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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 3-7

Derivation and validation of oral health impact profile-14 for odia-speaking adults


1 Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India
2 Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India
3 Department of Development Journalism and Electronic Media, Utkal University, Bhubaneswar, Odisha, India

Date of Web Publication11-Jun-2018

Correspondence Address:
Dr. Anurag Satpathy
Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Khandagiri Square, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdas.jdas_44_16

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  Abstract 


Background: Assessment of oral health-related quality of life (OHRQoL) is gaining importance. However, there is unavailability of such a tool in the linguistically and culturally different settings such as that of Odisha. The aim of this study was derivation and validation of Oral Health Impact Profile-14 (OHIP-14) for Odia-speaking adults. Methods: The OHIP-14 questionnaire was translated into the Odia language conforming to the standard cross-cultural translation methodology. The tool was validated and used for estimating the quality of life in 150 dental patients (36.31 ± 11.57 years; 77 males and 73 females). The internal consistency for reliability was measured using Cronbach's alpha. Construct validity of the instrument was checked with self-reported oral health and oral hygiene index scores. Results: Cronbach's alpha for the Odia version of the OHIP-14 was 0.862. The corrected item-total correlation coefficients ranged from 0.316 (functional limitation) to 0.674 (handicap). It was observed that patients with good self-perceived oral health had significantly lower OHIP-14od scores and those with poor oral hygiene had significantly greater OHIP-14od scores. Conclusion: Despite cultural variations, the translated Odia version of the OHIP-14 questionnaire is a reliable and valid instrument to measure the OHRQoL in the Odia-speaking adult population.

Keywords: Odia, oral health, Oral Health Impact Profile-14, oral health-related quality of life, psychometric properties, quality of life


How to cite this article:
Satpathy A, Shamim R, Nayak R, Rao EV, Panigrahi SK, Nanda R. Derivation and validation of oral health impact profile-14 for odia-speaking adults. J Dent Allied Sci 2018;7:3-7

How to cite this URL:
Satpathy A, Shamim R, Nayak R, Rao EV, Panigrahi SK, Nanda R. Derivation and validation of oral health impact profile-14 for odia-speaking adults. J Dent Allied Sci [serial online] 2018 [cited 2018 Oct 23];7:3-7. Available from: http://www.jdas.in/text.asp?2018/7/1/3/234189




  Introduction Top


Oral health-related quality of life (OHRQoL) focuses on a person's social and emotional experiences and physical functioning in defining appropriate treatment goals and outcomes.[1] It is gaining importance in recent times because of its implications for oral health disparities and access to care. Assessment of OHRQoL should be a part of the evaluation of oral health needs since clinical signs and symptoms alone cannot describe its relationship with general life.[2] Among several instruments [3],[4],[5],[6] that have been developed to assess OHRQoL, Oral Health Impact Profile (OHIP) has been most widely used in several countries. Its purpose is to offer a measure of the social impact of oral disorders drawn on a theoretical hierarchy of oral health outcomes.[7] The OHIP-14[8] is a 14-item questionnaire which measures self-reported functional limitation, discomfort, and disability in relation to oral conditions derived from an original extended version of 49-item.[6]

The OHIP-14 has been translated and validated in several languages such as Chinese, Finish, French, German, Japanese, Malaysian, Portuguese, Sinhalese, Somalian, and Swedish. An assessment tool should be validated in the language of the participants to whom it is administered. Most the OHIP-14 versions have been based only on the translation and linguistic adaptation of the original English language questionnaire.[9],[10],[11],[12],[13],[14],[15] Although a Hindi version has been recently validated [16] using a comparative study among Hindi-speaking adults, a thorough search of the literature did not yield any study on the Odia version of OHIP-14.

Odia is an Indian language which belongs to the Indo-Aryan branch of the Indo-European language family. It is the predominantly spoken and official language of the Indian state of Odisha, and it is spoken in parts of neighboring states such as West Bengal, Jharkhand, Chhattisgarh, and Andhra Pradesh. However, there is nonavailability of a tool to assess OHRQoL in the linguistically and culturally different settings such as that of Odisha. To adequately address the oral health needs and concerns of Odia-speaking population, it is thus deemed necessary to develop, or culturally adapt, a psychometric instrument such as the OHIP-14. Therefore, the aim of this study was derivation and validation of OHIP-14 for Odia-speaking adults.


