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Objective To investigate the influence of oral health literacy (OHL) and associated factors on dissatisfaction with oral health (DOH) among older people. Background Oral health literacy is a recent field of research that has been considered an important mediator between socioeconomic variables and oral health outcomes. However, there are few studies with older people. Materials and methods A cross‐sectional study was conducted with 535 non‐institutionalised older people aged 60‐100 years from Brazil. Individuals completed a questionnaire on general health, sociodemographic information and usual reason for dental visit. OHL was assessed using the Health Literacy in Dentistry questionnaire (HeLD‐14), validated in Brazil. DOH was the outcome of interest. Poisson regression with robust standard errors was applied as a statistical model to estimate bivariate and multivariable relationships of DOH with OHL after adjusting for sex, age, social characteristics and general health using the P‐value of ≤ .05. Results The overall prevalence of DOH was 21.1%. Multivariable regression analysis showed that older people with low OHL (HeLD‐14 score ≤35) had 1.28 times the odds of having DOH than those with high OHL (HeLD14 score >46), after adjusting for sociodemographic, economic and health outcomes. Conclusions Dissatisfaction with oral health in older people is a complex issue associated with OHL, social and behavioural factors. Health services should give greater attention to developing health literacy competences in older adults in order to empower them to achieve optimal oral health.

Oral health literacy, self-rated oral health, and oral health-related quality of life in Brazilian adults Bado FMR, De Checchi MHR, Cortellazzi KL, Ju X, Jamieson L, Mialhe FL. Oral health literacy, self-rated oral health, and oral health-related quality of life in Brazilian adults. Eur J Oral Sci 2020; 128: 218-225. © 2020 Eur J Oral SciThe aim of this study was to investigate associations between oral health literacy (OHL), self-rated oral health (SROH), and oral health-related quality of life (OHR-QoL) in Brazilian adults. A sample of 523 Brazilian adults completed the shortform Health Literacy in Dentistry (HeLD-14) and the Oral Health Impact Profile-14 (OHIP-14) instruments that measure OHL and OHRQoL, respectively. The prevalence ratios (PRs) for outcome variables and their 95% CIs were quantified. Multivariable log-binomial regression models were applied, as the statistical models, to estimate bivariate and multivariable relationships of oral health outcomes with OHL, after adjusting for covariates. No significant association was found between poor SROH (as measured by single items) and OHL (PR = 1.28; 95% CI: 0.87-1.88); by contrast, significant associations were found between poor SROH and income (PR = 1.52; 95% CI: 1.04-2.21), toothbrushing frequency (PR = 1.69; 95% CI: 1.11-2.58), reason for dental visiting (PR = 1.48; 95% CI: 1.03-2.13), and self-rated general health (PR = 3.44; 95% CI: 2.38-4.97). The OHL level (PR = 1.76; 95% CI: 1.21-2.56), educational level (PR = 0.62; 95% CI: 0.41-0.93), reason for dental visiting (PR = 1.84; 95% CI: 1.30-2.61), and self-rated general health (PR = 1.51; 95% CI: 1.03-2.23) were associated with poor OHRQoL.

ObjectiveThe objective of this study was to investigate the psychometric properties of the Oral Health Literacy Assessment in Spanish (OHLA-S) for the Brazilian-Portuguese language using robust analysis and with the results disclose possibilities to develop a shorter and more valid instrument.MethodsOHLA-S is an oral health literacy instrument comprising a word recognition section and a comprehension section. It consists of 24 dental words. It was translated into the Brazilian-Portuguese language (OHLA-B) and its psychometric properties were evaluated in a random sample of 250 adults aged 20–59 years. To assess the dimensionality and factor structure were tested by means of Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Reliability was assessed using two indicators: Cronbach's alpha and McDonald’s Omega.ResultsEFA and CFA demonstrated that the OHLA-B with 24 items did not present an adequate adjustment of the model, compromising its validity. In addition, reliability values at 0.50 for Cronbach's alpha and 0.67 for McDonald's omega were below the minimum acceptable rate of 0.70. As no support was found for the original structure, we decided to proceed with the withdrawal of individual items and successive reanalysis of the model until the indicators were adjusted in a shorter instrument. A new structure with 15 items produced an instrument with two dimensions and a better goodness of fit than the original instrument. The Alpha and Omega reliability index values increased to 0.83 and 0.80, respectively, and all scores were better in the OLHA-B with 15 items than in the instrument with 24 items.ConclusionOLHA-B with the original structure composed by 24 items did not show acceptable construct validity. The shorter version with 15 items showed more promising results for assessing oral health literacy levels in the Brazilian population.

