Child Oral Health Impact Profile Research Articles

Assessment of the quality of measures of child oral health-related quality of life.

BackgroundSeveral measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.MethodsA systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.ResultsThe search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.ConclusionThe three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

Oral Health-Related Quality of Life in Children With Cleft Lip and Palate

Considering the essential need for oral health-related quality-of-life measures for patients with craniofacial malformations, the current study aimed to investigate the oral health-related quality of life of Iranian patients with cleft lip and palate. Fifty children referred to Cleft lip/Palate Research Center of Mashhad Dental School (Iran) were recruited. Participants were asked to complete the Child Oral Health Impact Profile questionnaire. The questionnaire comprised 38 items and was divided over 5 subscales. The scores on all subscales were compared with regard to patients' age, sex, and type of cleft. A significant difference between boys and girls was found on the subscale "emotional well-being" (P = 0.027). There was no significant difference between 8- to 12-year-old patients and those older than 12 years. Also, no significant difference was found between bilateral and unilateral cleft lip and palate patients regarding mean score of Child Oral Health Impact Profile questionnaire and its subscales. Oral health-related quality of life of cleft lip and palate patients did not change with patients' age. Also, the impact of unilateral and bilateral clefts on OHRQoL was similar. Quality of life of girls was more affected by oral health.

Evaluation of the similarities and differences in response patterns to the Pediatric Quality of Life Inventory and the Child Oral Health Impact Scores among youth with cleft

To examine (a) the pattern of responses to a generic health-related quality of life (HRQL) measure (Pediatric Quality of Life Inventory--PedsQL) and an oral health-related quality of life (OHRQoL) measure (Child Oral Health Impact Profile--COHIP), and (b) the associations of these scores with surgical recommendation status among youth with cleft. Cross-sectional data (baseline) regarding clinicians' surgical recommendations and quality of life (QoL) measures were examined from an ongoing observational study on treatment outcomes. Approximately one-third of the racially and geographically diverse sample (N = 1,200; mean = 11.6 years) received surgical recommendations to correct either visible (aesthetic) or invisible (functional) defects. Effect sizes were used to quantify differences in QoL based on surgical recommendation and to compare the sensitivity of the PedsQL and COHIP subscales. Using Pearson coefficients, the scores of those recommended for surgery were compared with those without a surgical recommendation. A moderate correlation (0.52) was found between the total scores on the PedsQL and COHIP (p < 0.0001). Subscale correlations between the QoL measures ranged from 0.19 to 0.48 with the strongest correlation between the PedsQL Emotional (r = 0.47) and COHIP Socioemotional Well-being subscale. The effect size for the COHIP Socioemotional Well-being (0.39) was larger than the PedsQL Social/Emotional (0.07/0.11) subscale (Z = 5.30/Z = 4.64, p < 0.0001, respectively), and the total COHIP (0.31) was significantly greater than the total PedsQL scale (0.15, z = 2.65, p = 0.008). A significant relationship was found between generic HRQL, OHRQoL, and surgical needs among youth with cleft with the COHIP having larger effect sizes than the PedsQL among surgical groups.

Oral Health–Related Quality of Life in Children with Orofacial Clefts

Objectives : To determine the impact of orofacial clefts on the oral health-related quality of life of affected children and whether the oral health-related quality of life of children with orofacial clefts differs among different age groups. To assess whether the responses of children with orofacial clefts differ from the caregivers' perceptions of their child's oral health-related quality of life and compare with data from a control group. Design : Cross-sectional study. Patients/Setting : A total of 75 subjects with cleft lip and/or cleft palate (mean age, 13.0years) from the Nationwide Children's Hospital Craniofacial Anomalies Clinic, as well as their caregivers, and 75 control subjects (mean age, 13.9years). Main Outcome Measure : Self-reported oral health-related quality of life measured with the Child Oral Health Impact Profile, a reliable and valid questionnaire designed for use with children and teenagers. Results : Children with orofacial clefts had statistically significant lower quality of life scores than control subjects had for overall oral health-related quality of life, Functional Well-being, and Social Emotional Well-being. There was a statistically significant difference in the interaction of age group and Social-Emotional Well-being between children with orofacial clefts and control children. No statistically significant differences were found between the responses of children with orofacial clefts and their caregivers' reports. Conclusions : Presence of an orofacial cleft significantly decreases overall oral health-related quality of life, Functional Well-being, and Social-Emotional Well-being in children and adolescents. The negative impact of orofacial clefts on Social-Emotional Well-being is greater in 15- to 18-year-olds than in younger age groups. Children with orofacial clefts and their caregivers had very similar evaluations of the child's oral health-related quality of life.

