Development And Evaluation Of Early Childhood Oral Health Impact Scale (Chinese Version Of Ecohis)

Objectives Through from infanthood, early childhood to schooling-age, a child's primary set of teeth is one of the important components of organs assisting with chewing. Chewing stimulates the development of jaw bone and dental arch, making good contribution to holding space for the permanent teeth. Chewing helps a child digest and absorb the food they eat, supporting their growth. Healthy baby teeth are also useful for children to speak in the right way. Damage or premature loss of the baby teeth by any causes can make impact on chewing, and then the development of jaw bone and dental arch, leading to abnormal occlusion. As a result, children's chewing, right speaking, and also appearance, will be affected. It is meaningful in many aspects to examine and evaluate oral health-related quality of life for children. It reflects the true feeling of children about their oral health, promotes communication among children, parents and doctors, helps them better understand the significance of oral health for children and in family life, and provides important references to quality evaluation on clinical treatment. Oral health-related quality of life has attracted broad attention from the academic world at home and abroad. Scholars in Canada have developed the questionnaire of Child Oral Health Quality of Life, COHQoL, and it has been widely used. However, there have been few researches on this field in China so far. The study is aimed to develop an Early Childhood Oral Health Impact Scale (Chinese version of ECOHIS). It is proposed to be used in clinical oral health examination and evaluation of oral health-related quality of life, as to evaluate its reliability and validity.MethodsThe focus group and nominal group is founded under the principle of programmed decision. Qualitative and quantitative analyses combined is adopted in the process of formulating a draft scale through from first screening, evaluation to modification of items. Random selection is the basis of choosing 30 children with oral diseases for pre-experiment. Discrete trend analysis, correlation analysis, stepwise regression analysis, factor analysis and other statistical methods are used in review on the effects of the pre-experiment. The content and construct of the scale is to be adjusted according to the review, as to work out a final form of Early Childhood Oral Health Impact Scale (Chinese version of ECOHIS). The study's target population is children of 3~6 years old, and target place is the Oral Department, Affiliated Hospital of Medical School, Chifeng University, Inner Mongolia. The survey conducts among people randomly selected among children of 3-6 years old carried to see doctors in oral department and their parents (fathers/mothers/other gardians) between May-Dec 2008. Admission threshold: (1) the child is diagnosed clinically with oral diseases (in teeth, gum, lip, palate, jaw); (2) the child's parents are with the background of primary school education or above; and (3) the parents and child are willing to participate in the examination.The parents fill out the ECOHIS (Chinese version). The doctors of oral department, who have received uniformed standardized training, carry out the examination on the children's tooth decay, transposition and deformity, give objective evaluation, and then provide treatment, all of which are recorded in the Oral Health Questionnaire. The scale, including def index and the index of teeth aesthetic, is designed according to the Oral Health Questionnaire(for deciduous tooth) recommended in the third national epidemiological survey plan of oral health.The software package SPSS 11.5 is used for analysis of the clinical data. The statistical methods used include: correlation analysis, paired t test, exploratory factor analysis (EFA), t test, and etc. If without special explanations, p-value in the study represents the result of two-tailed probability. (1) In reliability test: using Cronbach′sαcoefficient test, Guttman formula of split-half reliability, t test, and correlation coefficient test between items and their correspondent domain and between items and the scale; (2) in construct and content validity test: using principal component analysis and EFA; and (3) In discrimination validity test: using Spearman correlation coefficient test.Results 200 sets of the scale were disseminated. 190 sets were filled out and returned, and the return rate is 95%. Of the 190 sets returned, 175 sets are valid, and the completion rate is 92.1%. Of the 175 sets valid, 21 sets are with data loss, accounting for 12%. The total scores, from the scale sets returned, are 32~96, and their average scores are 60.92±12.21. It have found no scale set marked with minimum score (26) or maximum score (130). 48 persons, including children and their parents, participated in test-retest conducted once every two weeks, assisting with test-retest reliability evaluation on the scale. Both times, the correlation coefficient between the total scores and their correspondent module scores were greater 0.9. And there is no statistical significance (P>0.05) in paired t test on differences between the average scores attained in test and retest. Tests in both these methods give the same conclusions. From the results of the reliability analysis of the scale, the Cronbach'sα, the internal consistency reliability, is 0.86, and the Guttman coefficient, the split-half reliability, is 0.74. From the results of the validity analysis, the correlation coefficients between items and the scale are 0.35~0.66, most of the item scores in domain had higher correlation to total domain scores than other total domain scores.The facror structures of the scale was explored by using principal components analysis with varimax orthogonal rotation.7 common factors (coefficient value>0.30)were extracted from the scale which reflected facets of independence,explaining 62.7% of the variable. There is correlation observed between the def index (P<0.0001) and the total score in a scale, which means that the higher the def index, the more serious the tooth decay and the higher the score in a scale. There found no correlation between the index of teeth aesthetic and the total score in a scale. Conclusions Following the international standard procedure of the project of development and evaluation of quality of life, the study has established Early Childhood Oral Health Impact Scale (Chinese version), and evaluated and proved that it is with good reliability and validity in the perspective of psychological measurement, providing theoretical evidences to application of the scale among children of the targeting age.Oral health related quality of life for children of 3~6 years old can make significant impacts on many aspects of family life.