  Methods Top


Oral Health Impact Profile-14

The OHIP-14[8] is a self-filled questionnaire that focuses on seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) with participants being asked to respond according to frequency of impact on a 5-point Likert scale coded never (score 0), hardly ever (score 1), occasionally (score 2), fairly often (score 3), and very often (score 4) using a 12-month recall period.

Linguistic and cross-cultural adaptation

Since to the best of our knowledge OHIP-14 has never been used in Odisha, a pilot study was undertaken to assess the face and content validity within the target population. The OHIP-14 was linguistically and culturally adapted to our setting using the back translation technique [17] to maintain cross-cultural equivalence. Hence, translations were independently made by two bilingual dentists, who then discussed and produced the Odia version (OHIP-14od) by consensus. This was translated back into English by a professional English native translator who had never seen the original version. The conceptual equivalence between the original instruments and the back-translated versions was supported by three Odia linguistic experts so that there is no difference in the meaning of the items in the original and the translated version.

Pilot study

A pilot study was conducted on a convenience sample (n = 40) obtained from patients and their companions who visited the Institute of Dental Sciences, Bhubaneswar, for an oral checkup. To test the comprehensiveness of OHIP-14od, participants were asked about difficulties in understanding items in the instrument. Necessary changes were made to optimize the face and content validity before the main study. The results of the pilot study were not included in the final data analysis of the study. Sample size estimation was done based on our pilot study results. To discover that the mean OHIP-14od scores are statistically different in three groups at 5% significance level, the power value of 0.8 and medium effect size of 0.3, a sample of 112 analyzable patients was required.

Subjects

A cross-sectional epidemiological study was performed in Bhubaneswar city, the state capital of Odisha. Participants were invited from dental screening camps organized by the Institute of Dental Sciences between December 2014 and May 2015 to take part in this study. The inclusion criteria were patients who could understand Odia language and who were above the age of 18 years. All participants were explained about the purpose and process of the study and informed written consent was obtained. Those unwilling to participate, seeking consultation for acute pain, having cognitive impairment, and alcoholism were not included in the study. The study's protocol was approved by the Institutional Ethics Committee of Siksha 'O' Anusandhan University. OHRQoL data were gathered by the piloted OHIP14 od, which was self-administered and completed in the waiting room and after the oral examination was conducted in camp by a trained and calibrated examiner.

Participants also answered and provided information on demographic and self-reported oral health (SPOH). SPOH was assessed based on the following questions: “How would you rate your oral health?” to which participants had options ranging from “good,” “fair,” to “poor.” The same individuals underwent clinical examinations by a calibrated dentist for assessment of their oral hygiene status using oral hygiene index (OHI) score [18] which categorized the oral hygiene of an individual into good, fair, and poor.

Statistical analysis

The psychometric properties of OHIP-14od were analyzed using a statistical software package (SPSS, Inc., Chicago, IL, USA, version 20). Level of significance was set at P ≤ 0.05 (95% confidence interval). Validity tests were carried out to ensure that the instrument was quantifying what it was intended to measure.[15] Since the convergent validity estimates closely a measure is related to other measures of the same construct, it was evaluated by identifying associations between SPOH and OHI scores with OHIP-14od scores. We hypothesized that lower OHIP-14 scores would be associated with better SPOH and OHI scores.


  Results Top


Of the 191 participants fulfilling the inclusion criteria, 41 volunteers declined to participate, either due to lack of time or were simply uninterested. Of the 150 successfully assessed participants, 73 were females and 77 were males, with a mean age of 36.35 ± 11.5 years. [Table 1] presents the demographic details of the study participants.
Table 1: Demographic distribution and descriptive statistics

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Reliability

Reliability was measured in terms of internal consistency using Cronbach's alpha which assesses the overall correlation between items within a scale. Corrected item-total correlation was also calculated for the different items in the OHIP-14od questionnaire. The overall Cronbach's alpha was 0.862 which shows good internal consistency of the instrument. [Table 2] shows the individual Cronbach's alpha when each item of the questionnaire is deleted. In addition, shown in the table is the corrected item-total correlation for each item of the questionnaire which evaluated the homogeneity of the translated scale. This considers the correlation between each individual item in the scale and the rest of the scale with the item of interest eliminated. The corrected item-total correlation coefficients ranged from 0.316 (functional limitation) to 0.674 (handicap). [Table 3] illustrates the inter-item correlations between all items of OHIP-14od. The inter-item correlation coefficients ranged from 0.07 (between item 2 and item 1) to 0.64 (between item 14 and item 4).
Table 2: Cronbach's alpha if individual items deleted and also the corrected item-total correlation