Assessing the oral health-related quality of life in Iranian adolescents: validity of the Persian version of the Child Oral Health Impact Profile (COHIP).

To evaluate the psychometric properties of an oral-health related quality of life (OHRQoL) instrument for application in the population of Iranian adolescents and to assess the discriminate and convergent validity and reliability of the Persian version of the Child Oral Health Impact Profile (COHIP) in a representative sample of this population. Using multistage stratified sampling, 597 schoolchildren aged from 13 to 18 years living in the city of Isfahan were recruited to complete the Persian COHIP questionnaire. They were also examined for dental caries and malocclusion by two trained, calibrated examiners. Overall COHIP scores ranged from 15 to 135 (mean ± SD: 103.6 ± 18). Sixty-six percent of the students experienced at least one frequent oral health-related impact over the past three months. The Cronbach alpha coefficient was 0.89 for the overall score. Discriminate validity was supported by the significant difference between COHIP scores in the caries-free group and the others (P = 0.01). In addition, the questionnaire was able to differentiate among the groups by various degrees of need for orthodontic treatment (P < 0.01). Convergent validity was confirmed by significant association between the quality of life scores, the self-perceived health and oral health ratings and the self-perceived treatment need (r = 0.36, 0.57, -0.40). The Persian COHIP demonstrated acceptable psychometric properties for the descriptive purposes. Some discrepancies observed between the clinical data and quality of life status were confirmed by the perceptual identity of such indices influenced by several overt and covert variables.

The effect of acculturation in the concordance of oral health related quality of life in Latino children and their parents

The Latino population is the fastest growing and the largest minority group in the United States comprising 16% of the population younger than 18 years of age. Yet, little is known about the effect of acculturation in oral health related quality of life in Latino children and their parents. Objective: The objective of this study was to assess the effect of acculturation in parent and child’s perceptions of the child’s oral health status and oral health related quality of life (OHRQoL) as well as the effect in the concordance between children and parents/caregivers. Method: Sixty-three Latino children between the ages of 8 and 15, and their parents were recruited from the waiting room at the University of California, San Francisco Orthodontic and Pediatric Clinics. Parent and children each separately completed the Child Oral Health Impact Profile questionnaire (COHIP) for children and COHIP for parent/caregiver. Results: Of the sixty-three children, fifteen children (23.8%) had a more negative perception of their oral health than their parents whereas twenty-three children (36.5%) had a more positive perception. In terms of agreement between children and parents, questions about oral health showed the lowest level of agreement (34.9%) and self-image questions the highest (55.6%). Conclusion: The study findings indicate that the more acculturated the child, the more negative their perception of their oral health. The level of disagreement between parent and child, underscores the importance of obtaining both the child and parent OHRQoL perceptions.

Health Disparities Among Children With Cleft

Oral health-related quality of life (OHRQoL) is a multidimensional construct that measures well-being associated with the teeth, mouth, and face. This cross-sectional study examined OHRQoL, demographic data, and clinical indicators in 839 treatment-seeking youths with cleft from 6 geographically diverse cleft treatment centers. Individuals without health insurance and representing ethnic minorities had lower OHRQoL scores on the Child Oral Health Impact Profile and a higher rate of surgical recommendations. These findings imply a risk factor for reduced OHRQoL and unmet needs among vulnerable youths with clefts.

