JKAOH Journal of Korean Academy of Oral Health J Korean Acad Oral Health 1225-388X 2093-7784 Journal of Korean Academy of Oral Health 10.11149/jkaoh.2015.39.4.237 jkaoh-39-237 Original Article Pilot study on development of oral health literacy evaluation tool for Korean adults LeeHae-Jin HongJin-Sil KimJu-Yeon ChangKee-Wan Department of Preventive & Community Dentistry, Institute of Oral-bio Science, Chonbuk National University Dental School, Jeonju, Korea Corresponding Author: Kee-Wan Chang Department of Preventive & Community Dentistry, Institute of Oral-bio Science, Chonbuk National University Dental School, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea Tel: +82-63-270-4034 Fax: +82-63-270-4035 E-mail: prevdent@jbnu.ac.kr 122015 12122015 39 4 237 244 17082015 20112015 07122015 Copyright © 2015 Journal of Korean Academy of Oral Health 2015 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objectives

Oral health literacy is defined as ‘the degree to which individuals have the capacity to obtain, process, and understand basic oral health information and services needed to make an appropriate health decision’. This goal of this study was to develop an instrument for assessing oral health literacy in Korean adults.

 Methods

This instrument was developed by using the adult literacy evaluation tool of the Korean Government. The components were mainly related to 2 conditions (‘oral health information’ and ‘dental treatment instruction’), and they were classified into 3 cognitive processes (realistic, deductive, and critical domains). Furthermore, all of the subcomponents were divided into prose and non-prose. Therefore, each of the 12 subcomponents had 4 items, resulting in a final questionnaire with 48 items. A pilot survey was conducted in 51 adults, and the quality of the questionnaire was subsequently evaluated. We identified reliability by using Cronbach’s α, discrimination, and difficulty. Two items from each of the 12 subcomponents were selected as the final items. We set the difference thresholds at over 0.5 and over 0.3 for reliability and discrimination, respectively. Finally, we distributed the difficulty from 35 to 95%.

 Results

The reliabilities of all items (48) and the final items (24) were 0.838 and 0.836, respectively. The mean discrimination of the final items was higher than that of all items (mean: 0.5 and 0.3, respectively). The difficulty curve of the final items followed a normal distribution.

 Conclusions

The reliability and validity demonstrated by the final 24 items indicates that they are appropriate for evaluating oral health literacy in adults.

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Study flow.

Problems configuration questions table

Cognitive processes subcategories Situation
1. Oral health information 2. Dental treatment instruction
Prose Un prose Prose Un prose
Realistic 1, 13, 25, 37 2, 14, 26, 38 3, 15, 27, 39 4, 16, 28, 40
Deductive 5, 17, 29, 41 6, 18, 30, 42 7, 19, 31, 43 8, 20, 32, 44
Critical 9, 21, 33, 45 10, 22, 34, 46 11, 23, 35, 47 12, 24, 36, 48

Number, question number; Prose, description, explication; Un prose, form, picture, table, advertisement.

Configuration contents of testing tool

No Contents No Contents
1 Water fluoridation business ad 25 Dental floss direction
2 Oral care products 26 Dental business card
3 Sealant notice 27 Sealant guidance
4 Scaling coverage ad 28 Course of inlay
5 School newsletter 29 The importance of the first molar
6 Oral health club ad 30 The role of teeth
7 Medication guide 31 Notices after fluoride
8 Scaling coverage period ad 32 Prosthetic treatment after tooth extraction
9 Toothpaste ad 33 Toothbrush storage
10 Caries prevention 34 Country number of child tooth decay
11 Instruction after prosthetic treatment 35 Notices after periodontal surgery
12 Notices of endo 36 Deductible information
13 Periodontal disease symptoms 37 Gingivitis prevention
14 Teeth’s day events 38 Rolling method
15 Notices after wisdom teeth extraction 39 Endodontic treatment notice
16 Mouthwash prescription 40 Student oral examination result notification
17 Electric toothbrush manual 41 Xylitol description
18 Caries process 42 Regular dental check-up results
19 Fluoride application method 43 Notices after scaling
20 Implant coverage ad 44 Fluoride solution mouthwash method
21 Dental checkups time 45 Plaque control methods
22 Water fluoridation business effect 46 Causing tooth decay index of food
23 Notices after resin filling 47 Notices after infiltration anesthesia
24 VAT Act amendment 48 Notices after inlay treatment

No, Item number; ad, advertisement.

