|Year : 2019 | Volume
| Issue : 3 | Page : 132-136
Reliability and validity of the thai version of rapid estimate of adult literacy in dentistry
Supasin Deeraksa1, Rajda Chaichit2, Benja Muktabhant3, Suwit Udompanich4
1 Doctoral of Public Health Program, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
2 Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University; Research Group on Prevention and Control of Diabetes Mellitus in the Northeast Region, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
3 Research Group on Prevention and Control of Diabetes Mellitus in the Northeast Region; Department of Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
4 Department of Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
|Date of Web Publication||25-Jun-2019|
Dr. Rajda Chaichit
Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002
Source of Support: None, Conflict of Interest: None
Aims: The study aimed to evaluate the reliability and validity of the Thai version of Rapid Estimate of Adult Literacy in Dentistry (ThREALD-30). Materials and Methods: The Rapid Estimate of Adult Literacy in Dentistry-30 items (REALD-30) was translated to Thai language and back-translation process to English version of REALD-30 by experts of dentistry and linguistics. This cross-sectional study was conducted with a sample of 1110 patients from the five provinces in Northeast of Thailand. All variables were performed by descriptive statistics. The quality of the development tool of ThREALD-30 was tested internal consistency, reliability, and validity from construct validity and predictive validity correlated with Thai Oral Health Impact Profile 14 items (Thai OHIP-14) and Oral health status, respectively. The statistics were analyzed using STATA version 10. Results: A total of 1110 adult patients with a mean age was 51.11 + 6.63 years old. The reliability of ThREALD-30 was excellent (α = 0.950; intraclass correlation coefficient = 0.970, 95% confidence interval: 0.939–1.000). The construct validity was evaluated to indicate the subscales of ThREALD-30 being trustable by showing the correlation coefficient with their own dimension between 0.345 and 0.773, and predictive validity from Spearman's with Thai OHIP-14 (rrho= −0.688, P < 0.001) and oral health status; decayed, missing, and filled teeth (rrho = −0.283, P < 0.001); Oral Hygiene Index Simplified (rrho = −0.432, P < 0.001); and clinical attachment loss (rrho= −0.470, P < 0.001), supporting the construct and criterion validity. Conclusion: ThREALD-30 is an oral health literacy tool that worked well in the Thai population. It offers a valid and reliable instrument for measuring oral health outcome of the individual in community settings.
Keywords: Oral health literacy, Oral health status, REALD-30, Reliability, Thai version of Rapid Estimate of Adult Literacy in Dentistry-30, Validity
|How to cite this article:|
Deeraksa S, Chaichit R, Muktabhant B, Udompanich S. Reliability and validity of the thai version of rapid estimate of adult literacy in dentistry. J Int Oral Health 2019;11:132-6
|How to cite this URL:|
Deeraksa S, Chaichit R, Muktabhant B, Udompanich S. Reliability and validity of the thai version of rapid estimate of adult literacy in dentistry. J Int Oral Health [serial online] 2019 [cited 2023 Apr 2];11:132-6. Available from: https://www.jioh.org/text.asp?2019/11/3/132/261265
| Introduction|| |
Health literacy is a recent new concept in health promotion and is also a component of health education and communication activities to describe a range of health outcome., Oral health, one of the components in general health, has an essential key to develop oral health literacy skills in the community. Oral health literacy presents definition among them, “the degree to which individuals have the capacity to obtain, process, and understand basic oral and craniofacial health information and service needed to make appropriate health decisions.” Thus, oral health literacy is an essential need to empowerment the people within the domain of oral health promotion and prevention, and advocates improvements in the sophistication of contemporary in oral health education strategies. In dentistry, dental literacy is a field that has several potentialities to be investigated, and studies evaluating the relationship between oral health literacy and oral health status began to be developed less than a decade ago. There is extensive evidence about the impact of oral health literacy on the oral health status.
There are many instruments to measure oral health literacy that focused to evaluate one or more of the following skills: recognition and pronunciation of dental terms, reading comprehension and numeracy, and decision-making about oral health., Different studies used different validity tools during 2007–2013 which were as follows: the Test of Functional Health Literacy in Dentistry, Oral Health Literacy Instrument, Comprehensive Measure of Oral Health Knowledge, the brief 20-item dental/medical health literacy screen, the Rapid Estimate of Adult Literacy in Dentistry-99 items (REALD-99), and the REALD-30. REALD-30 was the most commonly used instrument in oral health literacy. It consists of 30 dental terminologies; it was developed from the REALD-99 showing the effectiveness in measuring the oral health literacy in adults after testing for its validity. REALD-30 is easy to use and is beneficial for measuring the level of oral health literacy. REALD-30 is effective in the psychometric analysis and is considered as a good tool in measuring the oral health literacy among cultural difference populations. However, there is limitation in the use of this tool among specific countries. For example, Hong Kong, Turkey, Saudi Arabia, etc. used REALD-30 in their native language, which was already tested for its validity and reliability.
