Abstract
BackgroundAccess to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC).MethodsThe items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach’s Alpha, McDonald's Omega and Greatest Lower Bound – GBL), with a sample of 1227 individuals.ResultsThe final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03.ConclusionDVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.
Highlights
Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable
Stage 1: Evidence of content validity This stage utilized a convenience sample composed of 188 specialists from all regions of Brazil, of both sexes, aged over 18 years, who digitally signed the Informed Consent Form, and filled out the research questionnaire received, which had as key question, “if you have to measure dental vulnerability, which risk factors would you consider?”
The development of a measuring instrument is based on theory/concept [62] and since the literature still has no instrument capable of exclusively measuring dental vulnerability [63], we adopted the concept defined as being a set of factors of the social, structural, general, mental and oral dimensions, in addition to health services and public management that influence the dynamics of the health-disease process in dentistry
Summary
Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. There literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Oral health has been growing and strengthening itself as an integral and inseparable part of public health policies, based on the guidelines proposed by the Brazilian Ministry of Health, by means of a model of care that seeks to expand access to services through the Oral Health Teams (OHT) included in the Family Health Strategy (FHS) [1, 2]. For the identification of oral health needs, it is essential to discuss the concepts of risk and vulnerability, two distinct concepts that are commonly addressed together [7,8,9]
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