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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 469-474

Validation of Hindi version of oral health impact profile-14 for adults


1 Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
2 Department of Public Health Dentistry, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
3 Department of Oral Medicine and Radiology, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Vikram Pal Aggarwal
Department of Public Health Dentistry, Surendra Dental College and Research Institute, Sri Ganganagar, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171180

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  Abstract 

Introduction: Oral health has an impact on overall general health. It is important to assess the influence of these oral disorders on quality of life. Aim: To validate a Hindi version of the oral health impact profile-14 (OHIP-14) and to assess the instrument's psychometric properties in the Indian population. Materials and Methods: A cross-sectional study was performed in Moradabad city with a sample of 186 participants. The same individuals underwent clinical examinations by a calibrated dentist for recording simplified oral hygiene index (OHI-S) index. The OHIP was initially translated and cross-culturally adapted to Hindi following guidelines; then, subsequently validated for the psychometric characteristics of reliability and validity. The reliability of the OHIP-14 was assessed by the use of Cronbach's coefficient. Reproducibility was evaluated by measuring test-retest reliability (intraclass correlation coefficient). Results: The overall value of Cronbach's alpha (α) coefficient of the OHIP-14 was estimated to be 0.8. The corrected item-total correlation coefficients values were above 0.2 that has been recommended for including an item in a scale. All Spearman's rank correlation coefficients were statistically significant, whereas the highest association was detected within the physical disability subscale (rs = 0.37), and the lowest within the social disability (rs = 0.08). It was seen that the OHIP-14 scores were higher for those individuals who had higher OHI-S scores and vice-versa. Conclusion: The translated Hindi version of OHIP-14 questionnaire is a reliable and valid instrument to measure the oral health-related quality of life in the Indian adult population.

Keywords: Hindi, oral health, quality of life, validity


How to cite this article:
Batra M, Aggarwal VP, Shah AF, Gupta M. Validation of Hindi version of oral health impact profile-14 for adults. J Indian Assoc Public Health Dent 2015;13:469-74

How to cite this URL:
Batra M, Aggarwal VP, Shah AF, Gupta M. Validation of Hindi version of oral health impact profile-14 for adults. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Jul 17];13:469-74. Available from: http://www.jiaphd.org/text.asp?2015/13/4/469/171180


  Introduction Top


A patient-based assessment of health status is essential to the measurement of health.[1] While most oral diseases are not fatal, they do lead to significant morbidity, which ends up in serious physical, social, and psychological consequences that affect the patients' quality of life.[2]

Measurement of the impact of oral conditions on quality of life should be part of the evaluation of oral health needs because clinical indicators alone cannot describe the satisfaction or symptoms of dental patients or their ability to perform daily activities.[3] Over the last 20 years, several researchers have developed specific instruments aimed at the measurement of oral health [4] and its impact on the individual's quality of life.[5] Among these, the oral health impact profile (OHIP) is one of the most widely used with demonstrable psychometric properties. The original version of the OHIP-49 included 49 items based on a theoretical model developed by the World Health Organization (WHO) and adapted for oral health by Locker [6] but was too long, and therefore, Slade [7] developed a shorter version of 14-item version called as OHIP-14. It is a 14-items questionnaire designed to measure self-reported functional limitation, discomfort, and disability attributed to oral conditions.

The OHIP-14 was originally developed in English for English-speaking population. Therefore, when used in a non-English-speaking country that is culturally different, it should be translated and validated to ensure its proper use.[8] Several language versions of OHIP-14 already exist, for example, in German, Swedish, Hebrew, Chinese, and Scottish. The different versions of this scale have shown to be a valid and reliable instrument to assess Oral health-related quality of life (OHRQoL) in the respective populations.[9],[10],[11],[12],[13] The OHIP also has been applied to Sinhalese, Japanese, and Korean elderly.[8],[14],[15]

India has the second largest population of the world with Hindi being its national language. It is the fourth largest [16] spoken language in the world. Previously, Indian researchers have used OHIP-14 to assess the oral health impact on quality of life among various sets of the population, but they have taken the English version or had used translated version without validation of the instrument, in their research.[17] Therefore, the aim of this study was to validate a Hindi version of the OHIP-14 and to assess the instrument's psychometric properties in the Indian population.


  Materials and Methods Top


The study was conducted in Moradabad city, Uttar Pradesh state, India. The ethical clearance was obtained from the Research and the Ethics Committee of the dental institution, Moradabad. The evaluation process was conducted first by performing the translation to Hindi, followed by pilot study and finally, the main study was conducted.

Oral health impact profile-14 questionnaire

The OHIP-14 is a self-filled questionnaire that focuses on 7 dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) with participants being asked to respond according to frequency of impact on a 5-point Likert scale coded never (score 0), hardly ever (score 1), occasionally (score 2), fairly often (score 3), and very often (score 4) using a 12-month recall period.

