Psychometric properties of Health Literacy in Dentistry scale in an elderly Brazilian population

Abstract This study aimed to assess the reliability and validity of Brazilian-Portuguese versions of the Health Literacy in Dentistry (HeLD) scale in a sample of elderly Brazilian participants. HeLD was initially translated into and cross-culturally adapted to the Brazilian Portuguese language. The reliability and validity of HeLD were then assessed in a sample of 535 non-institutionalized older persons who also completed a questionnaire containing sociodemographic and health information. Data were then randomly separated into two sub-datasets, and Confirmatory Factor Analysis was performed through structural equation modelling, with a maximum likelihood estimate to test the fit of the data to the factor structure of the long-and short-form HeLD (HeLD-29 and HeLD-14) versions of the instrument. The models were compared using the Akaike Information Criterion to assess goodness-of-fit and to determine which models were preferred. Internal consistency of HeLD was evaluated using Cronbach´s coefficient α. Both versions of HeLD were observed to demonstrate high internal reliability (Cronbach´s α ≥ 0.87 for all seven subscales), acceptable convergent (estimates of ≥ 0.50 for AVE and ≥ 0.70 for CR) and discriminant validity. However, the goodness-of-fit of the confirmatory factor analysis models demonstrated satisfactory results only for HeLD-14 subsamples (x2/df = 1.8–2.3; CFI = 0.97–0.98; GFI/NFI = 0.98–0.99; RMSEA = 0.05 and SRMR = 0.03). In conclusion, HeLD-14 was shown to be a reliable and valid instrument to measure oral health literacy in elderly Brazilian participants.

摘要 本研究旨在评估牙科健康素养量表（Health Literacy in Dentistry, HeLD）巴西葡萄牙语版本在巴西老年参与者样本中的信度与效度。HeLD首先被译为巴西葡萄牙语并完成跨文化调适。随后，针对535名完成了包含社会人口学与健康信息问卷的非机构化老年人群样本，对HeLD的信效度进行评估。研究将数据随机划分为两个子数据集，通过结构方程模型（structural equation modelling, SEM）开展验证性因子分析（Confirmatory Factor Analysis, CFA），采用最大似然估计法检验该量表长表（HeLD-29）与短表（HeLD-14）的因子结构对数据的适配性。以赤池信息准则（Akaike Information Criterion, AIC）比较模型，以评估拟合优度并确定最优模型。采用克朗巴哈α系数评估HeLD的内部一致性。结果显示，HeLD两个版本均表现出较高的内部信度（7个分量表的克朗巴哈α值均≥0.87），聚合效度与区分效度均可接受（平均方差提取（Average Variance Extracted, AVE）估计值≥0.50，组合信度（Composite Reliability, CR）估计值≥0.70）。不过，验证性因子分析模型的拟合优度仅在HeLD-14子样本中达到满意水平（χ²/df=1.8–2.3；比较拟合指数（Comparative Fit Index, CFI）=0.97–0.98；拟合优度指数（Goodness-of-Fit Index, GFI）/规范拟合指数（Normed Fit Index, NFI）=0.98–0.99；近似误差均方根（Root Mean Square Error of Approximation, RMSEA）=0.05，标准化残差均方根（Standardized Root Mean Square Residual, SRMR）=0.03）。综上，HeLD-14可作为可靠且有效的工具，用于评估巴西老年人群的口腔健康素养。