A Psychometric Network Analysis of OHIP-14 across Australian and Brazilian Populations

Abstract

Objectives: The aim of this study was to assess the structural validity of the Oral Health Impact Profile–14 (OHIP-14) instrument in Indigenous and non-Indigenous populations from Australia and Brazil using a network analysis approach. Methods: Cross-sectional data collected using OHIP-14 were obtained for Indigenous and non-Indigenous populations from Australia and Brazil. Networks were estimated using the Gaussian graphical model. Items of the OHIP-14 instrument are represented as nodes and the partial correlations between items as edges. Dimensionality was assessed using exploratory graph analysis. Structural consistency and item stability were computed using a bootstrap sampling method. Standardized node strength across each dimension was also calculated. Results: Four dimensions were identified across all samples, although the item arrangement of most dimensions presented variation. Similarities with the theoretical domains of the instrument were found. Items from the conceptually derived OHIP-14 domains formed separated clusters or blended with other items in a single dimension. Most dimensions across all samples showed an acceptable structural consistency. Item stability revealed some discrepancies among items of dimensions of both Indigenous networks. Conclusion: The psychometric network perspective adopted in this study provides validation of the OHIP-14 structure in Indigenous and non-Indigenous populations. The structural consistency and item stability analyses showed that both Indigenous networks present a higher number of cross-domain items and less defined boundaries between dimensions. These findings indicate that OHIP-14 does not measure attributes in the same extent among different cultures. Knowledge Transfer Statement This study demonstrates a new analytical framework from which to conceptualize and interpret the construct oral health–related quality of life using the Oral Health Impact Profile (OHIP-14). Network graphs facilitate knowledge translation of findings to professionals with no expertise in psychometric methods. OHIP-14 is a valuable tool to oral health research and clinical practice. Differences in conceptions of health may influence the extent that the instrument measures oral health impacts. Consequently, dimension scores do not always provide appropriate measures and should be avoided in research reports and assessments of treatment outcomes.

The impact of interpersonal racism on oral health related quality of life among Indigenous South Australians: a cross-sectional study

“…The following three items evaluated the frequency with which problems with teeth, dentures or gums produced varying levels of psychological discomfort (uncomfortable at work, school or in social situations), functional limitation (not able to eat some foods or had to eat them slowly), and social disability (missed work, school or took time away from normal activities) (Additional file 1: Tables S1 and S2). This tool has been validated among Indigenous and non-Indigenous Australians [34]. We defined the dependent variable 'poor OHRQoL' as the presence of one or more OHIP-14 items rated 'very often' or 'fairly often' [35].…”

Use of Oral Health Impact Profile-14 (OHIP-14) in Different Contexts. What Is Being Measured?

“…This study presented results regarding how OHIP-14 works in samples of dental patients and non-dental patients in two different countries. Although previous studies have sought information regarding both the dimensionality (factorial structure) of the OHIP and its fit to data from different samples [2,13,15,16,18], this topic is still relevant for the following reasons. First, despite wide use of the OHIP-14, evaluation of the validity of the data obtained has often been neglected.…”

“…Convenience sampling can be considered as a limitation of this study. This type of sampling is, however, commonly used in observational studies that aim to estimate the psychometric properties of measurement instruments in different samples/contexts [10,13,15,18]. The use of a sample of dental patients in general, without specifying a clinical condition, can also be considered a limitation since, as previously mentioned, the clinical condition can affect how the instrument works.…”

“…Since its publication, the OHIP-14 has been translated and adapted into different languages [10][11][12][13][14]. It has also been widely applied in different samples and contexts different from those in which the instrument was proposed and evaluated, for example, in the general population (non-patient) [12,13,15], young orthodontic patients [11], indigenous population [15] and postpartum women [10,16].…”

“…Although two studies, one using a sample of the general population of British adults [17] and the other Brazilian dental patients [18], confirmed the adequacy of the original factorial structure of OHIP-14, other studies have refuted that OHIP (full or shortened version) has this factorial structure [12,13,15,16,19]. Montero et al [13] found a trifactorial structure of the OHIP (psychosocial impacts, pain-discomfort and functional limitation) in a sample of Spanish workers who were undergoing routine medical examinations at an employment risk prevention center.…”