Abstract

ObjectiveThe objective of this study was to investigate the psychometric properties of the Oral Health Literacy Assessment in Spanish (OHLA-S) for the Brazilian-Portuguese language using robust analysis and with the results disclose possibilities to develop a shorter and more valid instrument.MethodsOHLA-S is an oral health literacy instrument comprising a word recognition section and a comprehension section. It consists of 24 dental words. It was translated into the Brazilian-Portuguese language (OHLA-B) and its psychometric properties were evaluated in a random sample of 250 adults aged 20–59 years. To assess the dimensionality and factor structure were tested by means of Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Reliability was assessed using two indicators: Cronbach's alpha and McDonald’s Omega.ResultsEFA and CFA demonstrated that the OHLA-B with 24 items did not present an adequate adjustment of the model, compromising its validity. In addition, reliability values at 0.50 for Cronbach's alpha and 0.67 for McDonald's omega were below the minimum acceptable rate of 0.70. As no support was found for the original structure, we decided to proceed with the withdrawal of individual items and successive reanalysis of the model until the indicators were adjusted in a shorter instrument. A new structure with 15 items produced an instrument with two dimensions and a better goodness of fit than the original instrument. The Alpha and Omega reliability index values increased to 0.83 and 0.80, respectively, and all scores were better in the OLHA-B with 15 items than in the instrument with 24 items.ConclusionOLHA-B with the original structure composed by 24 items did not show acceptable construct validity. The shorter version with 15 items showed more promising results for assessing oral health literacy levels in the Brazilian population.

Highlights

  • Health literacy represents the degree to which individuals have the capacity to obtain, process and understand basic information and the functioning of health services, skills that are crucial for individuals making appropriate health decisions [1]

  • Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) demonstrated that the OHLA-S into the Brazilian Portuguese language (OHLA-B) with 24 items did not present an adequate adjustment of the model, compromising its validity

  • Health literacy covers a range of skills that surpass the mere individual capacity to read and make notes, because it includes a set of skills that allows people to participate more actively in society and to increase their control of factors that can impact on their health [2,3]

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Summary

Introduction

Health literacy represents the degree to which individuals have the capacity to obtain, process and understand basic information and the functioning of health services, skills that are crucial for individuals making appropriate health decisions [1]. One example is the Rapid Estimate of Adult Literacy in Dentistry (REALD-30) developed by Lee et al [11]. The assumption of these word-recognition tests is that there is a strong correlation between reading and comprehension abilities, such as process text and understand its meaning, with clinically observed oral health. Another group of OHL tests measure a respondent’s ability to understand and apply written information, including numerical data, as demonstrated by the Test of Functional Health Literacy in Dentistry (TOFHLiD)[9,10]

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