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.2017.41.3.214 jkaoh-41-214 Original Article Development of oral health literacy assessment tool for fifth and sixth grade elementary school students HongJinsil1 ShinYuna1 ChangKee-Wan12 Department of Preventive & Community Dentistry, Chonbuk National University Dental School, Jeonju, Korea Institute of Oral-bio Science, Chonbuk National University Dental School, Jeonju, Korea Corresponding Author: Kee-Wan Chang Department of Preventive & Community Dentistry, Chonbuk National University Dental School, Jeonju 54896, Korea Tel: +82-63-270-4034 Fax: +82-63-270-4035 E-mail: prevdent@chonbuk.ac.kr 092017 15092017 413 214221 12062017 18072017 26072017 Copyright © 2017 by Journal of Korean Academy of Oral Health 2017 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

The purpose of this study was to develop and appraise an oral health literacy assessment tool for upper elementary school students.

 Methods

Twenty-eight preliminary assessment items were developed on the basis of various types of oral health education literature for children. They contained verbal and functional sections and they were classified into 2 cognitive processes (literal and inferential). The questionnaires were analyzed using the testAn v.1.0 program for identified Cronbach's a, item discrimination, and difficulty through classical test theory. A final evaluation tool was developed and selected by conducting three surveys and 20 items.

 Results

The final survey was completed by 132 fifth and sixth grade elementary school students in Seoul. The Cronbach's a value, item discrimination, and difficulty were .71, .38, and .75, respectively. The mean score for oral health literacy of children was 14.9 (±3.2, theoretical range: 0-20, 75% correct answers).

 Conclusions

These results suggest that this tool could be relied on to help determine the level of oral health literacy in children and in preparing appropriate oral health education programs for children.

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Flow chart for tool development.

Details of each items for 2nd survey tool

No. Item Subject Classification Form Cognitive process
1 Def. of tooth BOK Verbal Prose Inferential
2 Function of teeth BOK Functional Nonprose Literal
3 Def. of caries ODP Verbal Nonprose Inferential
4 Explanation of dental sealant ODP Functional Prose Literal
5 Def. of permanent tooth BOK Verbal Prose Inferential
6 Structure of teeth BOK Functional Nonprose Literal
7 Def. of periodontal disease ODP Verbal Prose Inferential
8 Def. of dental plaque BOK Verbal Prose Inferential
9 Fluoride advertisement ODP Functional Nonprose Literal
10 Def. of fluoride ODP Verbal Prose Inferential
11 Def. of dental calculus BOK Verbal Prose Inferential
12 Symptoms of periodontal disease ODP Functional Nonprose Literal
13 Explanation of S. mutans BOK Functional Nonprose Literal
14 Def. of xylitol ODP Verbal Prose Inferential
15 Toothbrushing method BOK Functional Nonprose Inferential
16 Diet (healthy or not) BOK Functional Nonprose Inferential
17 Def. of toothbrush BOK Verbal Prose Inferential
18 Way to store toothbrush BOK Functional Prose Literal
19 Def. of primary teeth BOK Verbal Prose Inferential
20 Def. of malocclusion ODP Verbal Nonprose Inferential
21 Periodical exam of oral health ODP Functional Nonprose Inferential
22 Explanation of Oral care products BOK Verbal Prose Inferential
23 Uses for toothpaste BOK Functional Nonprose Inferential
24 Smoking risk ODP Functional Nonprose Literal
25 Def. of halitosis ODP Verbal Prose Inferential
26 Caries process ODP Functional Nonprose Literal
27 Def. of injury ODP Verbal Prose Inferential
28 Result of dental exam ODP Functional Nonprose Literal

*No.: item number, BOK: basic oral health knowledge, ODP: oral disease and preventive, Prose: description, explication, Nonprose: advertisement, figure, table.

Process for item modification and final selection of items

Section 1st survey item No. Reason for item modification 2nd survey item No. Reason for item modification 3rd survey item No. Reason for item modification Final item No.
BOK 1 Dif, adjustment 1 Dis, remove
-Verbal 5 Distractor adjustment 5 → 10 10
9 → 8 → 7 7
13 → 11 → 13 Finalize question item for this section 13
17 Dif, adjustment 17 Dis, remove
21 → 22 → 15 15
Add item 19 → 19 19
BOK 2 → 2 → 1 1
-Functional 6 Dif, adjustment 6 → 14 14
12 → 13 → 12 12
15 Rel, redevelopment 15 → 3 Finalize question item for this section 3
18 Dif, adjustment 18 Dis, remove
22 → 23 → 18 18
Add item 16 Dis, remove
ODP 3 → 3 Dis, remove
-Verbal 8 Dif, adjustment 7 → 4 4
11 → 10 → 6 6
14 → 14 → 8 Finalize question item for this section 8
19 → 25 → 21 21
23 Dif, adjustment 20 Dis, remove
Add item 27 → 16 16
ODP 4 → 4 → 2 → 2
-Functional 7 → 9 → 5 → 5
10 → 12 Dis, adjustment 11 Dis, remove
16 Dif, adjustment 26 Dis, adjustment 9 Dis, remove
20 → 21 Dis, adjustment 17 → 17
24 Dis, adjustment 24 → 20 → 20
Add item 28 Item error 22 → 22
No. of items 24 27 22 20

*BOK: basic oral health knowledge, ODP: oral disease and preventive, Dif: difficulty, Dis: discrimination, Rel: reliability.

Mean item characteristic indexes by sections

Section Item characteristic index Sequence of survey (No. of items)
1st (24) 2nd (27) 3rd (22) Final (20)
BOK-Verbal Dis .20 .33 .39 .40
Dif .88 .84 .76 .76
Rel .69 .72 .73 .69
BOK-Functional Dis .24 .27 .35 .34
Dif .83 .89 .83 .83
Rel .68 .72 .73 .70
ODP-Verbal Dis .30 .32 .35 .36
Dif .82 .77 .68 .68
Rel .68 .72 .73 .70
ODP-Functional Dis .21 .29 .39 .43
Dif .85 .77 .76 .71
Rel .68 .72 .73 .70
Total Dis (correlation) .37 .35 .40 .40
Dis (upper, lower) .24 .30 .37 .38
Dif .84 .82 .76 .75
Rel .69 .73 .74 .71

*BOK: basic oral health knowledge, ODP: oral disease and preventive, Dif: difficulty, Dis: discrimination, Rel: reliability.

Item characteristic index of final assessment tool for oral health literacy

BOK ODP
Verbal No. 7 10 13 15 19 4 6 8 16 21
Dis .47 .46 .34 .34 .41 .24 .44 .24 .63 .26
Dif .74 .75 .69 .83 .80 .27 .78 .89 .58 .89
Rel .69 .68 .71 .70 .69 .72 .69 .69 .69 .69
Functional No. 1 3 12 14 18 2 5 17 20 22
Dis .39 .27 .25 .39 .41 .37 .29 .54 .45 .49
Dif .86 .82 .86 .84 .78 .62 .86 .72 .56 .78
Rel .69 .70 .69 .69 .69 .70 .69 .69 .71 .69

Total difficulty: .75, discrimination: .38, Cronbach’s a value: .71 *No.: item number, BOK: basic oral health knowledge, ODP: oral diseases and preventive, Dif: difficulty, Dis: discrimination, Rel: reliability.