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Table 3: Reliability analysis: Oral Health Impact Profile-14 inter-item correlation in the study group

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Convergent validity

[Table 4] shows that comparison of mean SPOH scores among each of subscale components was significantly different (P< 0.001). Further, the OHI scores were also significantly correlated with each subscale component of OHIP-14od. It was observed that participants with good SPOH and lower OHI scores had significantly lower OHIP-14od scores (P< 0.001).
Table 4: Convergent validity of the Oral Health Impact Profile-14 Odia: Comparison of mean self-reported oral health scores and correlation coefficients (r) among subscale components with oral hygiene index scores

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  Discussion Top


An appropriate instrument to assess the OHRQoL in the Odia-speaking population was needed owing to the growing awareness and reach of oral care services in the recent past. English language being not native to the region where the majority of the population is poor it would not have been effective to administer it. Thus, a cross-cultural adaptation through translation and validation of the existing OHIP-14 was carried out in Odia language. This study has attempted to develop a suitable version of the OHIP-14 instrument in Odia and validate its psychometric properties. To the best of our knowledge, this is the first study in development and validation an Odia version of OHIP-14.

Cross-cultural adaptation is a significant step in the validation process of an instrument that has been developed among other target populations. In the present study, the translation process from English to Odia did not reveal conceptual or content differences. Odia equivalence of English words needed for translation of the questionnaire was not difficult because of the simple structure of the OHIP-14 and the universal nature of its contents.

Results from this study validate the Odia version of the OHIP-14 as a valid instrument to assess OHRQoL in Odia-speaking adults. Our results support the fact that instrument validation must be performed according to the cultural context of the population to be analyzed. The cultural and social differences may lead to important discrepancies in the results obtained with the instruments.

The reliability of any questionnaire is the consistency with which the same results are achieved. For any questionnaire to be effective, its reliability should be very high. OHIP-Odia obtained a high Cronbach's alpha value of 0.862 which satisfies the standard criteria for reliability by Nunnally and Bernstein of the minimum value of Cronbach's alpha as 0.7.[19]

This high-alpha value indicates that the 14 items of the OHIP-14od scale accurately measure the same construct implying that more than one person completing a questionnaire with the same knowledge and experience would have similar results. The internal consistency as achieved in our instrument was almost equal to Cronbach's alpha value of 0.88 achieved by Slade [8] and Kushnir et al.[11] It was higher than that reported by Khalifa et al.[9] and Wong et al.[20] but lower than Papagiannopoulou et al.[21] and Oliveira and Nadanovsky.[13]

It was observed that the value of Cronbach's alpha did not increase more than 0.862 even when any of the 14 items were deleted from the questionnaire suggesting good uniformity in the consistency of the questions and were well fitted to the scale. The corrected item-total correlation coefficients observed in the present study had a range from 0.316 to 0.674 indicating a very satisfactory homogeneity and justified the inclusion of the items in the scale. All values were above the minimum corrected item-total correlation of 0.20, which has been recommended for the inclusion of an item in a scale.[22] These scores are similar to those found in studies by Oliveira and Nadanovsky, Papagiannopoulou et al., and Castrejón-Pérez and Borges-Yáñez.[13],[21],[23]

Since it is difficult to demonstrate construct validity through a single study, we carried out the convergent validity tests using two scales (SPOH and OHI) to establish the validity of construct in OHIP-14od. Construct validity of OHIP-14od found to be in accordance with our proposed hypotheses.


  Conclusion Top


Despite cultural variations, the translated Odia version of the OHIP-14 was found to be a reliable and valid instrument like the original instrument. This makes it a suitable tool for cross-sectional and longitudinal studies. Finally, strategies to improve general as well as oral health among Odia-speaking people could help to reduce the effects of oral disorders on OHRQoL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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