Training and calibration of interviewers for oral health literacy using the BREALD-30 in epidemiological studies

Abstract

The objective of this study was to describe an interviewer training and calibration method to evaluate oral health literacy using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) in epidemiological studies. An experienced researcher (gold standard) conducted all training sessions. The interviewer training and calibration sessions included three different phases: theoretical training, practical training, and calibration. In the calibration phase, six interviewers (dentists) independently assessed 15 videos of individuals who had different levels of oral health literacy. Accuracy and reproducibility were evaluated using the kappa coefficient and the intraclass correlation coefficient (ICC). The percentage of agreement for each word in the instrument was also calculated. After training, the kappa values were higher than 0.911 and 0.893 for intra-and inter-rater agreement, respectively. When the results were analyzed separately for the different levels of literacy, the lowest agreement rate was found when evaluating the videos of individuals with low literacy (K = 0.871), but still within the range considered to be near-perfect agreement. The ICC values were higher than 0.990 and 0.975 for intra-and inter-rater agreement, respectively. The lowest percentage of agreement was 86.6% for the word "hipoplasia" (hypoplasia). This interviewer training and calibration method proved to be feasible and effective. Therefore, it can be used as a methodological tool in studies assessing oral health literacy using the BREALD-30.

The impact of oral health literacy and family cohesion on dental caries in early adolescence

“…The same individuals were re‐examined after 7 days for the determination of interexaminer and intra‐examiner agreement, using the Kappa statistic (K = 0.89‐0.90 and 0.88‐0.90, respectively). The training for the administration of the BREALD‐30 was conducted in three steps . First, a theoretical course on the instrument was provided; this was followed by practical training and a calibration phase involving 15 videos of individuals with different levels of OHL.…”

Impact of oral health literacy on self‐reported missing data in epidemiological research

“…The Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD‐30) was administered by a single examiner who had undergone a training exercise. The calibration consisted of four steps according to a previously published guideline . Following theoretical training, a set of 15 videos of adults who had answered the BREALD‐30 and demonstrated different degrees of OHL was used.…”

“…The participant read each word aloud for the interviewer, who scored one point for correct pronunciation or no point when the word was pronounced incorrectly. Pronunciation errors occurred in the following situations: replacement with similar word; irregular words read as regular; replacing, omitting or adding letters; failure to use matching rules; failure to recognize the stresses syllable and reading without rhythm or word repetitions . The final score was obtained by summing the score of each word, which could range from zero to 30.…”

“…replacing, omitting or adding letters; failure to use matching rules; failure to recognize the stresses syllable and reading without rhythm or word repetitions. 20 The final score was obtained by summing the score of each word, which could range from zero to 30. Higher scores characterized higher parental OHL level.…”

Caregiver’s oral health literacy is associated with prevalence of untreated dental caries in preschool children

“…The BREALD-30 was administered by a single examiner who had undergone a training exercise and was blinded to the clinical findings. After theoretical training, a set of 15 videos of adults who answered the BREALD-30 and demonstrated different degrees of OHL was used 19 . The gold standard in this calibration exercise was a researcher from the team that validated the questionnaire for use in Brazil.…”