Development and validation of a short form of the BOHLAT-P

Firmino, Ramon Targino; Granville-Garcia, Ana Flávia; Bendo, Cristiane Baccin; Ferreira, Fernanda Morais; Ortiz, Fernanda Ruffo; Mcgrath, Colman Patrick; Paiva, Saul Martins

doi:10.1590/1807-3107bor-2022.vol36.0074

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Original Research, Pediatric Dentistry • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0074 copy

Development and validation of a short form of the BOHLAT-P

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The authors developed and validated a short form of the Brazilian Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P). Data included responses from 200 parents of preschoolers to sociodemographic and oral health service access questions on the BOHLAT-P, the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), and the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). Data on the preschoolers’ dental caries experience (ICDAS-II) were also included. An item response theory-based approach was employed to develop the short form, while confirmatory factor analysis evaluated the instrument dimensionality. The validity and reliability of the short form were tested by statistical analysis using BREALD-30, B-ECOHIS, and sociodemographic and dental caries experience data. The short form (BOHLAT-P-30) comprises 30 items, is unidimensional, and presents better model fit estimates (TLI = 0.94; CFI = 0.94; RMSEA = 0.05) than those of the BOHLAT-P. Moreover, BOHLAT-P-30 demonstrated excellent reliability (Cronbach's alpha = 0.91; intraclass correlation coefficient [ICC] = 0.95). BOHLAT-P-30 scores were positively correlated with BREALD-30 scores (r = 0.71), with the number of years of schooling (r = 0.60), and with the number of hours spent reading (r = 0.33). BOHLAT-P-30 scores were negatively correlated with B-ECOHIS scores (r = -0.21), and with the number of teeth with cavitated caries (r = -0.18). After controlling for confounding factors, BOHLAT-P-30 scores were not found to be associated with caries presence, or with the number of teeth with cavitated caries. The BOHLAT-P-30 had properties similar to those of the BOHLAT-P, and proved to be a valid measure to assess the OHL of Brazilian parents.

Keywords:
Dental Caries; Quality of Life; Validation Studiy

Item		Item parameters
Item		a	b
Part I
	Q1	1.866	-0.796
	Q2	1.922	-0.275
	Q3	2.085	-0.684
	Q4	0.990	-1.814
	Q5	1.678	0.084
	Q6	2.063	-0.267
	Q7	2.343	-0.884
	Q8	2.401	-0.462
	Q9	0.778	-0.354
	Q10	2.338	-1.650
	Q11	1.680	-0.183
	Q12	1.586	-2.049
Part II
	Q13	1.901	-1.192
	Q14	1.538	-1.185
	Q15	2.209	-1.610
	Q16	2.301	-1.455
	Q17	3.131	-1.752
	Q18	1.175	-1.757
	Q19	1.607	-2.253
	Q20	1.361	-1.505
	Q21	1.381	-2.273
	Q22	2.408	-1.562
	Q23	1.648	0.049
	Q24	1.718	-1.171
	Q25	3.252	-1.350
	Q26	4.379	-1.572
	Q27	2.240	-1.841
	Q28	2.692	-1.692
	Q29	3.723	-1.502
	Q30	1.072	-2.174
	Q31	2.314	-1.516
	Q32	0.139	-17.629
	Q33	0.624	-1.686
	Q34	1.852	-1.060
	Q35	2.162	-1.457
	Q36	1.045	-1.018
Part III
	Q37	-0.104	2.518
	Q38	1.455	-0.993
	Q39	1.125	0.911
	Q40	1.553	0.466
	Q41	0.489	2.659
	Q42	1.816	-0.533
	Q43	0.979	-1.909
	Q44	0.439	0.525
	Q45	1.530	0.867
	Q46	1.544	-1.182
	Q47	1.329	-0.166
	Q48	0.891	0.102
	Q49	0.911	-0.915

Variable		TLI^* * Values ≥ 0.95 indicate excellent model fit. Values ≥ 0.90 and < 0.95 indicate acceptable model fit;	CFI^* * Values ≥ 0.95 indicate excellent model fit. Values ≥ 0.90 and < 0.95 indicate acceptable model fit;	RMSEA^ Values ≤ 0.06 indicate excellent model fit. Values ≥ 0.06 and ≤ 0.08 indicate acceptable model fit;	SRMSR^ Values ≤ 0.06 indicate excellent model fit. Values ≥ 0.06 and ≤ 0.08 indicate acceptable model fit;	AIC^* ***** Lower values indicate better adjustment.	AICc^* ***** Lower values indicate better adjustment.	SABIC^* ***** Lower values indicate better adjustment.	BIC^* ***** Lower values indicate better adjustment.	X²^* ***** Lower values indicate better adjustment.	df^* ***** Lower values indicate better adjustment.
IRT Models
	BOHLAT-P	0.92	0.92	0.06	0.08	8086.9	8279.0	8099.7	8410.2	–	–
	BOHLAT-P-30	0.94	0.94	0.06	0.08	4549.86	4602.5	4557.6	4747.7	–	–
CFA Models
	BOHLAT-P	0.92	0.92	0.04	–	–	–	–	–	609.66	404
	BOHLAT-P-30	0.94	0.94	0.05	–	–	–	–	–	1540.32	1124

Variable		r^* * Spearman's correlation coefficients of the BOHLAT-P-30 and designated variables.	p-value
BREALD-30 scores		0.719	< 0.001
Years of schooling		0.605	< 0.001
Hours spent reading		0.332	< 0.001
B-ECOHIS scores		-0.217	0.002
Number of teeth with cavitated caries		-0.182	0.010
		Median (Interquartile range)
Dental caries
	Yes	23.0(8)	0.004^ Mann-Whitney test. Results significant at the 5% level.
	No	26.0(5)
Did the child ever visit the dentist?
	Yes	24.0(9)	0.803^ Mann-Whitney test. Results significant at the 5% level.
	No	24.0(8)

Variable	BREALD-30	Number of teeth with cavitated caries	Presence of dental caries	B-ECOHIS
BOHLAT-P-30	1.024^* * Statistically significant association at the multivariate level (p < 0.05).	0.994	0.999	0.965^* * Statistically significant association at the multivariate level (p < 0.05).
BOHLAT-P-30	(1.017–1.031)	(0.948–1.042)	(0.990–1.009)	(0.932–0.998)
Monthly family income	1.015	0.906	0.882^* * Statistically significant association at the multivariate level (p < 0.05).	0.916
Monthly family income	(0.994–1.036)	(0.696–1.178)	(0.814–0.956)	(0.719–1.167)
Years of schooling	1.009^* * Statistically significant association at the multivariate level (p < 0.05).	0.901^* * Statistically significant association at the multivariate level (p < 0.05).	1.007	0.969
Years of schooling	(1.002–1.017)	(0.837–0.971)	(0.985–1.030)	(0.907–1.035)

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[1] Corresponding Author: Ramon Targino Firmino E-mail: ramontargino@gmail.com