Issues in measuring change in self-perceived oral health status

Abstract

An important goal of a health care intervention or system is to improve the health of an individual or a population. The challenge for health services research is to measure and explain this change. However, the issue of how changes in health status should be defined and measured has been given relatively little attention. This paper draws on the rather sparse literature to examine some issues involved in measuring changes in oral health status and illustrates these using data from a longitudinal study of the oral health of older adults. The paper draws a distinction between quantitative and qualitative change and the challenges involved with each. Four different ways of assessing change are reviewed and their strengths and weaknesses highlighted. Global transition judgements, although relatively simple measures of change, incorporate patients' values and avoid the statistical problems associated with measures such as change scores. Nevertheless, the measurement of change in oral health status is complex and controversial and no approach is universally accepted. Consequently, the decision as to which strategy to adopt is far from simple.

Oral health-related quality of life of children in relation to dental appearance and educational transition

“…35 It should also be recognised that the examination of before and after scores alone does not provide information about the number of children who experienced an improvement in their OHRQoL or answer questions related to the magnitude or meaningfulness of these changes. 31,36 If it is, however, to be accepted that the measure has reliably assessed a true change in children's OHRQoL, then the examination of the CPQ subscales allows exploration of other possible explanations for this apparent improvement in OHRQoL. The finding that children's emotional wellbeing improved following educational The CPQ measure used to assess OHRQoL has been criticised for solely focusing on the frequency of impacts on children's oral health and well-being.…”

The effectiveness of out-of-hours dental services: I. pain relief and oral health outcome

“…However, the test-retest reliability of a similar VAS-based transition question was assessed and found to be good in a study of out-of-hours medical care (although after the acute phase of the presenting problem), 7 and the value of transition judgements is acknowledged by a recent review in the dental field. 25 Ultimately the validity of transition questions hinges on how accurately people can recall their level of dental pain or health status at some point in the past, and this may be distorted by a number of factors. 28 Lastly there is evidence about the validity of using VAS for measuring dental pain 30,31 and their suitability for measuring change in acute pain states has been demonstrated in other contexts, 32 but the use of visual analogue scales remains controversial.…”

Perceived need for and utilization of dental care in Indonesia in 2006 and 2007: a secondary analysis

“…In other words, the need for professional care and the effectiveness of interventions will be revealed by studies that utilize both. The subjective measures assessed herein can themselves be interpreted as indicators of need that complement conventional clinical measures for the need for dental care (16).…”

“…Despite the doubts expressed about single-item assessments of change, these assessments possess a number of distinct advantages. They are simple, clear, and relatively easy to use than complex questionnaires, especially in cases in which administration and clinical scoring are not feasible and brevity is essential (16). Given the current economic situation in Indonesia, single-item indicators of dental health, like the one provided annually by the Susenas, provide benefits to the policy-maker seeking to monitor and evaluate dental health needs and utilization, and also to researchers seeking to identify the determinants of dental health and track levels of risk factors.…”