Abstract
Oral health related quality of life research among children in India is still nascent and no measures have been validated to date. Although CPQ11-14 has been previously used in studies from the Indian sub-continent, the instrument has never been tested for cross-cultural adaptability. This study aimed to assess the validity and reliability of CPQ11-14 in Telugu speaking Indian school children. Primary school children of Medak district, Telangana State, India, were recruited by a multi-stage probability sampling method. The translated questionnaire was initially pilot tested on a small subset of children (n = 40). Children with informed consent from parents (N = 1342) were then provided with questionnaires containing the Telugu translation of CPQ11-14, followed by a clinical examination conducted by a single examiner, using Basic WHO survey methods for dental caries, malocclusion, and Dean’s Fluorosis index. Children (n = 161) in randomly chosen schools were re-administered the same questionnaire after a two week interval to test reliability of CPQ11-14 on repeated administrations. Internal consistency and test-retest reliability as determined by Cronbach’s alpha and Intra-class correlation coefficient for overall CPQ11-14 scale were 0.925 and 0.923, respectively. CPQ11-14 discriminated between the categories of fluorosis and malocclusion while its discriminant validity with respect to dental caries was limited. CPQ11-14 also demonstrated good construct validity with both overall CPQ11-14 and its subscales having significant positive correlation with global ratings of oral health and overall wellbeing, even after adjusting for confounding variables. CPQ11-14 had a correlation of 0.405 with self-evaluated oral health and 0.407 with self-evaluated impact of oral health on overall wellbeing. In conclusion, Telugu translation of CPQ11-14 demonstrated good internal consistency and excellent reliability on repeated administrations after two weeks. It also exhibited good discriminant and construct validity.
Highlights
Quality of Life (QoL) has been defined by the World Health Organization (WHO) as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” [1]
Previously the evaluation of Oral Health Related Quality of Life (OHRQoL) in children was made using questionnaires administered to parents as proxy, it has to be understood that the perception of children and adults on the impact of oral heath on QoL is likely to be different [38]
The Intra-class Correlation Coefficient (ICC)’s observed in the present study are in accordance with those reported by the developers of the CPQ11-14 in their validation study11 and that observed in a study that validated CPQ8-10 and CPQ11-14 in Brazil [20]
Summary
Quality of Life (QoL) has been defined by the World Health Organization (WHO) as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” [1] These concepts apply to Health Related Quality of Life (HRQoL) including Oral Health Related Quality of Life (OHRQoL). OHRQoL is integral to general health and wellbeing [2] and comprises several dimensions including absence of impairment, appropriate physical, emotional and social functioning [3] It is a holistic concept which does not rely solely on traditional clinical variables [4,5], which complements clinical indicators by determining the subjective functional and psycho-social impacts of oral disease on overall wellbeing [4]. CPQ11-14 has been most widely used and has been tested for crosscultural adaptation in many countries including Thailand [15], Cambodia [16], Korea [17], Peru [18], Brazil [19, 20], China [21], Australia [22], New Zealand [23], UK [24], Canada [11], Saudi Arabia [25], Germany [26], Denmark [27] and Italy [28]
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