Factor Analysis of Oral Health Literacy-Adults Questionnaire (OHL-AQ) among Patients Attending a Tertiary Institution of Shimla: A Validity and Reliability Study

Abstract

ABSTRACT Background and Aim: Oral health literacy (OHL) is an important component of health literacy that is indicated by various constructs of reading, writing, speaking, listening comprehension, and decision-making. Validity and reliability are essential for the accuracy and precision of any questionnaire-based qualitative study. Our aim was to perform a factor analysis of the OHL-AQ scale among patients of Shimla visiting a tertiary institution, for a better understanding of the OHL-AQ scale generalizability in our population. A cross-sectional study was conducted on patients visiting the outpatient department of public health dentistry. Materials and Methods: Data collection procedure included information obtained from the subject that was recorded on a structured proforma using the Oral Health Literacy-Adults Questionnaire (OHL-AQ) developed by Sistani et al. in 2013. Exploratory factor analysis was done in Statistical Package for the Social Sciences (SPSS) 22, and confirmatory factor analysis was done in Jeffreys’s Amazing Statistics Program (JASP) 0.16.3. Convergent validity was determined from the average variance extracted (AVE), and composite reliability (CR) was determined from the rotation component matrix. Discriminant validity was determined by the heterotrait–monotrait matrix ratio of correlation (HTMT). The confirmatory factor analysis results are based on the categories of model fit with various model indices within the recommended accepted levels. Results: The most important to be considered is the root mean square error of approximation (RMSEA = 0.04). The χ2 value was 82.254 and χ2/df was 1.61 with a P value <0.004, which indicates a good fit. Similarly, the goodness of fit index (GFI) was 0.96. Conclusion: Exploratory factor analysis based on correlation matrix reported adequate construct and discriminant validity for this study. Confirmatory factor analysis based on the covariance matrix provided an adequate model fit within the study data. Thus, the OHL-AQ scale has adequate validity and reliability in our study population, though further studies are indicated in other populations and its operationalization is based on predictive validity.