Objectives To perform cross‐cultural adaptation and validation of the Health Literacy Dental scale (HeLD) in Brazilian adults. Methods The HeLD instrument was translated and cross‐culturally adapted to the Brazilian Portuguese language to create longer (HeLD‐29) and shorter (HeLD‐14) versions. The reliability and validity of these versions were assessed in a sample of 603 adults living near six primary care units in the city of Piracicaba, São Paulo, Brazil. Results Both versions of HeLD demonstrated high internal reliability, acceptable convergent validity and discriminant validity. However, the confirmatory factor analysis showed that only HeLD‐14 demonstrated satisfactory goodness of fit. There were associations between HeLD‐14 scores and social demographic characteristics, general and oral health and oral health‐related behaviours. Higher scores were observed for the total HeLD‐14 and/or individual components of HeLD‐14 among women, ethnic white subjects, those with high educational attainment, those with higher income, those reporting toothbrushing twice or more daily, regular dental attenders, those who usually attended for dental care for a check‐up, those with excellent or very good self‐ratings of general health, those with excellent or very good self‐ratings of oral health, and those without tooth extraction and oral health impact. Conclusion The Brazilian version of HeLD‐14 was demonstrated to be a reliable and valid instrument for measuring broad aspects of oral health literacy in the adult Brazilian population.

Objective: To translate the Spanish version of the instrument to measure oral health literacy-Oral Health Literacy Assessment-Spanish (OHLA-S)-into Portuguese (Brazilian) and perform their cross-cultural adaptation. Material and Methods: OHLA-S evaluates the level of oral health literacy from questions measuring pronunciation and comprehension skills of 30 dental terms concerning the etiology, anatomy, prevention and treatment of oral conditions. A committee of experts was created to evaluate all the steps of the process, right from the original version, through to the final one. The steps were: initial translation into Portuguese language by two Spanish teachers, backtranslation into Spanish by two native Spanish speaking, review by the committee, and pre-test. For the pre-test of cross-cultural adaptation, the alternative "did not understand" was added to each item of the tool. The instrument was applied to a sample of 20 adults. Results: In the initial translation, some differences were observed between the translated versions, and after the committee had reviewed these versions, a few words were replaced by other synonyms to enable better understanding of the instrument by the population. When the back-translation was compared with the original version, the results were very satisfactory and there was no need to make any further change or replacement. In the pre-test, the version of the tool Oral Health Literacy Assessment-Brazilian (OHLA-B) was very well understood by the studied population and there was no need for other cultural adaptations. Conclusion: OHLA-B proved to be easily understood by Brazilian adults and could be an important tool for measuring levels of oral health literacy.

Objective: to investigate the psychometric properties of the Brazilian Portuguese version of the health literacy questionnaire European Health Literacy Survey Questionnaire short-short form (HLS-EU-Q6) in Brazilian adults. Method: the instrument was translated and pre-tested in a sample of 50 individuals. Subsequently, it was applied to a sample of 783 adult individuals. The data went through an appropriate process of testing the properties, with the combination of techniques of Exploratory Factor Analysis, Confirmatory Factor Analysis and Item Response Theory. For the assessment of reliability, the Cronbach's alpha and McDonald's Omega indicators were used. Cross-validation with full data analysis was applied. Results: the majority of the participants was female (68.1%), with a mean age of 38.6 (sd=14.5) years old and 33.5% studied up to elementary school. The results indicated a unidimensional model with an explained variance of 71.23%, adequate factor load levels, commonality and item discrimination, as well as stability and replicability of the instrument to other populations. Conclusion: the Brazilian version of HLS-EU-Q6 indicated that the instrument is suitable for indiscriminate application in the population to which it is intended to assess health literacy levels.

This study aimed to investigate the association between Oral Health Literacy (OHL) and dental outcomes. A sample of 920 adults above 18 years of age living in areas covered by 10 Family Health Units (FHUs) in a large city in São Paulo state, Brazil, was included. OHL was assessed using the short-form Health Literacy in Dentistry Scale . Data on sociodemographic factors, oral health, and general health were obtained through a structured questionnaire. The investigated outcomes "tooth loss" and "reason for the last dental appointment" were evaluated using self-reported data. Simple logistic regression models were used to analyze the associations between each independent factor and outcomes. Factors that presented a significance level of ≤0.20 in the bivariate analysis were included in the hierarchical multiple logistic regression models. Participants with an education level up to high school, low OHL, and poor/fair self-rated oral health had 1.35 (95%CI, 1.01-1.80), 1.48 (95%CI, 1.12-1.95), and 1.46 (95%CI, 1.11-1.92) times more probability to report missing teeth, respectively. Adults from families with lower monthly income, low OHL, and poor/fair self-rated oral health had 1.70 (95%CI, 1.29-2.26), 1.89 (95%CI, 1.42-2.51), and 1.73 (95%CI, 1.30-2.30) times more chance, respectively, to have gone to the last dental appointment due to pain or caries. Adults with low OHL levels are more likely to have missing teeth and have gone to the last dental visit for pain, reinforcing the importance of OHL as an important determinant for promoting oral health.