Participants answered and provided information on demographic, dental utilization; socioeconomic status according to Kuppuswamy classification;[18] and self-reported oral health as well as satisfaction with dental services. Oral health was evaluated in an ordinal scale on the basis of the question: "How would you rate your oral health?" and three possible responses ranging from "good," "fair," to "poor." Satisfaction was also evaluated with the question: "Are you satisfied with your oral health status?" and two possible responses "satisfied or dissatisfied."[19] The same individuals underwent clinical examinations by a calibrated dentist for recording Simplified Oral Hygiene Index (OHI-S) index [20] using artificial light, mouth mirror and a number 5 explorer (Shepherd's hook).

Hindi translation

The OHIP-14 was linguistically and culturally adapted to our setting by using the back translation technique [21] in order to maintain cross-cultural equivalence. In this procedure, translations were independently made by two bilingual dentists, who then discussed and produced a consensus Hindi version which was translated back into English by a professional English native translator who had never seen the original version. These three copies (original English, Hindi, and back translated English copies) were assessed by two public health dentists. The contraindications and inconsistencies between the back-translated (OHIP-14 Hindi) and the original version were compared and corrected, and making sure that the translation was conceptually equivalent to the original version. The final OHIP-14 Hindi was used for the pilot study.

The pilot study was conducted on a convenience sample (n = 48) obtained from patients and their companions who came to the Dental College and Research Centre for an oral check-up. Participants were clinically examined according to the WHO methodology (1997)[22] and completed the pilot OHIP-14 Hindi. The comprehensiveness of the instrument was tested by asking about difficulties in understanding items or frequencies, in order to optimize the face and content validity before the main study.

A cross-sectional, epidemiological study was performed in Moradabad city during March–April 2012. A consecutive sample of 186 participants with mean age of 38 ± 2.4 years who attended the dental screening camps organized by Dental College and Research Centre were invited to take part in this study. All participants Were briefed of the purpose and process of the study and informed written consent was obtained. Individuals seeking dental treatment or diagnosis for acute dental problems were excluded.

OHRQoL data were gathered by using the piloted OHIP14 Hindi, which was self-administered and completed in the waiting room and after the oral examination was conducted in camp by a trained and calibrated examiner.

Scoring method

Using the additive method, the total score of the OHIP-14 was calculated by summing up the responses for the 14 items. The values of OHIP score ranged from 0 to 56, with higher scores indicating lower OHRQoL.

Statistical analysis was conducted by means of the Statistical Package for Social Sciences (SPSS) Version 20 (Armonk, NY:IBM Corp). The psychometric properties of OHIP-14 were further tested via reliability and validity tests. Level of significance was set at P ≤ 0.05 (95% confidence interval).

Reliability

The reliability of the OHIP-14 (i.e., the internal consistency and homogeneity) was assessed using Cronbach's coefficient. By removing one item at a time, a lower value than the original for the OHIP-14 instrument should be obtained, supporting in this way the hypothesis that all 14 items should be included. Reproducibility was evaluated by measuring test-retest reliability. It was calculated using intraclass correlation coefficient.

Construct validity

Discriminant and convergent validity were used to evaluate a construct validity of the instrument. A relationship between the OHIP-14 total score and participants' oral health status was assessed by correlation matrix. Discriminant validity was evaluated by comparing the OHIP-14 scores between different groups with objectively assessed dental status. The main assumption was that adolescents with low oral health status would correspond to lower levels of OHRQoL and higher OHIP-14 scores. The statistical significance of the differences in oral health and OHIP-14 scores were assessed using the nonparametric tests–Mann–Whitney U-test and Kruskal–Wallis test. Spearman's correlation coefficient (rs) was further used to examine convergent validity of OHIP-14 by examining the association of OHIP-14 total score and each domain score with the self-perceived oral health status and the self-assessment of oral satisfaction.


  Results Top


According to the data collected from the sociodemographic profile, 63% were males among the 186 respondents. Analyzing the socioeconomic division of respondents showed that 72.67% of the patients belong to middle- and lower-socioeconomic class while upper socioeconomic class was reported only in 27.33% of the respondents. It was observed that 20.97% of the respondents were illiterate, and 44.71% had at least secondary education. The dental utilization rate among respondents was mere 20.43%.

The overall value of Cronbach's alpha (α) coefficient of the OHIP-14 was estimated to be 0.8, indicating good internal consistency [Table 1]. The exclusion of one of the 14 items from the list resulted in lower alpha value supporting the hypothesis that all 14 items should be included. The degree of homogeneity within the seven subscales varied from poor to satisfactory and the alpha values for the different subscales ranged from 0.1 (psychological discomfort) to 0.7 (physical and psychological disability). The homogeneity of the scale was evaluated on the basis of the corrected item-total correlation coefficients. These analyses computed the correlation between each individual item in the scale and the rest of the scale with the item of interest eliminated. The corrected item-total correlation coefficients values were above 0.2 that has been recommended for including an item in a scale.
Table 1: Corrected item-scale correlations and Cronbach's alpha values if item deleted

