Linguistic adaptation and psychometric evaluation of original oral health literacy-adult questionnaire (OHL-AQ)

Introduction: Linguistically adapted oral health literacy tools are helpfulto assess oral health literacy among local population with clarity andunderstandability. The original oral health literacy adult questionnaire,Oral Health Literacy Adult Questionnaire, was given in English (2013),consisting of 17 items under 4 domains. The present study rationalizes toculturally adapt and validate Oral Health Literacy Adult Questionnaireinto Hindi language. Thus, we objectified to translate Oral Health LiteracyAdult Questionnaire into Hindi and test its psychometric properties likereliability and validity among primary school teachers.Methods: The Oral Health Literacy Adult Questionnaire was translatedinto Oral Health Literacy Adult Questionnaire – Hindi Version usingthe World Health Organization recommended translation backtranslationprotocol. During pre-testing, an expert panel assessedcontent validity of the questionnaire. Face validity was assessed on asmall sample of 10 individuals. A cross-sectional study was conducted(June-July 2015) and OHL-AQ-H was administered on a convenientsample of 170 primary school teachers. Internal consistency and testretestreliability were assessed using Cronbach’s alpha and Intra-classcorrelation coefficient (ICC), respectively, with 2 weeks interval toascertain adherence to the questionnaire response. Predictive validitywas tested by comparing OHL-AQ-H scores with clinical indicatorslike oral hygiene scores and dental caries scores. The concurrent anddiscriminant validity was assessed through self-reported oral healthand through negative association with sociodemographic variables.The data was analyzed by descriptive tests using chi-square andbivariate logistic regression in SPSS software, version 20 and p<0.05was considered as the significance level.Results: The mean OHL-AQ-H score was 13.58±2.82. ICC andCronbach’s alpha for Oral Health Literacy Adult Questionnaire – HindiVersion were 0.94 and 0.70, respectively. Comparisons of varyinglevels of oral health literacy with self-reported oral health establishedsignificant concurrent validity (p=0.01). Significant predictive validitywas observed between OHL-AQ-H scores and clinical parameters likeoral hygiene status (p=0.005) and dentition status (p=0.001).Conclusion: The translated and culturally adapted Oral Health LiteracyAdult Questionnaire – Hindi Version indicated good reliability andvalidity among primary school teachers to assess oral health literacyamong Hindi speaking population. Hence, improving OHL levels andimplementing education oriented policies can improve the quality of life.Keywords: Oral health; Health literacy; Validation studies; Reproducibility of results; Translating