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Validity of the FACT-H&N (v 4.0) among Malaysian oral cancer patients

Doss JG, Thomson WM, Drummond BK, Raja Latifah RJ

Oral Oncol, 2011 Jul;47(7):648-52.
PMID: 21602094 DOI: 10.1016/j.oraloncology.2011.04.023

To assess the cross-sectional construct validity of the Malay-translated and cross-culturally adapted FACT-H&N (v 4.0) for discriminative use in a sample of Malaysian oral cancer patients. A cross-sectional study of adults newly diagnosed with oral cancer. HRQOL data were collected using the FACT-H&N (v 4.0), a global question and a supplementary set of eight questions ('MAQ') obtained earlier in pilot work. Of the 76 participants (61.8% female; 23.7% younger than 50), most (96.1%) had oral squamous cell carcinoma; two-thirds were in Stages III or IV. At baseline, patients' mean FACT summary (FACT-G, FACT-H&N, FACT-H&N TOI, and FHNSI) and subscale (pwb, swb, ewb, fwb, and hnsc) scores were towards the higher end of the range. Equal proportions (36.8%) rated their overall HRQOL as 'good' or 'average'; fewer than one-quarter rated it as 'poor', and only two as 'very good'. All six FACT summary and most subscales had moderate-to-good internal consistency. For all summary scales, those with 'very poor/poor' self-rated HRQOL differed significantly from the 'good/very good' group. All FACT summary scales correlated strongly (r>0.75). Summary scales showed convergent validity (r>0.90) but little discriminant validity. The discriminant validity of the FHNSI improved with the addition of the MAQ. The FACT-H&N summary scales and most subscales demonstrated acceptable cross-sectional construct validity, reliability and discriminative ability, and thus appear appropriate for further use among Malaysian oral cancer patients.
Oral health promotion activities in the workplace: a scoping review

Bakri NN, Smith MB, Broadbent JM, Thomson WM

Health Promot Int, 2023 Jun 01;38(3).
PMID: 35425975 DOI: 10.1093/heapro/daac039

There is limited literature and no reviews on oral health promotion activities in the workplace to guide planning and practice. This review summarizes evidence about oral health promotion activities in the workplace (nature and extent), its impact and the factors that facilitate or act as barriers to implementation. Using the PRISMA-ScR guidelines, scientific articles written in English and published in peer-reviewed journals up to April 2021, from six databases (Medline, PubMed, CINAHL, Scopus, EMBASE and Emcare) were screened and selected. The full texts of 95 articles were then considered; 21 articles met the inclusion criteria of using oral health status or oral health predisposing factors as primary outcome after an intervention in the workplace. Almost all included articles took a quantitative approach (n = 18), two used a qualitative design and another used a mixed-method approach. The most common activities were personalized or group oral health education interventions and oral health screenings conducted by a dental professional. Two studies reported the cost-benefit of workplace oral health promotion (WOHP). The literature indicated that WOHP interventions can be successful in achieving improvements in oral health, measured using a range of clinical (plaque accumulation, gingival inflammation, periodontal inflammation) and self-rated oral health indicators. Based on the limited literature available, WOHP may have benefits for employee oral health and employers, and the support of managers and organizations potentially improves the success of programmes. The workplace would appear to be an ideal setting to promote oral health. However, there is limited information to guide oral health promotion planning and implementation, and policy.
Validation of an oral health-related quality of life measure for Cambodian children

Turton BJ, Thomson WM, Foster Page LA, Saub RB, Razak IA

Asia Pac J Public Health, 2015 Mar;27(2):NP2339-49.
PMID: 24097924 DOI: 10.1177/1010539513497786

This study aimed to determine the impact of dental caries in terms of Oral Health-Related Quality of Life (OHRQoL) for Cambodian children. The Child Perceptions Questionnaires (CPQ) were cross-culturally adapted and validated for the Cambodian population using a sample of 430 Cambodian children. The participants had a high caries burden, with a mean number of decayed-missing-and-filled deciduous tooth surfaces (dmfs) of 8.8 (SD = 11.1) and a mean DMFS of 3.7 (SD = 5.5) for the permanent dentition. Two in 5 children had at least one pulpally involved tooth. There was a significant difference in mean CPQ8-10 and CPQ11-14 scores by caries experience and by global item response for the respective age-groups, with those in the more severe caries categories scoring higher. Similar gradients were apparent with the CPQ11-14 in the 8- to 10-year age-group. The differences in OHRQoL scores by caries experience demonstrate the construct validity of the CPQ11-14 for the 8- to 14-year age-group.
Workplace oral health promotion activities among community-aged care workers: A qualitative exploration

Bakri NN, Ferguson CA, Majeed S, Thomson WM, Oda K, Bartlett S, et al.

