Developing a new self-reported scale of oral health outcomes for 5-year-old children (SOHO-5)

Abstract

BackgroundInformation on the impact of oral health on quality of life of children younger than 8 years is mostly based on parental reports, as methodological and conceptual challenges have hindered the development of relevant validated self-reported measures. This study aimed to develop and assess the reliability and validity of a new self-reported oral health related quality of life measure, the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), in the UK.MethodsA cross-sectional study of two phases. First, consultation focus groups (CFGs) with parents of 5-year-olds and review by experts informed the development of the SOHO-5 questionnaire. The second phase assessed its reliability and validity on a sample of grade 1 (5-year-old) primary schoolchildren in the Greater Glasgow and Clyde area, Scotland. Data were linked to available clinical oral health information and analysis involved associations of SOHO-5 with subjective and clinical outcomes.ResultsCFGs identified eating, drinking, appearance, sleeping, smiling, and socialising as the key oral impacts at this age. 332 children participated in the main study and for 296 (55% girls, mean d3mft: 1.3) clinical data were available. Overall, 49.0% reported at least one oral impact on their daily life. The most prevalent impacts were difficulty eating (28.7%), difficulty sleeping (18.5%), avoiding smiling due to toothache (14.9%) and avoiding smiling due to appearance (12.5%). The questionnaire was quick to administer, with very good comprehension levels. Cronbach’s alpha was 0.74 and item-total correlation coefficients ranged between 0.30 and 0.60, demonstrating the internal consistency of the new measure. For validity, SOHO-5 scores were significantly associated with different subjective oral health outcomes (current toothache, toothache lifetime experience, satisfaction with teeth, presence of oral cavities) and an aggregate measure of clinical and subjective oral health outcomes. The new measure also discriminated between different clinical groups in relation to active caries, pulp involvement, and dental sepsis.ConclusionsThis is the first study to develop and validate a self-reported oral health related quality of life measure for 5-year-old children. Initial reliability and validity findings were very satisfactory. SOHO-5 can be a useful tool in clinical studies and public health programs.

Parental influence on children’s answers to an oral-health-related quality of life questionnaire

“…7,9 Moreover, children have demonstrated the ability to understand the questionnaire appropriately. 4 The present results show that the answers of children on the SOHO-5 were not influenced by the presence of their parents/guardians. Although parenting styles are a result of a parent's attitudes, beliefs and behaviors, and establish the emotional context for the child, 20 the mean SOHO-5 total and item scores did not differ significantly when the children were alone or accompanied.…”

“…However, the development of OHRQoL measures for young children is challenging, due to their limited cognitive and emotional development and to social contexts. 3,4 There are few OHRQoL measures for preschool children. 4,5 The relatively limited research in this respect is a consequence of conceptual Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.…”

“…Thus, parental proxy reports may offer a different perception, but should not be used alone, without the self-reports of children. 4,8 Studies involving the SOHO-5 that evaluate the perception of parents/guardians and children have demonstrated that five-year-old children are capable of providing their own perceptions regarding their OHRQoL. 4,7,9,10,11 However, their comprehension is dependent on social, emotional, cognitive and linguistic development.…”

“…4,8 Studies involving the SOHO-5 that evaluate the perception of parents/guardians and children have demonstrated that five-year-old children are capable of providing their own perceptions regarding their OHRQoL. 4,7,9,10,11 However, their comprehension is dependent on social, emotional, cognitive and linguistic development. 12 Moreover, children in this age group are influenced by their parents/guardians, who are the main decision makers regarding healthcare issues.…”

“…Previous studies evaluating the perception of children regarding their OHRQoL have not clarified this issue. 4,7,9,10,11 The aim of the present study was to evaluate how the presence of parents/guardians influences the answers to an OHRQoL questionnaire directed at five-year-old preschool children.…”