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[Table 2] illustrates the pattern of inter-item correlations between all items. More particularly, the inter-item correlation coefficients ranged from − 0.02 (between item 10 and item 3) to 0.65 (between item 14 and item 7). On the subjective evaluation of the oral health status, 52.69% stated "good' oral health, followed by 34.95% reporting "fair," and another 12.37% describing their oral health as "poor." As far as oral health satisfaction was concerned, 60.75% of the interviewees reported that they were satisfied with their oral health and the remaining 39.25% as not satisfied.
Table 2: Reliability analysis: OHIP-14 inter-item correlation in the study group

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The convergent validity of the OHIP-14 showed that as the participants' perceived oral health status was improved from poor to good, both the mean OHIP total score and the subscales scores were improved too, with the most and the least affected sub-scales being the physical pain 3.26 (±1.8) and psychological and social disability, with mean values of 1.16 (±1.3) and 0.89 (±1.7), respectively [Table 3].
Table 3: Convergent validity of the OHIP-14: Mean scores and Spearman's rank correlation coefficients (rs) among the OHIP-14 and subscale scores and self-perceived oral health status

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All the Spearman's rank correlation coefficients were positive and statistically significant, whereas the highest association was detected within the physical disability subscale (rs = 0.37), and the lowest within the social disability (rs = 0.08). There was high correlation between the examined oral health status and the OHI-S scores. The OHI-S scores for each individual was noted down and correlated with the OHIP-14 scores. It was seen that the OHIP-14 scores were higher for those individuals who had higher OHI-S scores and vice-versa.


  Discussion Top


The aim of this study was the cultural and linguistic adaptation of the OHIP-14 instrument into India and its validation. A suitable instrument to measure the OHRQoL in the Indian population was needed since a very long time. Since, the English version of OHIP-14 would not have been locally effective to administer; hence, a translation and validation of the existing OHIP-14 was carried out into Hindi language. As far as the authors' knowledge and according to the literature search, the present research was conducted on larger sample than the previous study [23] to validate the Hindi version of OHIP-14 instrument.

Intercultural process of adaptation of OHIP-14 from English into Hindi language was simple, and the comparison between the original OHIP-14 and translated English version did not create differences in meaning or context. For any instrument to be effective, its reliability should be very high. The reliability for these instruments is generally measured in terms of Cronbach's alpha. In this case, we obtained a high Cronbach's alpha value of 0.83. According to Nunnally and Bernstein,[24] the standard criteria for reliability should have a minimum value of Cronbach's alpha as 0.7. The value of Cronbach's alpha did not rise more than 0.84 even when any of the 14 items was deleted from the instrument. This signifies that the consistency of the questions in the instrument had good uniformity. Another significant consideration for including any item in the scale is that the minimum corrected item-total correlation coefficient should be 0.20. The corrected item-total correlation coefficients, in this case, had a range from 0.50 to 0.67 which indicated a very satisfactory homogeneity and justified the inclusion of the items in the scale. There was high correlation between the OHIP-14 scores and OHI-S scores. Individuals in whom the OHI-S scores were high had higher OHIP-14 scores and vice-versa. This correlation, therefore, supports the construct validity of the instrument.

Mean total score of the OHIP-14 in the present study was higher than that of previous studies,[25],[26],[27] indicating the problems or particular needs for dental treatment. All researchers have agreed with the approach that physical disability, functional limitations, and psychological discomfort have the highest correlation with oral health and an important impact in adolescent quality of life.[25],[27]

In our investigation, the values of OHIP Cronbach's alpha coefficient had a range of 0.78–0.84 for the seven subscales which were higher than the values obtained from the other [9],[11],[13] versions. Inter-item and item-total correlations were also good enough to support the internal consistency of the instrument. In particular, although inter-item correlations varied from −0.01 to 0.65, none was high enough for any item to be redundant while the item-total correlations coefficients were above a recommended threshold for including an item in a scale.[27] Similar results have been observed in studies evaluating the reliability of the instrument among adolescents.[26],[28]

Statistically significant associations were found between questions aiming to subjectively evaluate individuals' oral health status (such as self-perceived oral health status and self-assessment of oral satisfaction) and OHIP scores. The finding that higher the OHIP-14 total and the subscale scores, the more diminished OHRQoL, and thus, the poorer the perceived oral health status and satisfaction, provided further evidence of the instrument's construct validity. The capability of the index to detect people with problems out of a small sample makes it a very sensitive instrument.

Limitations

The population in the present study was obtained by convenience sampling the female to male ratio was 63–27%, respectively and thus, the proportion not necessarily represents the actual ratio between females and males. For having a proper representation of gender and other confounding factors, more robust sampling technique is advocated.

Recommendations

It is suggested that further there is a need to implement longitudinal studies to increase the degree of evidence and assess the sensitivity of the OHIP-14 Hindi version to detect changes in OHRQoL.


  Conclusion Top


The translated Hindi version of the OHIP-14 questionnaire is a reliable and valid instrument to measure the OHRQoL in the Indian adult population. Further studies on the OHRQoL in the Indian population may be carried out using Hindi translated version of the OHIP-14 instrument.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3]


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