However, in Thailand, the oral health literacy instrument in the Thai version does not exist and evaluation of this tool is not available. If the Thai version is created, it will help in strategic implementation for improving the oral health status, the level of understanding, and communication between oral healthcare providers and patients. Therefore, the current study was aimed to evaluate the reliability and validity of the Thai version of the Rapid Estimate of Adult Literacy in Dentistry (ThREALD-30).
| Materials and Methods|| |
The cross-sectional study was conducted after obtaining approval from the Khon Kaen University Ethical Committee in human research (Reference no. HE. 612061), Khon Kaen, Thailand. Written informed consent was signed by the participants of the study.
The sample was calculated using the formula of Hsieh et al. The approximate sample size was 385.5 which was adjusted to control the overfitting, using the rho (ρ) of 0.50 and variance inflation factor equal to 2.00. Thus, the total number of sample size was 899, which was adjusted by 10% base on expert recommendation. Therefore, the total sample size was included in the current study was 1110.
Inclusion criteria of the study were literate patients who had natural teeth and age between 20 and 59 years. The multistage random sampling method was used to select sample size in the Northeast region of Thailand. First, 10 hospitals were randomly selected from the five provinces in the Northeast region of Thailand. Then, two of 10 hospitals were continuously randomly selected from each of the provinces. Finally, 10 hospitals were applied by systematic random sampling to select 1110 patients for this study. The structured questionnaire was interviewed after the patients' signed consent. The data collection was conducted from May 2018 to July 2018.
Translation and tool
Lee et al. had built REALD-30, who selected 30 words from dental terminology, obtained in the dental clinic and developed from REALD 99 words. The original English version of REALD-30 words was translated into Thai language by experts of dentistry and linguistics. After developing the ThREALD-30 of the existing and previously validated REALD-30, using the back-translation method and expert review committee evolution. The ThREALD-30 was pretested in the dental clinic among 30 samples. Moreover, oral health-related quality of life (OHRQoL) was also pilot tested with the sample group using the Thai version of Oral Health Impact Profile-14 items (Thai OHIP-14) and oral health status from the World Health Organization (WHO) Oral Health Assessment Form for Adults: Basic methods 5th edition.
The tool was conducted from the list of ThREALD 30 words with the purpose of testing patient's reading abilities of loud pronunciation; higher score means a high level of oral health literacy. Moreover, the structured interview about background characteristic was recorded for the following demographic factors: age, gender, education level, marital status, dental visit, and dental health insurance coverage. In addition, Thai OHIP-14 was administered for measuring the quality of life; it is composed of seven parts with two questions in each of the parts. A higher score in Thai OHIP-14 means poorer OHRQoL. Moreover, oral health status component by the WHO basic oral survey was assessed in terms of the number of dental caries history (decayed, missing, and filled teeth [DMFT]), Oral Hygiene Index Simplified (OHI-S), and clinical attachment loss (CAL). The clinical oral examination was performed by a dentist, with the participants sitting in a dental operating chair that was assessed with a dental mirror, an explorer, and a periodontal probe.
Summary measure for all variables was calculated. All variables were performed by descriptive statistics. The quality of the development tool of ThREALD-30 was estimated reliability from Cronbach's alpha and internal consistency from the intraclass correlation coefficient (ICC) with 95% confidence interval (95% CI). Moreover, the validity from Spearman's rank correlation coefficient was estimated for construct validity and predictive validity with a significance level at P < 0.001. All analyses were performed using STATA version 10 (StataCorp LP. College Station, TX, USA).
| Results|| |
Among 1110 patients, the age ranged from 20 to 59 years and the mean age was 51.11 years. Three-fourth of patients were female and most of them got married. About half of the patients were primary school education level. Nearly most of them had dental health insurance and the majority was 30 Bath Universal Coverage Scheme (78.92%). Eighty percent of patients experienced visit to the dental clinic and one in two of the patients visited the dental clinic 1 time/year [Table 1].
ThREALD-30 average was 20.12 ± 8.71 and Thai OHIP-14 items average was 14.33 ± 9.73. The oral health status was demonstrated; DMFT average was 5.20 ± 4.22, OHI-S average was 1.93 ± 0.48, and CAL average was 4.53 ± 1.77.