Qualidade de vida de crianças com fissura labiopalatina: análise crítica dos instrumentos de mensuração

INTRODUÇÃO: A equipe multidisciplinar que trata crianças portadoras de fissura labiopalatina busca promover qualidade de vida (QV) a essa população. O objetivo do presente trabalho foi identificar, na literatura, instrumentos que possibilitem a avaliação global da QV dessa população, envolvendo aspectos estéticos, funcionais e resposta do indivíduo ao tratamento. MÉTODO: Foi realizada revisão da literatura disponível no PubMed, no período de 2001 a 2011, em busca de instrumentos específicos para avaliação de QV em crianças portadoras de fissura labiopalatina, com as seguintes palavras-chave (em língua inglesa): quality of life & oral cleft, quality of life & craniofacial deformities, quality of life & oral cleft speech, voice related quality of life. RESULTADOS: Foram identificados 457 artigos relacionados ao tema. Foram avaliados os seguintes instrumentos específicos para a faixa etária pediátrica utilizados na mensuração da QV de pacientes com fissura labiopalatina: Quality of Life Instrument - Craniofacial Surgery (YQOL-CS), Youth Quality of Life Instrument-Facial Differences (YQOL-FD), Child Oral Health Quality of Life Questionnaire (COHQOL), Child Oral Health Impact Profile (COHIP), Pediatric Voice Outcome Surgery (PVOS) e Pediatric Voice-Related Quality of Life Survey (PVRQOL). CONCLUSÕES: Não se identificou, na literatura, um instrumento que avaliasse integralmente as crianças com fissura labiopalatina, no que se refere aos aspectos estéticos, às consequências conceituais e perceptuais, bem como a todos os aspectos funcionais (aparelhos mastigatório e respiratório e ressonância vocal) que envolvem essa importante anomalia craniofacial congênita.

Validation of a Korean version of the Child Oral Health Impact Profile (COHIP) among 8‐ to 15‐year‐old school children

The purpose of this study was to assess reliability, discriminant validity, and convergent validity of the Oral Health Impact Profile (COHIP) Korean version in a representative community sample of 8- to 15-year-old Korean children. A Korean version of COHIP was developed according to the standard procedure of cross-cultural adaptation of self-reported instruments. A representative community sample of 2236 schoolchildren was selected by cluster sampling method. Mean age of the participants was 11.8 years. Mean and median of the overall COHIP score were 103.3 (SD 13.3) and 106, respectively. Internal reliability and retest reliability were excellent with Chronbach's alpha 0.88 and intraclass correlation coefficient 0.88. Face validity was confirmed with 98% of participants reporting the COHIP questionnaire was easy to answer. Nonclinical factors such as self-rated oral health or satisfaction with oral health were significantly related with overall COHIP score and five subscale scores (P < 0.001) in a consistent manner. Children with carious permanent teeth and with orthodontic treatment need had highly significantly lower overall COHIP score (P < 0.01). The Korean version of the COHIP was successfully developed. The internal reliability, retest reliability, face validity, discriminant validity, and convergent validity of the COHIP Korean version were confirmed.

Measuring Quality of Life in Cleft Lip and Palate Patients

Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons. The authors performed a literature review to identify questionnaires validated in cleft lip and palate patients. Qualifying instruments were assessed for adherence to guidelines for development and validation by the scientific advisory committee and for content. The authors identified 44 measures used in cleft lip and palate studies. After 15 ad hoc questionnaires, eight generic instruments, 11 psychiatric instruments, and one non-English language questionnaire were excluded, nine measures remained. Of these, four were never validated in the cleft population. Analysis revealed one craniofacial-specific measure (Youth Quality of Life-Facial Differences), two voice-related measures (Patient Voice-Related Quality of Life and Cleft Audit Protocol for Speech-Augmented), and two oral health-related measures (Child Oral Health Impact Profile and Child Oral Health Quality of Life). The Youth Quality of Life-Facial Differences, Child Oral Health Impact Profile, and Child Oral Health Quality of Life questionnaires were sufficiently validated. None was created specifically for clefts, resulting in content limitations. There is a lack of comprehensive, valid, and reliable questionnaires for cleft lip and palate surgery. For thorough assessment of satisfaction, further research to develop and validate cleft lip and palate surgery-specific instruments is needed.

