Abstract
ObjectivesTo develop computerized adaptive testing (CAT) and short forms of self‐report oral health measures that are predictive of both the children's oral health status index (COHSI) and the children's oral health referral recommendation (COHRR) scales, for children and adolescents, ages 8–17.Material and methodsUsing final item calibration parameters (discrimination and difficulty parameters) from the item response theory analysis, we performed post hoc CAT simulation. Items most frequently administered in the simulation were incorporated for possible inclusion in final oral health assessment toolkits, to select the best performing eight items for COHSI and COHRR.ResultsTwo previously identified unidimensional sets of self‐report items consisting of 19 items for the COHSI and 22 items for the COHRR were administered through CAT resulting in eight‐item short forms for both the COHSI and COHRR. Correlations between the simulated CAT scores and the full item bank representing the latent trait are r = .94 for COHSI and r = .96 for COHRR, respectively, which demonstrated high reliability of the CAT and short form.ConclusionsUsing established rigorous measurement development standards, the CAT and corresponding eight‐item short form items for COHSI and COHRR were developed to assess the oral health status of children and adolescents, ages 8–17. These measures demonstrated good psychometric properties and can have clinical utility in oral health screening and evaluation and clinical referral recommendations.
Highlights
The importance of maintaining oral health status has been noted in Healthy People 2020 (Office of Disease Prevention and Health Promotion, 2011)
Computerized adaptive testing (CAT), based on item parameters estimated from item response theory (IRT), further enables more accurate estimation of the underlying concepts being measured while minimizing response burden (Cella et al, 2007)
This paper presents results of CAT simulation and derives short forms for two existing oral health measures for children and adolescents, ages 8–17, which are predictive of both the children's oral health status index (COHSI) and the children's oral health referral recommendation (COHRR) scale (Liu et al, 2018)
Summary
The importance of maintaining oral health status has been noted in Healthy People 2020 (Office of Disease Prevention and Health Promotion, 2011). Our previous research developed self-report items to assess oral health status for children and adolescents. Based on an item bank and various statistical approaches, short forms have been recently developed for children and adolescents aged 8 to 17, using the framework and methodology of the Patient Reported Outcomes Measurement Information System (PROMIS®) (Liu et al, 2018; Marcus et al, 2018; Wang et al, 2018). One advantage of CAT is that items are selected from a database (item bank) based on the survey respondent's responses, using a preset computerized algorithm, which is derived from item information functions (Weiss & Kingsbury, 1984). It is possible for CAT algorithms to allow the same respondent to respond to different items over time, depending on developmental change of symptom, while still maintaining comparability of scores at different times for the patient. Compared with the short form, a higher level of measurement precision could be achieved using few items (Lai et al, 2011)
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