Evaluation criteria of questionnaires by 4-point Likert scale

No. Evaluation contents
1. Were questions correctly distinguish each situation?
-Situation 1; Literacy about obtain the oral health information.
- Situation 2; Literacy about dental instruction.
2. Were questions correctly distinguish each classification?
- Prose; description, explication etc.
- Un prose; form, advertisement, picture, table etc.
3. Were questions correctly distinguish each cognitive processes
subcategories?
- Realistic; understanding superficial information only.
- Deductive; obtaining the new information.
- Critical; obtaining the misinformation.
4. Were the number of question arranged depending on all the
subcategories evenly?
5. Were questions choose either indeterminate or positive form?
6. Were correct answers cleary, incorrect answers respectably?
7. Were correct answers number mixed and distributed?
8. Were the number of correct choices equal?
9. Were the length of choices arranged from short to long?
10. Were the questions avoid duplicate of content?

Point; 1 = not at all; 2 = a little; 3 = yes, guite; 4 = yes, very.

Question by discrimination, difficulty and CID

Cognitive processes Situation 1. Oral health information Situation 2. Dental treatment instruction
Prose (description, explication) Un prose (form, picture, table, advertisement) Prose (description, explication) Un prose (form, picture, table, advertisement)
Realistic No. 1 13 25 37 2 14 26 38 3 15 27 39 4 16 28 40
Dis 0.29 0.54 0.13 0.08 0.08 0.23 0.08 0.43 0.46 0.34 0.46 0.23 0.05 0.17 0.54 0.47
Dif 51.0 76.5 52.9 98.0 96.1 94.1 98.0 52.9 76.5 68.6 88.2 92.2 68.6 72.5 82.4 74.5
CID 0.837 0.831 0.842 0.837 0.838 0.834 0.836 0.833 0.832 0.836 0.832 0.835 0.844 0.840 0.831 0.833
Deductive No. 5 17 29 41 6 18 30 42 7 19 31 43 8 20 32 44
Dis 0.32 0.33 0.47 0.37 0.70 0.78 0.25 0.08 0.16 0.62 0.71 0.39 0.13 0.48 0.20 0.15
Dif 84.3 25.5 76.5 37.3 60.8 64.7 19.6 94.1 88.2 62.7 51.0 76.5 5.9 58.8 64.7 94.1
CID 0.834 0.835 0.832 0.836 0.832 0.828 0.839 0.837 0.835 0.832 0.831 0.834 0.836 0.836 0.839 0.837
Critical No. 9 21 33 45 10 22 34 46 11 23 35 47 12 24 36 48
Dis 0.64 0.16 0.54 0.54 0.38 0.15 0.46 0.45 0.38 0.39 ―0.04 0.70 0.33 0.29 0.38 0.02
Dif 64.7 90.2 74.5 76.5 88.2 47.1 86.3 39.2 80.4 84.3 70.6 58.8 72.5 49.0 35.3 43.1
CID 0.829 0.839 0.831 0.831 0.834 0.839 0.830 0.835 0.836 0.834 0.843 0.831 0.837 0.840 0.838 0.843

No, question number; Dis, discrimination; Dif, difficulty (percentage of correct answers); CID, Cronbach's a If item deleted; Italics, final selected question.

Distribution of CID, discrimination and difficulty by questions

Variable Distribution Total question N (%) Selected question N (%)
CID 0.824-0.829 2 (4.2) 2 (8.3)
0.830-0.834 20 (41.7) 16 (66.7)
0.835-0.839 20 (41.7) 6 (25.0)
0.840 - 6 (12.5) -
Total 48 (100.0) 24 (100.0)
Discrimination -0.19 10 (20.8) -
0.20-0.39 14 (29.2) 4 (16.7)
0.40-0.59 18 (37.5) 14 (58.3)
0.60- 6 (12.5) 6 (25.0)
Total 48 (100.0) 24 (100.0)
Difficulty -39 5 (10.4) 2 (8.3)
40-59 9 (18.8) 5 (20.8)
60-79 17 (35.4) 10 (41.7)
80-89 9 (18.8) 5 (20.8)
90- 8 (16.7) 2 (8.3)
Total 48 (100.0) 24 (100.0)

CID, Cronbach's a If item deleted; Difficulty, percentage of correct answers