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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 71-74

Validity and reliability of a questionnaire for measuring oral health-related quality of life in tobacco users


1 Department of Public Health Dentistry, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India
2 Department of Periodontics, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Sai HVN Krishna
Department of Public Health Dentistry, Meghna Institute of Dental Sciences, Nizamabad - 503 001, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_20_17

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  Abstract 


Background: The Oral Health Impact Profile (OHIP) is a well-known method for identifying dimensions in oral health-related quality of life. It measures the individuals' perception of the social impact of oral disorders on their well-being.
Objective: To assess the validity and reliability of the oral health-related quality of life questionnaire in tobacco users.
Materials and Methods: Data were collected from a sample of 210 patients using a modified (OHIP-21) questionnaire adopted from the OHIP-49 original questionnaire; responses were graded on a 5-point Likert scale.
Results: The internal consistency reliability of the questionnaire, as estimated by Cronbach's alpha coefficient (α = 0.75), indicated that the components of the scale measured the same construct. Factor analysis provided a seven-factor model explaining 62.5% of the variance. Physical pain was loaded on the first factor.
Conclusion: These preliminary results provided initial supportive evidence of the OHIP-21 reliability and validity in tobacco users. Further studies are needed to confirm this preliminary conclusion.

Keywords: Oral health-related quality of life; reliability; tobacco users; validity


How to cite this article:
Krishna SH, Eaturi M. Validity and reliability of a questionnaire for measuring oral health-related quality of life in tobacco users. Indian J Multidiscip Dent 2017;7:71-4

How to cite this URL:
Krishna SH, Eaturi M. Validity and reliability of a questionnaire for measuring oral health-related quality of life in tobacco users. Indian J Multidiscip Dent [serial online] 2017 [cited 2018 Apr 25];7:71-4. Available from: http://www.ijmdent.com/text.asp?2017/7/2/71/221758




  Introduction Top


Tobacco is one of the major causes of deaths and diseases in India, accounting for almost a million deaths every year. India is the second largest consumer and producer of tobacco (after China) in the world.[1] As per the Global Adult Tobacco Survey 2010, more than one-third (35%) of adults in India use tobacco in some form. More than 75% of tobacco users, both smokers and users of smokeless tobacco, are daily users of tobacco. Smokeless tobacco is an important etiological factor in cancers of the mouth, lip, tongue, and pharynx. India has one of the highest rates of oral cancer in the world. Nearly 65% of all cancers in men and 33% of all cancers in women are tobacco related. The annual incidence of oral cancer is said to be 10/100,000 of males.[2] In oral cavity, dental caries, periodontal diseases, oral mucosal lesions, and other deleterious oral conditions are seen which have a diminishing effect on oral health and quality of life.

A variety of patient-centered outcome measures termed “oral health-related quality of life measures” (OHRQoL) have been developed to assess the extent to which oral health problems affect not only physical functioning and pain, but broader constructs such as psychosocial functioning and life satisfaction. The Oral Health Impact Profile (OHIP-14) is a 14-item questionnaire designed to measure self-reported functional limitation, discomfort, and disability attributed to oral conditions.[3] It is derived from the original extended version of 49-item[4] questionnaire based on a theoretical model developed by the World Health Organization [5] and adapted for oral health by Locker.[6]

A considerable body of evidence now exists on the validity and reliability of the OHIP-14 in a number of hospital settings and dental conditions, including surgical removal of impacted molars, elderly partially edentulous and complete edentulous patients seeking dental rehabilitation, and oral lichen planus.

Numerous studies have been carried out on the OHRQoL in patients with impacted molars, partially edentulous and complete edentulous patients seeking dental rehabilitation, and patients with oral mucosal diseases. However, there are relatively few studies carried out on tobacco users and quality of life and the validity of OHIP-21 questionnaire. Hence, the present study was undertaken to determine the validity and reliability of OHRQoL questionnaire in tobacco users.