Orthodontie en levenskwaliteit

The impact of oral health on quality of life among orthodontic patients was assessed using the Child Oral Health Impact Profile. Responses of parents and children to questions about the quality of life of the child were very similar, suggesting that the parents were quite well able to assess the oral health-related quality of life of their children. Girls experienced more adverse effects on their quality of life due to oral health problems as compared to boys. Subscales of the Child Oral Health Impact Profile appeared to have little predictive value with respect to the general feeling of healthiness among orthodontic patients.

Levenskwaliteit bij craniofaciale afwijkingen

Children with a serious congenital craniofacial disorder experience a variety of problems. Research on quality of life in these children has commenced relatively late. A specially developed questionnaire, the Child Oral Health Impact Profile, was used for a group of cleft lip and palate children and their parents. The study set out to determine the extent to which the answers given by the children corresponded to those of their parents. The children's perception of oral health-related quality of life appeared to differ from that of their parents.

Comparison of the COHIP and OHIP- 14 as measures of the oral health-related quality of life of adolescents.

To compare the validity and reliability of the Oral Health Impact Profile-14 (OHIP-14) and the Child Oral Health Impact Profile (COHIP) for investigating oral health related quality of life (OHRQoL) of adolescents. We studied 234 adolescents from two publicly funded schools in Hamedan, Iran. Participants completed questionnaires and had a clinical examination. We compared convergent and discriminative validity of the instruments by analyzing their association with self reported health indicators and number of decayed teeth. Both instruments showed good convergence with self-rated health and self-rated oral health. Those who perceived dental treatment needs, who had experienced dental pain in last month, were more dissatisfied with their oral health, or had more decayed teeth scored higher on both OHIP-14 and COHIP. The discriminative validity of the two instruments varied slightly and inconsistently. The convergent and discriminative validity of both instruments were established independent of their scoring methods. Both the OHIP-14 and COHIP were valid and reliable measures for investigating OHRQoL among 15-17 year old adolescents. The COHIP is preferable when the aim is identifying more impacts. Both measures have shown good convergent and discriminative validity, however, for practical reasons; the shorter instrument (OHIP-14) may be more suitable for epidemiological studies.

Perceptions of Dutch Orthodontic Patients and Their Parents on Oral Health-Related Quality of Life

To test the hypotheses that 1) there is no difference between orthodontic patients' and their parents' reports of patients' oral health-related quality of life, and 2) there are no gender differences. The sample consisted of 182 orthodontic patients (age range, 8-15) and their parents. Respondents were required to complete the Child Oral Health Impact Profile (COHIP). Items were divided into five different subscales, and scores on all subscales were compared between and within groups. Also, scores on six additional items regarding treatment expectations and global health perception were compared. Two hypotheses were tested: first, that no differences between parents and patients would be detected, and second, that no differences between boys and girls would be found. The first hypothesis could not be rejected. Only a few minor differences between parents and patients were found. The second hypothesis was rejected. Differences between boys and girls were found on the subscales Emotional Well-Being and Peer Interaction, indicating that girls experience more effects of oral health on their quality of life than do boys. Parents' reports on their children's oral health-related qualities of life were in agreement with reports of the orthodontic patients. This suggests that parents are suitable alternatives to their children in surveys measuring oral health-related quality of life.

Oral Health-Related Quality of Life of Children with Craniofacial Conditions

Evaluation of the Dutch Child Oral Health Impact Profile (COHIP), assessing the level of concordance between parents and children. The internal consistency and the predictive validity of the COHIP for self-reported general health were examined. Sample size was 35 pairs of parents and children age 11 to 14 with craniofacial conditions. Cronbach alphas were calculated and the level of concordance between parents and children was studied using t tests and intraclass correlations. Predictive validity was assessed using Pearson correlations and linear regression analyses. The COHIP and its subscales, except for one, had satisfactory to high Cronbach alphas (.59 to .94). Parents and children did not differ significantly. Correlations between parents and children were high (.62 to .91). Only "Oral symptoms" proved to be a significant predictor of general health, but only in the parent sample. In spite of the high level of concordance found, proxy reports have to be considered complementary to the reports of the children themselves. The Dutch version of the COHIP performs adequately, but could use some further psychometric evaluation and revision. It does not seem advisable to use the subscales separately as predictors in the same regression model, since they are strongly intercorrelated. For use in craniofacial patients, further validation is needed on a larger sample and some items need to be revised or removed. Finally, given the small number of cases, conclusions must be drawn with caution.