Community Dent Oral Epidemiol, 2024 Aug;52(4):389-397.
PMID: 37950336 DOI: 10.1111/cdoe.12924

BACKGROUND: The workplace is an ideal-and priority-setting for health promotion activities. Developing and implementing workplace health promotion interventions, including oral health promotion activities, can help create health-supporting workplace environments.
OBJECTIVE: To pilot workplace oral health promotion activities among staff working in the aged care sector, report their impact and explore participants' views on the factors that contribute to participation and effectiveness.
METHODS: This study comprised three phases: (i) the development and face validation of the resources, (ii) a 3-h educational session and (iii) five interview sessions with participants 4-6 weeks following the education session. The recorded interviews were transcribed verbatim and analysed thematically.
RESULTS: Eleven community-aged care workforce were invited to five feedback sessions. Ten participants were female and ranged in age from 18 to 64. All participants gave favourable comments about the content and delivery of the training session and accompanying resources. The participants felt that the benefits of WOHP include improved staff knowledge, awareness and oral care routine, the ability to share (and put into practice) the gained knowledge and information with their dependants, a lower risk of having poor oral health that adversely affects their well-being and work tasks, and potentially beneficial impacts on the organization's staff roster. Their attendance in the WOHP was facilitated by being paid to attend and scheduling the sessions during work time. Future WOHP suggestions include the possibility of a one-stop dental check-up at the workplace or staff dental care discounts from local dental practitioners and combining oral health with other health promotion activities.
CONCLUSIONS: Planning and implementing WOHP was deemed acceptable and feasible in this study context and successfully achieved short-term impacts among community-aged care workers. Appropriate times and locations, organizational arrangements and a variety of delivery options contributed to successful programme planning and implementation.
Psychometric assessment of the short-form Child Perceptions Questionnaire: an international collaborative study

Thomson WM, Foster Page LA, Robinson PG, Do LG, Traebert J, Mohamed AR, et al.

Community Dent Oral Epidemiol, 2016 12;44(6):549-556.
PMID: 27477903 DOI: 10.1111/cdoe.12248

OBJECTIVE: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ11-14 ) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts.
METHODS: Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ11-14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted.
RESULTS: Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings.
CONCLUSION: The CPQ11-14 performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy.
Fulltext Structural Determinants and Children's Oral Health: A Cross-National Study

Baker SR, Foster Page L, Thomson WM, Broomhead T, Bekes K, Benson PE, et al.

J Dent Res, 2018 09;97(10):1129-1136.
PMID: 29608864 DOI: 10.1177/0022034518767401

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.
Rasch model of the child perceptions questionnaire in multi-country data

Stamm TA, Omara M, Bakerc SR, Foster Page L, Thomson WM, Benson PE, et al.

J Dent, 2020 02;93:103267.
PMID: 31866414 DOI: 10.1016/j.jdent.2019.103267

OBJECTIVE: To be fit-for-purpose, oral health-related quality of life instruments must possess a range of psychometric properties which had not been fully examined in the 16-item Short Form Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14 ISF-16). We used advanced statistical approaches to determine the CPQ's measurement accuracy, precision, invariance and dimensionality and analyzed whether age range could be extended from 8 to 15 years.
METHODS: Fit to the Rasch model was examined in 6648 8-to-15-year-olds from Australia, New Zealand, Brunei, Cambodia, Hong Kong, Malaysia, Thailand, Germany, United Kingdom, Brazil and Mexico.
RESULTS: In all but two items, the initial five answer options were reduced to three or four, to increase precision of the children's selection. Items 10 (Shy/embarrassed) and 11 (Concerned what others think) showed an 'extra' dependency between item scores beyond the relationship related to the underlying latent construct represented by the instrument, and so were deleted. Without these two items, the CPQ was unidimensional. The three oral symptoms items (4 Food stuck in teeth, 3 Bad breath and 1 Pain) were required for a sufficient person-item coverage. In three out of 14 items (21 %), Europe and South America showed regional differences in the patterns of how the answer options were selected. No differential item functioning was detected for age.
CONCLUSION: Except for a few modifications, the present analysis supports the combination of items, the cross-cultural validity of the CPQ with 14 items and the extension of the age range from 8 to 15 years.
CLINICAL SIGNIFICANCE: The valid, reliable, shortened and age-extended version of the CPQ resulting from this study should be used in routine care and clinical research. Less items and a wider age range increase its usability. Symptoms items are needed to precisely differentiate between children with higher and lower quality of life.