  Materials and Methods Top


This cross-sectional study was conducted among patients (tobacco users) attending the outpatient Department of Public Health Dentistry, Meghna Institute of Dental Sciences, Nizamabad, over a period of 2 months (March 1, 2017–April 30, 2017) and those who met inclusion criteria given below and agreed to participate formed the study population (210). Ethical clearance was obtained from the Institutional Review Board.

Inclusion criteria

  • Individuals aged 18 years and above with a habit of tobacco presently
  • Individuals who agreed to give informed consent (verbal consent).


Collection of data

The data collection instrument for the assessment of OHRQoL was modified OHIP-21 questionnaire adopted from OHIP-49 original questionnaire where 21 questions were taken which would influence the tobacco users on their quality of life; the questionnaire was self-administered and completed in a room by a trained and calibrated examiner, and the responses were graded as never (0), hardly (1), occasionally (2), fairly often (3), and very often (4).

Statistical analysis

The completed questionnaires were collected and data were entered into a standard Microsoft Excel 2007 sheet. The collected data were subjected to statistical analysis using SPSS software (17.0, Chicago IL, USA). Internal consistency of the questionnaire was done by Cronbach's alpha and validity was tested by factor analysis.


  Results Top


The present study brings out the profile of the tobacco patients participating in the study. The age groups of patients were in the range of 24–59 years. Nearly 24.2% of them were in the age group of 15–24 years, 34.2% of them were in the age group of 25–34 years, 20.4% of them were in the age group of 35–44 years, 11.4% of them in the age group of 45–54 years, and 9.8% were aged above 55 years [Table 1]. Of the 210 patients, 204 (97.15%) were males and 6 (2.85%) were females [Table 2].
Table 1: Distribution of patients according to age groups

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Table 2: Distribution of patients according to gender

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According to the form of tobacco usage, 57.6% of them used cigarettes, 17% of them used bidi, 22.3% of them used gutkha, and 3.0% of them used pan masala [Table 3].
Table 3: Distribution of patients according to the form of tobacco usage

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Validity

Factor analysis allows identification of a small number of factors that explain most of the variance observed in a much larger number of manifest variables. In the current study, factor analysis was conducted using principal component analysis that revealed one principal component with an eigenvalue of 4.1 that accounted for 19.7% of variation and an additional six principal components that had Eigen values ranging from 1.1 to 2.0. Six of the OHIP questions had factor loadings that exceeded 0.4 for the first rotated factor. The retention criterion for factors was set at eigenvalue >1. The first seven Eigen values are 4.1, 2.0, 1.7, 1.5, 1.2, 1.2, and 1.1 and therefore a seven-factor solution was proposed. Physical pain was highly loaded in component 1 (0.732, 0.778), social disability was highly loaded in component 2 (0.736), handicap was highly loaded in component 3 (0.804), psychological disability was highly loaded in component 4 (0.775) and component 7 (0.808), social disability was loaded in component 5 (0.843), and functional limitation was loaded in component 6 (0.737). Factor analysis provides construct validity & all the variables in the domain retained higher values [Table 4].
Table 4: Validity of Oral Health Impact Profile-21

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Reliability

Cronbach's alpha internal consistency indicator was used to estimate the reliability of the 14-item scale of OHIP-21 (α = 0.75) and could be improved only to the third decimal place by deletion of individual questions [Table 5].
Table 5: Cronbach's alpha internal consistency indicator