The reliability of ThREALD-30 was excellent, and Cronbach's alpha coefficient was 0.950 and ICC was 0.970 (95%CI: 0.939–1.000). The ICC was used to examine the prepost test reliability of the 30 patients, which revealed excellent results [Table 2].
|Table 2: Descriptive statistic and reliability of the Thai version of the rapid estimate of adult literacy in dentistry-30|
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The validity was demonstrated in supporting the construct and criterion validity. The construct validity was evaluated to indicate the subscales of ThREALD-30 being trustable by showing the correlation coefficient with their own dimension between 0.345 and 0.773. The predictive validity of ThREALD-30 was a modest of negative correlation and significantly with OHIP-14 from Spearman's rank correlation coefficient (rrho= −0.688, P < 0.001) and ThREALD-30 correlated with a low negative significantly with oral health status; DMFT (rrho= −0.283, P < 0.001), OHI-S (rrho= −0.432, P < 0.001), and CAL (rrho= −0.470, P < 0.001), respectively. The negative correlation significant that mean score of ThREALD-30 opposite the score of oral health outcome among adult patients [Table 3].
|Table 3: Predictive validity of the Thai version of rapid estimate of adult literacy in Dentistry-30|
Click here to view
| Discussion|| |
To maintain the good oral health was required the three components of an individual, for example, to understand the oral health, how to access to oral health information, and to communicate in verbal or written form. Thus, following oral health literacy can improve the communication between the dental health provider and patients which contributes to patient's oral health care. Therefore, oral health literacy instrument needs to be reliable and validated in the language of the participants for whom it is being used. To our knowledge, the oral health literacy instrument in the Thai version did not exist. Therefore, this study was aimed to evaluate the reliability and validity of the ThREALD-30 for Thai populations. This tool was negative correlation predicted validity characterized as dental terminology recognition test. ThREALD-30 can provide a quick and easy assessment in patients' care setting.
In the present study, the internal consistency expresses as Cronbach's alpha coefficient of ThREALD-30 which was 0.950 appropriated, has similar resulted to recently conduct research 2018 in Chile and also original version (REALD-30) and other conducted new versions for example: Hong Kong (HKREALD-30), Turkey (TREALD-30), and Arabic (AREALD-30) that Cronbach's alpha coefficient of REALD-30 were >0.84 and ICC >0.78. According to the findings of this study, ICC demonstrated an excellent instrument of ThREALD-30 has a similarity to the earlier studies.,,, Almost of the oral health literacy tools, it might be found the appropriate reliability. However, the short form of the Brazilian version of the oral health literacy assessment did not acceptable in reliability <0.7 from Cronbach's alpha. In addition, the ThREALD-30 and other versions demonstrated the character of instrument related to the adverse oral health condition and arranged in ascending order of reading difficulty.
The validity was used to evaluate in ThREALD-30 for this study. The construct validity was a positive correlation that was indicated by the subscale of ThREALD-30 representing similarity from the study of Health Literacy in Dentistry scale and Thai OHIP-14, but some studies compared with the other oral health assessment instrument, or indicated a correlation between the English and native language. The predictive validity of ThREALD-30 was a significant negative association between the Thai OHIP-14, DMFT, OHI-S, and CAL. The findings of this study were similar to the results in Spain, Saudi Arabia, India, and the first version of Lee et al. found that the negative correlation with OHIP-14 was statistically significant. The newest study conducted in Chile 2018 showed a negative association with DMFT and OHI-S, which were in accordance with this study, but it used OHIP-49sp to test the validity which revealed statistically significant results. In contrast, the Arabic version tested validation with self-perceived oral health status and dental visit which did not correlate significantly with AREALD-30. Moreover, the first version of REALD-30 did not reveal significant results with dental visits and the control factors. Therefore, we may confirm that the association between high scores of dental health literacy could lead to a better of oral health status and OHRQoL among adult patients. However, only a few studies of dental terms literacy did not reveal significant correlation after controlling for its covariates factors., The merit of ThREALD-30 is a series of psychometric tests to evaluate reliability and validity in the Thai population.
This is a cross-sectional studied conducted only for a snap of time to validate the properties of the research instrument. Future studies are recommended to test the reliability and validity of the ThREALD-30 with similar populations. Experimental research and longitudinal study would be necessary to evaluate ThREALD-30 quick assessment with less fieldwork effort and burden.
| Conclusion|| |
ThREALD-30 is the oral health literacy tool that worked well in the Thai population and it proves to be a valid and reliable instrument for measures of oral health outcomes in the context of the Thai community. ThREALD-30 could also be used to conduct outcome-based oral health research. Such studies are necessary to improve the understanding of oral health literacy, its determinants, and its association with oral health outcome.
The researcher team would like to gratitude to all patients who participated in this study. We also appreciated the support from the administration and dental health personnel of hospitals that helped the study achieve its goal successfully.
