychometric properties of the instruments of oral health literacy in adults. METHODS: An electronic search for instrument studies was performed in the PubMed, PubMed Central, ScienceDirect, Scopus, EMBASE, and PsycINFO databases to find articles published up to June 2021. The risk of bias of the included studies was assessed using the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk of Bias checklist for systematic review. RESULTS: From an initial sample of 2617 articles, 14 instrument studies were included in the present review. Their sample sizes ranged from 177 to 1405 adults, and the number of items per measurement instrument ranged from 14 to 99. For structural validity, statistical techniques were performed using the classical test theory (exploratory and confirmatory factor analysis) and the item response theory (dichotomous and polytomous models). The Rapid Estimate of Adult Literacy in Dentistry 30, elaborated in the USA, was the measurement instrument that had the greatest number of cultural adaptations, having been validated in such countries as Saudi Arabia, Brazil, Turkey, and Romania. The evaluation of the risk of bias, undertaken using the COSMIN Risk of Bias checklist, showed that 6 of the 10 parameters had been evaluated. CONCLUSION: The psychometric properties that were evaluated in the present systematic review were structural validity, internal consistency, reliability (test-retest), and hypothesis testing for construct validity. To date, there is no gold standard measuring instrument to evaluate the criterion validity parameter.
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Alfabetización en Salud , Adulto , Humanos , Psicometría , Reproducibilidad de los Resultados , Brasil , Bases de Datos FactualesRESUMEN
Objetivo: Determinar la equivalencia lingüística al español y la consistencia interna del Rapid Estimate of Adult Literacy in Dentistry 99 (REALD-99) en población mexicana. Métodos: la equivalencia del REALD-99 se hizo mediante la metodología traducción-retraducción por expertos en la traducción de la lengua inglesa y se validó su contenido por parte de cinco odontólogos generales. El instrumento se aplicó a una muestra de 995 personas de 15 a 54 años que solicitaron atención odontológica por primera vez. La participación de los individuos fue voluntaria y el consentimiento se hizo por escrito. Se analizaron variables epidemiológicas y se determinó la consistencia interna del instrumento con la prueba del Alfa de Cronbach. Resultados: se identificaron dos palabras con traducción idéntica y tres sin aplicación en el contexto odontológico local. La edad promedio de los participantes fue de 30 años (DE ±11); el 62 % fueron mujeres. La aplicación del instrumento tuvo un promedio de 87 aciertos (DE ±9.2) con un tiempo promedio de aplicación de 2.24 minutos. El alfa de Cronbach fue de 0.91 con las 99 palabras. Conclusiones: el instrumento es intercambiable y equivalente con una consistencia interna similar al obtenido en otros países; sin embargo, los resultados son una aproximación a la habilidad de lectura, pues no garantiza la comprensión, conocimiento y la operatividad de todas las palabras; además, no explica las complejas habilidades involucradas en la alfabetización en salud.
Objective: To determine the linguistic equivalence in the Spanish language and the internal consistency of the Rapid Estimate of Adult Literacy in Dentistry 99 (REALD-99) applied to a sample group of Mexican people. Method: The equivalence of the REALD-99 was performed by expert translators of the English language by means of translation-retranslation; its content was validated by fve bachelors of dentistry. The instrument was applied to a sample group of 995 people between 15 and 54 years old who requested dental care for the frst time. The people participated voluntarily, and their consent was given in writing. Epidemiological variables were analyzed, and the internal consistency of the instrument was determined with the Cronbach's Alpha test. Results: Two words with identical translation and three without application in the local dental context were identifed. The average age of the participants was 30 years old (SD ±11); 62% were women. The application of the instrument was 87 correct answers (SD ±9.2) on average and the application time was a median of 2.24 minutes. Cronbach's alpha was 0.91 with the 99 words. Conclusions: The instrument is interchangeable and equivalent with an internal consistency similar to that obtained in other countries. However, the results are an approximation to the reading ability and do not guarantee the knowledge, comprehension, or operability of related vocabulary and neither they explain the complex skills involved in health literacy.
