Pilot study on development of oral health literacy evaluation tool for Korean adults

Hae-Jin Lee; Jin-Sil Hong; Ju-Yeon Kim; Kee-Wan Chang

doi:10.11149/jkaoh.2015.39.4.237

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Lee, Hong, Kim, and Chang: Pilot study on development of oral health literacy evaluation tool for Korean adults

Original Article

J Korean Acad Oral Health 2015;39(4):237-244.

Published online: 12 December 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.4.237

Pilot study on development of oral health literacy evaluation tool for Korean adults

Hae-Jin Lee, Jin-Sil Hong, Ju-Yeon Kim, Kee-Wan Chang

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

Received 17 August 2015 Revised 20 November 2015 Accepted 7 December 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.

Keywords: Development of tool, Korean version, Oral health literacy

References

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Fig. 1.

Study flow.

Table 1.

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.

Table 2.

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.

Table 3.

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.

Table 4.

Question by discrimination, difficulty and CID

Cognitive processes	Situation 1. Oral health information									Situation 2. Dental treatment instruction
Cognitive processes	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.

Table 5.

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

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