Development of oral health literacy assessment tool for fifth and sixth grade elementary school students

Jinsil Hong; Yuna Shin; Kee-Wan Chang

doi:10.11149/jkaoh.2017.41.3.214

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Hong, Shin, and Chang: Development of oral health literacy assessment tool for fifth and sixth grade elementary school students

Original Article

J Korean Acad Oral Health 2017;41(3):214-221.

Published online: 15 September 2017

DOI: https://doi.org/10.11149/jkaoh.2017.41.3.214

Development of oral health literacy assessment tool for fifth and sixth grade elementary school students

Jinsil Hong¹, Yuna Shin¹, Kee-Wan Chang^1,^2,

¹Department of Preventive & Community Dentistry, Chonbuk National University Dental School, Jeonju, Korea

²Institute 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

Received 12 June 2017 Revised 18 July 2017 Accepted 26 July 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.

Keywords: Children, Oral health literacy, Tool development

References

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Fig. 1.

Flow chart for tool development.

Table 1.

Details of each items for 2^nd 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.

Table 2.

Process for item modification and final selection of items

Section	1^st survey item No.	Reason for item modification	2^nd survey item No.	Reason for item modification	3^rd 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.

Table 3.

Mean item characteristic indexes by sections

Section	Item characteristic index	Sequence of survey (No. of items)
Section	Item characteristic index	1^st (24)	2^nd (27)	3^rd (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.

Table 4.

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.

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