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Alfabetización en Salud , Odontología , LingüísticaRESUMEN
BACKGROUND: Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children's oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL). METHODS: This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI). RESULTS: Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p < 0.05). A reduced impact on OHRQOL is also associated with having siblings (PR = 0.70, 95% CI 0.52-0.95). A higher age of the mother reduced OHRQOL impacts (PR = 0.72, 95% CI 0.52-0.98). CONCLUSIONS: The factors associated with children's OHRQOL were the number of siblings, the mothers' age, and dental caries. This study observed no association between parental OHL and children's OHRQOL.
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Caries Dental , Alfabetización en Salud , Brasil/epidemiología , Cuidadores , Niño , Preescolar , Estudios Transversales , Caries Dental/epidemiología , Femenino , Humanos , Salud Bucal , Calidad de VidaRESUMEN
OBJECTIVES: The purpose of this study is to describe Mexican-American parents' experiences navigating the dental care system for their children. METHODS: Thirty in-depth qualitative interviews were conducted with Spanish-speaking caregivers of young children in an urban county of Northern California, asking about their experiences navigating dental care for their children. Interviews were digitally recorded, translated, transcribed, coded, and analyzed using standard qualitative procedures. RESULTS: Caregivers reported challenges that highlight how various aspects of navigating the health care system are elemental to oral health literacy. These included making appointments, finding a provider they trust, using their dental insurance, and communicating with the dental care provider. CONCLUSIONS: When addressing oral health literacy, it is important to consider the navigational components to improve children's oral health literacy.
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Hispánicos o Latinos , Americanos Mexicanos , Niño , Preescolar , Atención Odontológica , Humanos , Salud Bucal , PadresRESUMEN
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.
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Alfabetización en Salud , Adulto , Brasil , Femenino , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To investigate whether oral health literacy (OHL) impacts missing data obtained through self-reporting in oral health epidemiological research. METHODS: A cross-sectional study was conducted with parents (n = 344) of 4- to 5-year-old children randomly selected from public schools within the city of Curitiba, Brazil. Parental OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Parents answered a set of questionnaires comprising 88 items concerning sociodemographic and economic data, children's access to dental services, oral hygiene behaviour, diet and mealtime behaviour. The total number of unanswered items (TUI) and the number of unanswered items in each type of question (open-ended, dichotomous, multiple choice with up to 4 options and with 5-9 options) for each participant was compared across different levels of OHL (chi-squared, Mann-Whitney, Kruskal-Wallis and Spearman's correlation test). Multiple Poisson regression was used to estimate rate ratios (RR) of TUI between OHL scores and their respective 95% confidence interval (95% CI). RESULTS: Approximately one-third of studied parents (37%) exhibited low OHL (BREALD-30 ≤ 21). The prevalence of missing data in at least one item was 85.5%. Low OHL was associated with failing to respond open-ended items (P = 0.003) and multiple-choice items with up to 4 (P = 0.003) and between 5 and 9 options (P = 0.030). There was a negative correlation between OHL scores and TUI (r = -0.195; P < 0.001), as well as with the number of unanswered items in all types of questions (P < 0.01), except dichotomous questions. Parents with lower OHL were more likely to show higher values of TUI (RR 0.95: 0.93-0.98), when adjusted by income and education. CONCLUSIONS: Participants with lower OHL were significantly more likely to fail to complete research questionnaires. The impact of OHL on missing data was greater with more complex types of items.