Confirmative factor analysis of the dimensions of the Child Oral Health Impact Profile (Dutch version)

The aim of this study was to examine the subscales of the Child Oral Health Impact Profile (COHIP). The Dutch version of the COHIP consists of the subscales 'Oral Symptoms', 'Functional Well-being', 'Emotional Well-being', 'School', and 'Peer Interaction'. The questionnaire was administered to a sample of 510 children in Amsterdam. Missing data were replaced with the personal mean. Subsequently, questionnaire reliability was investigated by means of corrected item-total correlations and Cronbach's alpha if-item-deleted. Based on these results, six items were excluded from further analysis. Then, the questionnaire and its subscales were examined using confirmative factor analyses. One-factor models were fitted on each subscale and a five-factor model was applied to the entire questionnaire. In several cases, model fit was below an acceptable level. In conclusion, the structure of five subscales does not seem to be entirely supported in this study population.

Reliability and convergent and discriminant validity of the Child Oral Health Impact Profile (COHIP Child’s version)

The purpose of the current study was to assess the reliability as well as the convergent and discriminant validity of the Child Oral Health Impact Profile (COHIP). The questionnaire consisted of five domains that assessed oral health, functional well-being, social-emotional well-being, school environment, and self-image. COHIP was designed to measure self-reported oral health-related quality of life (OHRQoL) of children between ages 8 and 15 years old, using both positively and negatively worded items. Children were recruited from pediatric, orthodontic, and craniofacial clinical settings in the USA and Canada. A comparison group of children not seeking dental treatment was recruited from two US elementary schools. Participants included 157 pediatric, 152 orthodontic and 110 patients with craniofacial anomalies, and 104 community-based participants. Scale reliability was assessed with Cronbach's alpha coefficient. Retest reliability was examined by intraclass correlation and paired t-test for a subset of participants who did not report a health change. Discriminant validity was assessed in two ways: (i) the COHIP scores of the four groups of children (three clinical and one community-dwelling) were compared by anova and (ii) for two of the clinical groups, the association between COHIP scores and clinical indices was calculated. Convergent validity was examined using partial Spearman correlations between COHIP scores and Global Health Ratings controlling for demographic variables. The children (n = 523) averaged 11.6 years (SD = 1.60); 51.6 % were female; and represented diverse ethnicities (black = 22.4%, Latino = 32.1%, white = 35.1%, other 10.4%). Overall COHIP scores ranged from 28 to 135 (mean +/- SD, 99.0 +/- 19.2) for the children. Scale reliability for the overall COHIP was excellent: Cronbach's alpha coefficient = 0.91 for the overall score. The test-retest reliability of the overall COHIP was also excellent (ICC = 0.84) and there was no statistically significant shift in scores over time. Discriminant validity was supported by significant differences (P = 0.003 overall COHIP) among the three clinical groups: the craniofacial group reported the lowest overall COHIP quality of life scores of the clinical groups. Within the pediatric dental group, children with greater dental decay reported lower COHIP scores suggesting a lower OHRQoL (r = -0.26, P = 0.02) and within the orthodontic group, children with larger overjet reported lower COHIP scores (r = -0.25, P = 0.005). Controlling for the effect of the participants' age, gender, and ethnicity, the association between the overall COHIP score and Global Health rating was statistically significant (P < 0.05) and similar in strength for the three clinical groups (pediatric dental = 0.29, orthodontic = 0.23, and craniofacial = 0.24) and highest for the community group (0.36). The overall COHIP showed excellent scale reliability overall and test-retest reliability. Both discriminant and convergent validity of the COHIP were supported by the comparisons among and within the four groups of children. Further testing will examine the utility of the instrument in both clinical and epidemiological samples.

