The utility of network analysis in the context of Indigenous Australian oral health literacy

Abstract

Background The study of oral health literacy (OHL) is likely to gain new and interesting insights with the use of network analysis, a powerful analytical tool that allows the investigation of complex systems of relationships. Our aim was to investigate the relationships between oral health literacy and oral health-related factors in a sample of Indigenous Australian adults using a network analysis approach. Methods Data from 400 Indigenous Australian adults was used to estimate four regularised partial correlation networks. Initially, a network with the 14 items of the Health Literacy in Dentistry scale (HeLD-14) was estimated. In a second step, psychosocial, sociodemographic and oral health-related factors were included in the network. Finally, two networks were estimated for participants with high and low oral health literacy. Participants were categorised into 'high' or 'low' OHL networks based on a median split. Centrality measures, clustering coefficients, network stability, and edge accuracy were evaluated. A permutation-based test was used to test differences between networks. Results Solid connections among HeLD-14 items followed the structure of theoretical domains across all networks. Oral health-related self-efficacy, sporting activities, and self-rated oral health status were the strongest positively associated nodes with items of the HeLD-14 scale. HeLD-14 items were the four most central nodes in both HeLD-14 + covariates network and high OHL network, but not in the low OHL network. Differences between high and low OHL models were observed in terms of overall network structure, edge weight, and clustering coefficient. Conclusion Network models captured the dynamic relationships between oral health literacy and psychosocial, sociodemographic and oral health-related factors. Discussion on the implications

A psychometric network perspective to oral health literacy: Examining the replicability of network properties across the general community and older adults from Brazil

“…In line with our results, a previous study found a consistent pattern of strong item conditional associations within HeLD-14 theoretical domains. [32] Nevertheless, the findings of this study demonstrate that the Brazilian version of the HeLD-14 presents a slightly distinct structure to the originally proposed 7-factor composition. [32] The different number of dimensions is likely to result from measuring attributes of the Brazilian version of the instrument or cultural aspects related to how these constructs (most specifically Utilization and Communication) are understood by this population.…”

Exploratory Graph Analysis of the Strengths and Difficulties Questionnaire for Aboriginal and/or Torres Strait Islander Children

“…On the other hand, a network model assumes the reciprocally reinforcing causal relations between the behaviors of fighting, lying, stealing, losing temper, and disobeying of children that can be labeled as "conduct problems" (Borsboom and Cramer, 2013). Network models seem particularly suitable to understand SEWB among Indigenous people as their wellbeing is holistic (Kendall et al, 2019) and influenced by a complex interplay of structural, contextual, and individual factors, such as colonization, historical trauma, resilience, and discrimination (Soares et al, 2020). For instance, previous studies have emphasized the importance of network models to describe the health of Aboriginal and/or Torres Strait Islander by comparing the unique causal components of a psychological network (nodes) and their associations (edges) with Aboriginal and/or Torres Strait Islanders most distinctive art style, dot painting (Soares et al, 2021).…”

Chronic disease health literacy in First Nations people: A mixed methods study

“…While Australia has reported the nation's health literacy in 2006 and 2018 (Australian Bureau of Statistics [ABS], 2008; 2018), different methods were used on each occasion with the most recent results, indicating that those with chronic diseases had lower health literacy abilities and were also less engaged with the healthcare system. Previous Australian studies have examined First Nations people's health literacy in dental care (Parker et al, 2012; Soares et al, 2020), men's health (Smith et al, 2020), cancer care (Treloar et al, 2013), chronic disease (de‐identified for review) and primary health care (Lakhan et al, 2017). Four of these studies assessed only functional health literacy (Lakhan et al, 2017; Parker et al, 2012; Soares et al, 2020) while three studies explored First Nations people's health literacy qualitatively (Rheault et al, 2021; Smith et al, 2020; Treloar et al, 2013 (de‐identified for review)), indicating that communication with healthcare providers is problematic.…”

“…Previous Australian studies have examined First Nations people's health literacy in dental care (Parker et al, 2012; Soares et al, 2020), men's health (Smith et al, 2020), cancer care (Treloar et al, 2013), chronic disease (de‐identified for review) and primary health care (Lakhan et al, 2017). Four of these studies assessed only functional health literacy (Lakhan et al, 2017; Parker et al, 2012; Soares et al, 2020) while three studies explored First Nations people's health literacy qualitatively (Rheault et al, 2021; Smith et al, 2020; Treloar et al, 2013 (de‐identified for review)), indicating that communication with healthcare providers is problematic. Greater understanding of the multidimensional health literacy capabilities of First Nations people is urgently needed particularly in the context of chronic disease.…”