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Alfabetización en Salud , Salud Bucal , Adolescente , Adulto , Brasil , Preescolar , Estudios Transversales , Atención Dental para Niños/estadística & datos numéricos , Mediciones Epidemiológicas , Femenino , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Higiene Bucal/psicología , Padres , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
According to the World Health Organization, Health Literacy (HL) corresponds to the cognitive and social abilities that determine the motivation and ability of individuals to gain access, to understand, and to use information in ways that provide and maintain good health. The development of HL in dentistry came late, and only in the last decade did it reach a level similar to that in the medical area. In dentistry, HL centered on the concept of Oral Health Literacy (OHL), defined as the degree to which individuals have the capacity to obtain, process, and understand basic information on oral health and services that is necessary to make appropriate health decisions. The evidence suggests that people with low HL have worse health status and greater use of medical resources, which results in an increase in costs in the general population. Determinants of the level of OHL include age, level of education, and socioeconomic level. These determinants are reflected in low oral health and in less access to information or less understanding regarding care, pathologies, or dental treatments. The instruments for measuring HL and OHL are mainly aimed at recognizing arithmetic and reading skills, which are not fully related to the ability of the people surveyed to find, understand and use information related to health. OHL is an important issue at the level of health programs, because knowledge of OHL helps in medical practice, in disease prevention and in health promotion. OHL instruments must have validated and demonstrate adequate psychometric properties.
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Humanos , Salud Bucal , Alfabetización en Salud , ChileRESUMEN
INTRODUCTION: Oral health education/promotion interventions have been identified as cost-efficient tools to improve the oral health of the population. These interventions are regularly made in contexts where the target population is captive, for example, in health centres. In Chile, there are no oral health interventions delivered at home. METHODS AND ANALYSIS: This community trial covers two disadvantaged urban areas in the province of Concepción. Both sectors have public preschool education coverage with a traditional programme (TP) to promote oral health. The intervention will comprise four to six visits by dental hygienists trained in the delivery of a standardised oral health promotion programme using motivational interviewing (MI) at home. The experimental group will receive TP and MI, while the control group will receive only TP. If a positive and significant effect of MI is found, this will be administered to the control group. For a 50% reduction in the incidence of caries, a sample size of 120 preschoolers per group is estimated. Data will be gathered on demographic and socioeconomic variables; oral health outcomes using WHO oral health indicators (the prevalence and severity of caries, periodontal disease, dentofacial anomalies and oral hygiene); the oral health literacy of caregivers, measured by the Rapid Estimation of Adult Literacy in Dentistry and the Oral Health Literacy Instrument, both validated for the Chilean population. Assessments will take place at baseline and at 12-month follow-up. ETHICS AND DISSEMINATION: The university bioethics committee approved this study (EI/21/2014). We will submit the trial's results for presentation at international scientific meetings and to peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12615000450516.
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Cuidadores/educación , Caries Dental/prevención & control , Alfabetización en Salud , Entrevista Motivacional , Salud Bucal/educación , Adulto , Preescolar , Chile , Caries Dental/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Humanos , Masculino , Morbilidad , Higiene Bucal , Proyectos de Investigación , Población Urbana , Poblaciones VulnerablesRESUMEN
OBJECTIVE: To report the adaptation and cultural validation of the Oral Health Literacy Instrument (OHLI) for the adult Chilean population attending public and university health services. STUDY DESIGN: The original OHLI in English was translated to Spanish and back-translated, then a preliminary version was obtained following review by four experts. A pilot study was carried out in 30 patients, who were asked to assess their understanding of the questionnaire. The following variables were included: sociodemographic factors (sex, age, average monthly income, education and marital status); oral health (history of caries, periodontal disease and oral hygiene); oral health-related quality of life; health literacy; oral health literacy; and psychometric properties (internal consistency, temporal stability, convergent validity and predictive validity). Clinical examination and questionnaire administration were carried out at the public health centres where the participants were receiving treatment. RESULTS: A total of 482 persons participated in the study. The internal consistency was high; Cronbach's alpha values were 0.864 for the first section, 0.739 for the second section and 0.887 for the entire instrument. The temporal stability was good, and the intraclass correlation coefficient was >0.6. Regarding convergent validity, the correlation of Chilean version of OHLI (OHLI-cl) with health literacy was positively moderate to strong (r > 0.5 and ρ > 0.5) and statistically significant (P < 0.01). Regarding predictive validity, the correlation of OHLI with oral health damage was negatively weak to moderate (r < -0.2 and ρ < -0.2) and statistically significant (P < 0.01). CONCLUSION: The OHLI-cl demonstrates adequate psychometric properties for measuring the oral health literacy in Chilean populations attending public and university health services.