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Development and validation of an International Patient’s Attitudes to Prevention in Oral Health Questionnaire
Author(s) -
Csikar Julia,
Leggett Heather,
VinallCollier Karen,
Whelton Helen,
Pavitt Susan,
Kang Jing,
Douglas Gail V.A.
Publication year - 2023
Publication title -
community dentistry and oral epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.061
H-Index - 101
eISSN - 1600-0528
pISSN - 0301-5661
DOI - 10.1111/cdoe.12781
Subject(s) - medicine , focus group , questionnaire , health care , feeling , family medicine , nursing , public health , psychology , social psychology , social science , marketing , sociology , economics , business , economic growth
Objectives To develop a patient's attitude questionnaire regarding prevention in oral health for use internationally. Methods Using a mixed methods approach, a questionnaire was developed and refined as part of ADVOCATE (Added Value for Oral Care) study, involving partners in six countries: Netherlands, Hungary, Denmark, Ireland, Germany, and the UK. A literature review explored the history of oral healthcare delivery systems to develop a template for each of the six ADVOCATE countries. A systematic review identified the perceived barriers and facilitators to preventive oral healthcare and underpinned a topic guide and established the patient questionnaire domains. Focus groups in each ADVOCATE country developed the first version of the questionnaire. Patient and Public Involvement and Engagement (PPIE) in each ADVOCATE country tested the questionnaire and led to further refinement. The questionnaire was produced in five languages. Content validity and reproducibility used principal component analysis (PCA) and exploratory factor analysis (EFA) refined the questionnaire. Results The literature review aided an understanding of each country's oral healthcare system, and the findings from the 25 studies identified in the systematic review found the main barriers/facilitators to preventive oral healthcare were cost, knowledge (preventive treatments and advice), and a patient awareness and adherence to preventive advice/treatments. Interviews and focus groups with 148 participants in the ADVOCATE study identified receiving the appropriate level of care/feeling valued, cost, level of motivation/priority, not feeling informed, knowledge, and skill mix as the main barriers/facilitators. Fifty‐three PPIE members refined the questionnaire. The pilot questionnaire was tested with 160 participants. Non‐essential or highly correlated variables were then removed, leaving 38 items, covering 6 domains (cost, advice received, advice wanted, message delivery, motivation, knowledge, and responsibility) within the questionnaire. A second pilot test‐run was undertaken with 185 participants. The test‐re‐test reliability demonstrated strong consistency of responses between the two time points (kappa range 0.3–0.7, most p < .0011), which culminated with a final version of the Patient Attitudes to Prevention in Oral Health Questionnaire (PAPOH) questionnaire. Conclusions This mixed‐methods approach enabled the development of a multi‐language attitudinal questionnaire for use with patients (PAPOH) to compare attitudes to oral disease prevention internationally.