Construction And Validation Of Oral Health Literacy Measurement Tools And Conceptual Model

Objective:Oral health literacy(OHL)was one of the main determinants of health.Scholars have explored the concept model of OHL,but it has not been fully defined.In addition,most researchers in our country used foreign OHL measurement tools to investigate OHL,which was affected by specific populations and cultural differences in practical application Therefore,this study aimed to define the concept of OHL,and to build a conceptual model and measurement tool of OHL suitable for the Chinese.Methods:The systematic review was used to retrieve the literature related to the OHL concept connotation.The basic information,methodological information and OHL concept connotation information were extracted referring to the review framework method of squiers.Using the concept mapping method to define the core and definition of OHL Referring to hinkin's questionnaire development and validation steps,we developed an OHL measurement tool.A cognitive interview was used to evaluate the items of the questionnaire.Exploratory factor analysis(EFA)and confirmatory factor analysis(CFA)were used to evaluate the validity and reliability of the questionnaire.Cronbach's alpha coefficient was used to test the internal consistency of the questionnaire.We sorted out the relationship between the concepts in the OHL model,summarized the construction principles of the OHL conceptual model,and used the structural model to construct an OHL conceptual model.Finally,we used the OHL measurement tool constructed in this study to investigate and analyze the current situation of residents' OHL in Shanxi Province and its influencing factors,and further verify the OHL conceptual model.Results:1.The conception of OHL.The concept of OHL includes 5 core dimensions and 16 sub-dimensions:(1)Basic skill dimensions:Literacy/reading comprehension,calculation/oral expression/communication,knowledge;(2)information-related competence dimensions:information acquisition ability,information comprehension ability,information communication skills,information evaluation ability,information utilization ability and information decision-making ability;(3)Oral health maintenance ability dimensions:interpersonal communication ability,self-regulation ability,goal achievement ability.(4)Dimensions of personal characteristics:personal characteristics,personal attitudes;(5)Dimensions of social support:emotional support and information support.2.Construction of OHL measurement tool.The OHL measurement tool constructed based on the concept connotation contains 90 items,distributed in 5 core dimensions and 14 sub dimensions,reflecting the five core dimensions of OHL concept connotation:basic skills,information-related abilities,oral health maintenance ability,personal characteristics,and social support.Among them,the basic skill dimension ?2/df=2.886,RMSEA=0.068(95%CI:0.064?0.072);IFI=0.837;TLI=0.807;CFI=0.832;information-related ability dimension:?2/df=4.021,RMSEA=O.086(95%CI:0.081-0.092);IFI=0.823;TLI=0.885;CFI=0.820;oral health maintenance ability:?2/df=4.718,RMSEA=0.119(95%CI:0.102?0.273);IFI=0.903;TLI=0.864;CFI=0.902;personal characteristics:?2/df4.685,RMSEA=0.108(95%CI:0.009?0.203);IFI=0.885;TLI=0.852;CFI=0.884;social support dimension:?2/df=4253,RMSEA=0.072(95%CI:0.061?0.0.083);IFI=0.934;TLI=0.927;CFI=0.938.The Cronbach's alpha coefficient of each dimension is between 0.709 and 0.920.3.Construction of OHL conceptual model.The overall fitness index of OHL conceptual model constructed in this study is acceptable,with RMSEA(90%CI)=0.057(0.052?0.062),GFI=0.931,IFI=0.656,TLI=0.595.The relationship between the sub-dimensions in the core dimension of information related competence is as follows:1)information access capability is the foundation,and its improvement can promote information evaluation capabilities;2)information evaluation capabilities can affect information utilization capabilities;3)information understanding capabilities can promote informed decision-making capabilities;4)information decision-making capabilities can promote information utilization capabilities;5)information access capability can influence the information application ability by influencing the information evaluation ability;6)the information understanding ability can influence the information application ability by influencing the information decision-making ability.Other core dimensions have an impact on information-related capabilities:1)Among the basic skills,literacy ability can promote information acquisition ability,information decision-making ability and information evaluation ability,while knowledge can promote information understanding ability and information decision-making ability.2)The ability of computing comprehension in basic skills has an impact on the ability of information understanding,information evaluation,information decision-making and information application.3)The ability of interpersonal communication in oral health maintenance can promote the ability of information understanding,decision-making and application.4)The ability to achieve goals in oral health maintenance can promote the ability of information application and information evaluation.5)The personal characteristics of personal characteristics have an impact on the ability of information evaluation and informed decision-making.6)Personal attitude in personal characteristics can promote the ability to use information and decision-making.7)Emotional support in social support has an impact on the ability of information utilization,information acquisition and informed decision-making.8)Information support in social support influences information acquisition,information understanding,information evaluation and informed decision-making.4.OHL conceptual model validation.Based on the previous OHL conceptual model,this paper further validates the Chinese residents' OHL conceptual model by investigating the current situation of OHL and integrating the influencing factors of the internal structure model and external model of OHL information capability.The results show that information-related ability and its interrelationship constitute the main framework of oral health literacy.In addition,each information-related ability is also affected by other dimensions.Compared with the OHL theoretical model established earlier,in addition to the effect of information support on information evaluation ability and emotional support on information utilization ability,the information related ability is weakened,The other dimensions and information related capabilities play an important role in the OHL conceptual model.5.Application of OHL measurement tools.The average OHL comprehensive score was(175.27±22.51),the lowest score was 73,and the highest score was 253.The scores in each dimension from high to low were:information-related ability(54.21±8.16),personal characteristics(42.81±5.84),health maintenance ability(33.91±4.84),social support(29.62±4.54),basic skills(14.72±6.28).The overall OHL score of the surveyed population was concentrated in the range of 160 to 190,and there were fewer people with a score of less than 150 and more than 200.Males,who don't engage in the medical and health industry,and never suffered from oral diseases are the influencing factors of OHL.Among them,the risk of low OHL in men was 1.449 times higher than that in women(OR=1.449,95%CI:1.102?1.905);OHL in the medical and health industry was higher than that in non-medical and health industry(OR=0.615,95%CI:0.467?0.809);OHL in patients with oral diseases was higher than that in patients without oral diseases OR=0.741,95%CI:0.563?0.976),whether they are engaged in medical treatment The health industry is the root node of the decision tree.Gender and whether you have ever suffered from oral diseases are the branch nodes of the decision tree.Conclusion:1.By defining the concept of OHL,this study constructed the OHL measurement tool The items in the questionnaire have high credibility and good internal consistency,which can stably reflect the latent variables,and can be used by oral health workers in scientific research and clinical practice.2.The overall adaptability of the OHL conceptual model is fine.In the conceptual model,information-related capabilities constitute the main framework of OHL,including information acquisition ability,information understanding ability,information evaluation ability,information application ability and information decision-making ability.Basic skills,oral health maintenance ability,social support and personal characteristics affect OHL by influencing information-related ability.3.The high OHL score is related to the high information related ability of the population,which indicates that improving the information related ability of the residents through various ways is an important way to improve the OHL of the residents,in which men and non-medical and health professionals should be the key population for oral health literacy intervention.4.Using OHL measurement tools to investigate the OHL status of residents,it is found that gender,whether engaged in medical and health industry,whether ever suffered from oral diseases are the key factors affecting OHL,suggesting that improving the information related ability of residents is the key link to improve the OHL of residents,which can provide the basis for OHL related health policy-making,health education or other intervention measures.