Financial support and sponsorship
This study was financially supported by the Research Group on Prevention and Control of Diabetes Mellitus in the Northeast Region, Thailand. Faculty of Public Health, Khon Kaen University (KKU), Thailand.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into 21th
century. Health Promot Int 2000;15:259-67.
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al.
Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 2012;12:80.
National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services. The invisible barrier: Literacy and its relationship with oral health. A report of a workgroup sponsored by the National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services. J Public Health Dent 2005;65:174-82.
Bado FM, Ferreira FM, Barbosa TD, Mialhe FL. Translation and cross-cultural adaptation of the oral health literacy assessment-Spanish to Brazilian Portuguese. Pesqui Bras Odontopediatria Clin Integr 2017;17:e2976.
Dickson-Swift V, Kenny A, Farmer J, Gussy M, Larkins S. Measuring oral health literacy: A scoping review of existing tools. BMC Oral Health 2014;14:148.
Taylor CL, Pretty I. An introduction to health literacy and oral health: The importance of awareness amongst dental care professionals. Dent Update 2014;41:605-12.
Gong DA, Lee JY, Rozier RG, Pahel BT, Richman JA, Vann WF Jr., et al.
Development and testing of the test of functional health literacy in dentistry (TOFHLiD). J Public Health Dent 2007;67:105-12.
Sabbahi DA, Lawrence HP, Limeback H, Rootman I. Development and evaluation of an oral health literacy instrument for adults. Community Dent Oral Epidemiol 2009;37:451-62.
Macek MD, Haynes D, Wells W, Bauer-Leffler S, Cotten PA, Parker RM, et al.
Measuring conceptual health knowledge in the context of oral health literacy: Preliminary results. J Public Health Dent 2010;70:197-204.
Gironda M, Der-Martirosian C, Messadi D, Holtzman J, Atchison K. A brief 20-item dental/medical health literacy screen (REALMD-20). J Public Health Dent 2013;73:50-5.
Richman JA, Lee JY, Rozier RG, Gong DA, Pahel BT, Vann WF Jr., et al.
Evaluation of a word recognition instrument to test health literacy in dentistry: The REALD-99. J Public Health Dent 2007;67:99-104.
Lee JY, Rozier RG, Lee SY, Bender D, Ruiz RE. Development of a word recognition instrument to test health literacy in dentistry: The REALD-30 – A brief communication. J Public Health Dent 2007;67:94-8.
Wong HM, Bridges SM, Yiu CK, McGrath CP, Au TK, Parthasarathy DS, et al.
Development and validation of Hong Kong rapid estimate of adult literacy in dentistry. J Investig Clin Dent 2012;3:118-27.
Peker K, Köse TE, Güray B, Uysal Ö, Erdem TL. Reliability and validity of the Turkish version of the rapid estimate of adult literacy in dentistry (TREALD-30). Acta Odontol Scand 2017;75:198-207.
Tadakamadla SK, Quadri MF, Pakpour AH, Zailai AM, Sayed ME, Mashyakhy M, et al.
Reliability and validity of Arabic rapid estimate of adult literacy in dentistry (AREALD-30) in Saudi Arabia. BMC Oral Health 2014;14:120.
Hsieh FY, Bloch DA, Larsen MD. A simple method of sample size calculation for linear and logistic regression. Stat Med 1998;17:1623-34.
Nammontri O. Validation of the Thai version of the 14-item oral health impact profile (Thai OHIP-14) among the general Thai adults population in the community setting. J Health Res 2017;31:481-6.
World Health Organization. Oral Health Surveys: Basic Method. 5th
ed. Geneva: World Health Organization; 2013.
Cartes-Velásquez R, Luengo-Machucaa L. Adaptation and validation of the rapid estimate of adult literacy in dentistry for Chilean population.P R Health Sci J 2018;37:52-4.
Bado FM, Rebustini F, Jamieson L, Cortellazzi KL, Mialhe FL. Evaluation of the psychometric properties of the Brazilian version of the oral health literacy assessment in Spanish and development of a shortened form of the instrument. PLoS One 2018;13:e0207989.
Ju X, Brennan DS, Parker E, Chrisopoulos S, Jamieson L. Confirmatory factor analysis of the health literacy in dentistry scale (HeLD) in the Australian population. Community Dent Health 2018;35:140-7.
Goje SK, Patel J, Kalyan P, Kulkarni P, Shah R, Modi B. Translation of English version of oral health impactprofile-14 into Gujarati. J Int Oral Health 2017;9:16-9. [Full text]
Kapoo P, Prasad S, Tandon S. Development of a word instrument to test dental health literacy: The DFLD determination of functional literacy in dentistry. J Community Med Health Educ 2016;6:467.
[Table 1], [Table 2], [Table 3]
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