Validation of a pediatric oral health-related quality of life scale in Navajo children
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American Indian (AI) children experience the highest rates of early childhood caries (ECC) in the USA, yet no tool has been validated to measure the impact of ECC on their oral health-related quality of life (OHRQoL).
To validate a pediatric OHRQoL scale in a preschool, rural, reservation-based AI population.
In 2011 and 2012, we measured the OHRQoL of AI children attending Head Start in Navajo Nation with the 12-item preschool version of the pediatric oral health-related quality of life (POQL) scale administered to their parents/caregivers. Parents/caregivers also reported their children’s subjective oral health status (OHS) and oral health behavior adherence. Concurrently, calibrated dental examiners measured the children’s decayed, missing, and filled tooth surfaces (dmfs). Validation was assessed with internal reliability and convergent and divergent validity testing and exploratory factor analyses.
We measured the outcomes in 928 caregiver-child dyads. All children were AI and in preschool [mean (SD) child age was 4.1 (0.5) years]. The majority of children had experienced decay [dmfs: 89 %, mean (SD): 21.5 (19.9)] and active decay [any ds: 70 %, mean (SD): 6.0 (8.3)]. The mean (SD) overall POQL score was 4.0 (9.0). The POQL scale demonstrated high internal consistency reliability (Cronbach alpha = 0.87). Convergent validity of the POQL scale was established with highly significant associations between POQL and caries experience, OHS, and adherence to oral health behaviors (all ps < 0.0001).
The POQL scale is a reliable and valid measure of OHRQoL in preschoolers from the Navajo Nation.
KeywordsEarly childhood caries Oral health-related quality of life American Indian Validation Psychometrics Severe early childhood caries
American Indian/Alaska Native
Early childhood caries
Decayed, missing, filled surfaces
Oral health-related quality of life
Oral health status
Pediatric oral health-related quality of life
Funding for the study was provided by the National Institute for Dental and Craniofacial Research (U54 DE019259-03, Albino). The findings and conclusions are those of the authors and do not necessarily represent the official position of the National Institutes of Health. We would like to thank the Navajo Tribe as well as the participants who gave so graciously of their time. We would like to thank Lucinda Bryant for her assistance with revising this manuscript and Carmen George and Nikola Toledo for their tireless work in Navajo Nation. Finally, we are grateful for the technical assistance provided by Michelle Henshaw and Sharron Rich at Boston University.
Conflict of interest
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