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  Discussion Top


Quality of life is increasingly acknowledged as a valid, appropriate, and significant indicator of service need and intervention outcome in contemporary public health research and practice. The quality of life includes social, psychological as well as functional aspects. For this, the OHIP is one of the self-reported measurements of the adverse impacts of oral condition on daily life.[7] The OHIP scale is concerned with the behavioral and psychosocial aspects of the impact and does not include measures of “disease” and “impairment,” which are depicted in the model on which it is based. Oral health-related quality of life is measured in relation to not only physical, emotional, and social well-being but also functional activities such as eating, swallowing, and speaking.[8] Sufficient indications about the reliability and validity of the OHIP-14 were obtained in this study. Cronbach's alpha values (0.5–0.7) are generally considered to indicate sufficient reliability for an instrument or scale to be used to make group comparisons; the results of this study showed that the OHIP-21 was reliable with an alpha value of 0.75. Factorial analysis provides a seven-factor model explaining 62.5% of the variance. Six of the OHIP questions had factor loadings that exceeded 0.4 for the first rotated factor. Physical pain was highly loaded in component 1 (0.732, 0.778) and social disability was highly loaded in component 2. This finding is consistent with the study done by Acharya.[9] This may be because a majority of Indians still visit a clinician only for relief of pain as and when it occurs. This may account for the strong association between the domain of physical pain and the factors, which in turn impact their quality of life. Kaplan et al.[10] found that factors and items that contribute little to explaining variance (<0.4) in occurrence or frequency are considered unimportant in factor analysis. Oral health quality deserves to be promoted in the national oral health plan to meet the needs of the population and achieve optimal benefits from the available resources. The OHRQoL can measure the effectiveness of dental public health programs, assessing the oral health needs of populations.[11]


  Conclusion Top


The present findings of the study indicate that, like the original questionnaire, this shorter version of OHIP-21 is a reliable, consistent, and valid instrument for measuring OHRQoL in tobacco users. Consequently, it will be important to investigate the reliability and validity of the OHIP-21 in other populations. Longitudinal studies are then necessary to determine its longitudinal construct validity, responsiveness, and minimal clinically important difference.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Reddy KS, Gupta PC. Report on Tobacco Control in India. New Delhi: Ministry of Health and Family Welfare, Government of India; 2004. Available from: http://www.who.int/fctc/reporting/Annex6_Report_on Tobacco_Control_in_India_2004.pdf. [Last accessed on 2017 Jun 20].  Back to cited text no. 1
    
2.
World Health Organization. Report on Global Adult Tobacco Survey (GATS) 2009-2010 International Institute of Population Sciences: Ministry of Health and Family Welfare, Government of India; 2009-2010. Available from: http://www.who.int/tobacco/surveillance/en_tfi_india_gats_fact_sheet.pdf. [Last accessed on 2017 Jun 16].  Back to cited text no. 2
    
3.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.  Back to cited text no. 3
    
4.
Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dent Health 1994;11:3-11.  Back to cited text no. 4
    
5.
World Health Organization. International Classification of Impairments, Disabilities and Handicaps, (ICIDH). Geneva: WHO; 1980. Available from: http://www.who.int/iris/handle/10665/41003. [Last accessed on 2017 Mar 02].  Back to cited text no. 5
    
6.
Locker D. Measuring oral health: A conceptual framework. Community Dent Health 1988;5:3-18.  Back to cited text no. 6
    
7.
Jokovic A, Locker D, Stephens M, Kenny D, Tompson B, Guyatt G, et al. Validity and reliability of a questionnaire for measuring child oral-health-related quality of life. J Dent Res 2002;81:459-63.  Back to cited text no. 7
    
8.
Molek, Abidin T, Bachtiar A, Pintauli S, Marsaulina I, Rahardjo A. Determining validity and reliability of oral health-related quality of life instrument for clinical consequences of untreated dental caries in children. Asian J Epidemiol 2016;9:10-7.  Back to cited text no. 8
    
9.
Acharya S. Oral health-related quality of life and its associated factors in an Indian adult population. Oral Health Prev Dent 2008;6:175-84.  Back to cited text no. 9
    
10.
Kaplan RM, Bush JW, Berry CC. Health status: Types of validity and the index of well-being. Health Serv Res 1976;11:478-507.  Back to cited text no. 10
    
11.
Huntington NL, Spetter D, Jones JA, Rich SE, Garcia RI, Spiro A 3rd, et al. Development and validation of a measure of pediatric oral health-related quality of life: The POQL. J Public Health Dent 2011;71:185-93.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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