Concurrent validity of the COHIP

This study examined the relationship between children's perception of their OHRQOL and their perceptions of their dentofacial image, social anxiety, and self-concept as an assessment of the concurrent validity for the Child Oral Health Impact Profile (COHIP). A nonrandom, consecutive sample of children, ages nine to 14 years, was recruited for this observational validation study. Participants had been accepted for treatment in the University of North Carolina Graduate Orthodontic clinic. Data were collected after gathering initial orthodontic records and prior to delivery of any fixed or removable orthodontic appliances. Participants completed the COHIP and standardized dimension-specific questionnaires with known psychometric properties designed to assess self-concept, social anxiety, and perception of facial image. Child assent with caregiver consent was obtained prior to data collection. Pearson's correlations between each of the domains of the COHIP and the Dento-facial Image, the Social Anxiety Scale, and the self-concept domains of the Multidimensional Self Concept Scale (MSCS) were calculated. Criteria for support of concurrent validity was established based on directionality of expected relationships and strength of the observed correlation coefficient. Each correlation was assessed as meeting or not meeting the criteria. A one-tailed one sample Z-test was used to test the null hypothesis that 58% of the calculated correlations would meet the criteria (expected a priori) with an alterative that less than 58% would meet the criteria. The average age of the 52 subjects enrolled was 11.8; 40% were male; and 85% were Caucasian. The hypothesis that 58% of the calculated correlations defined a priori as expected relationships would meet the criteria was supported by the data (P = 0.63). The perception of dentofacial appearance was positively correlated (range = 0.39 to 0.45; with all of the COHIP domains except for the School domain. Overall, the COHIP domains, particularly Self-Image and Social Emotional subscales, were positively correlated (0.32-0.52) with the MSCS self-concept domain scores, except Family Self-Concept. The COHIP domains, particularly Functional Well-being and Social Emotional subscales, were negatively correlated (-0.76 to -0.33) with the three Social Anxiety subscales that include both fear of negative evaluation and social avoidance. The findings in this study lend support to the validity of the COHIP since 77% of the expected relationships between the domains of the COHIP and the domains of general, standardized dimension-specific instruments were observed. The decision to use condition-specific, dimension-specific, or general quality of life (QOL) measures is dependent on the purpose of the study. For investigations in children on the effect of dental treatments or in epidemiologic studies of an oral health outcome, the use of condition-specific QOL measures like the COHIP have the advantages of increased patient responsiveness since the assessment is focused on a specific condition, oral health, and increased sensitivity to treatment effects.

Questionnaire development: face validity and item impact testing of the Child Oral Health Impact Profile

The Child Oral Health Impact Profile (COHIP) was designed to assess oral-facial well-being in school-age children as reported by the child and via proxy report from a caregiver. This article describes the development of the COHIP using a multi-staged impact approach recommended by Guyatt et al. (Quality of life and pharmacoeconomics in clinical trials. Philadelphia, PA: Lippincott-Raven; 1996. p. 41). There were multiple phases to the development of the questionnaire: (i) initial pool of items developed from the literature and expert review; (ii) face validity of items; (iii) impact evaluation of the initial item pool; (iv) development of positive items and face validity of new items; (v) impact evaluation of the revised questionnaire and (vi) factor analysis and final revision of the questionnaire. Factor analysis was completed on the final questionnaire using data from the impact evaluation in order to evaluate whether the COHIP measured independent conceptual domains. Factor analysis identified five domains: oral health, functional well-being, social/emotional well-being, school environment and self-image. Readability was calculated using the Flesch-Kinkaid readability score that was finalized at a 3.5 grade reading level. Finally, two response sets, and a revised format (e.g., including pictures, increasing font size, and shading every other item) were implemented to decrease respondent fatigue and increase accuracy of participant responses. The final questionnaire consisted of 34 items and five conceptually distinct subscales: oral health, functional well-being, social/emotional well-being, school environment and self-image. Subsequent papers present the validity and reliability of the COHIP.

The child oral health impact profile: current status and future directions

The child oral health impact profile: current status and future directions