Measuring oral health literacy: a scoping review of existing tools

Abstract

BackgroundThis article presents findings from a scoping review of tools used to measure oral health literacy. Internationally, interest in oral health literacy is driven by oral health disparities, particularly for disadvantaged groups, with conditions such as dental caries and periodontal disease contributing substantially to the global burden of disease. The increasing focus on measuring oral health literacy aligns with reasons for measuring broader health literacy, that is, by assessing oral health literacy, decisions can be made about instigating interventions at policy and practice level to improve individual and population level oral health. There are numerous tools available that measure oral health literacy using a range of indicators.MethodsA scoping review was designed to map the existing tools designed to measure oral health literacy (OHL). Key search terms were developed and mapped. Selected databases were used that identified 32 relevant studies reporting a range of OHL tools.ResultsWe identified 32 articles that reported a range of oral health literacy tools. Many of the studies used the Rapid Estimate of Adult Literacy in Dentistry (REALD) and/or the Test of Functional Health Literacy in Dentistry (ToFHLiD) that were developed from earlier tools designed to measure broader health literacy. These tools have been widely criticised for providing only an approximate measure of OHL based mainly on word recognition. A number of newer tools have included new measures of oral health literacy including numeracy and oral health conceptual knowledge however tools that measure important indicators of oral health literacy such as service navigation are rare.ConclusionsFindings from this scoping exercise confirm our findings from preliminary scans that the majority of tools are heavily biased towards word recognition, numeracy and reading skills, rather than what this means in terms of health behaviours and service utilisation. More recent developments have attempted to incorporate other aspects considered important, including decision making and service navigation. The incorporation of these aspects into newer tools will provide oral health researchers and policy makers with further evidence of the importance of oral health literacy when designing interventions to improve oral health.

Validation of the Health Literacy in Dentistry scale in Brazilian adults

“…Our sample was considered large enough to test the two versions of HeLD, and of moderate size compared with previous validation studies of oral health literacy instruments. In addition, participants were recruited from settings (homes and public health services) other than the dental clinics of schools of dentistry, which are generally used in oral health literacy instrument‐validation studies. This fact contributed to generalisibility of the findings because PHUs are located in all districts of the municipality, covering almost the entire population.…”

“…In the Brazilian context, until the writing of this article, only three instruments were adapted and validated to measure oral health literacy: the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD‐30); the 20‐item Rapid Estimate Adult Literacy in Medicine and Dentistry (REALMD‐20); and the Brazilian version of the Oral Health Literacy Assessment in Spanish. Despite some advantages, including being quick and easy to apply, these instruments provide only a narrow measure of oral health literacy, namely functional health literacy, and consequently fail to measure other important constructs, such as personal competences to navigate health systems and effective individual, social and political skills necessary to improve personal oral health.…”

The value of a combined word recognition and knowledge measure to understand characteristics of our patients’ oral health literacy

“…The studies within the review were all cross‐sectional in nature, and the review confined itself to the efficacy and characteristics of the instruments and did not discuss their association with sociodemographic characteristics and/or dental health. A scoping review conducted to map the existing oral HL tools since 2007 concluded that, while the preponderance of tools was based on either word recognition, numeracy or reading skills, a variety of newer composite measures had been created to assess listening, knowledge, communication and decision‐making. Further, a few were developed for specific groups, such as specific populations by country (eg the Hong Kong REALD‐30), for vulnerable populations (eg the HeLD) or as a screening instrument that could be used for patients attending medical and dental clinics (eg REALMD‐20) …”

Parental Oral Health Literacy and Child Oral Health Impact Profile among 15-year-old Schoolchildren in Davangere City, Karnataka, India

“…The development and evaluation of the HeLD-14 have been described previously. 8,9 Efforts have been made to develop a measure of OHRQoL that would be appropriate for use with children. The COHIP is a measure of the impact of the oral health, functional well-being, social/emotional wellbeing, school environment, and self-image.…”

“…The questionnaire used for parents to assess their OHL 8,9 and for children to assess their OHRQoL 7 was previously validated by piloting, and the appropriate changes have been made before it was finalized for the study. The list of schools obtained from the District Education Office showed that the city is divided into north and south zones.…”