Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Dental Ecology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Public Health Dent. 2019 Sep;79(3):253-263. doi: 10.1111/jphd.12323. Epub 2019 Jun 17.
The purpose of this study was to develop an instrument in English (ENG) and Spanish (SPA) for use in assessing perceptions of dental home characteristics among low-income adults.
An expert panel selected 21 items from a pool of 81 items mapped to domains in the American Academy of Pediatrics' medical home. Pilot testing with mothers (n = 795) of children in Early Head Start (EHS) resulted in an expanded 36-item scale, which was field-tested in interviews with ENG- (N = 665) and SPA-speakers (N = 116). An exploratory factor analysis of 23 usable items was carried out in an EHS reference group (N = 272). The selected model was evaluated by confirmatory factor analysis (CFA) in two other subgroups (N = 393; N = 116). We tested measurement and structural invariances using a multiple-group approach. Known-groups validity was examined by testing factor mean differences between two groups defined by whether or not the mother used a single dental office.
A three-factor CFA model with 10 items was retained for its close fit for all three subgroups. Invariance tests found the two ENG subgroups to be homogenous and were combined. Several item and factor parameters in the SPA group differed from the combined ENG group. The proposed dental home measure demonstrated good known-group validity in that people who used the same dental office reported better dental care experiences.
An instrument to measure the dental home concept among low-income adults was developed with three domains (accessible-comprehensive, compassionate, and health literate care) that demonstrated good validity and reliability.
本研究旨在开发一种英文（ENG）和西班牙文（SPA）工具，用于评估低收入成年人对牙科家庭特征的认知。
一个专家小组从与儿科学会医疗之家相关领域的 81 项中选择了 21 项条目。对早期开端（EHS）项目中儿童的母亲（n=795）进行了试点测试，结果产生了一个扩展的 36 项量表，随后在对 ENG （n=665）和 SPA 语言者（n=116）的访谈中进行了实地测试。在 EHS 参考组（n=272）中对 23 项可用条目进行了探索性因素分析。在另外两个亚组（n=393；n=116）中通过验证性因素分析（CFA）评估了选定的模型。使用多组方法测试了测量和结构不变性。通过检验根据母亲是否使用单一牙科诊所定义的两个组之间的因子均值差异来检验效标效度。
保留了具有 10 项内容的三因素 CFA 模型，因为该模型非常适合所有三个亚组。不变性测试发现两个 ENG 亚组是同质的，并将其合并。SPA 组中的几个条目和因子参数与合并的 ENG 组不同。该拟议的牙科家庭测量方法在具有良好的已知组有效性方面表现良好，即使用同一牙科诊所的人报告了更好的牙科护理体验。
开发了一种用于衡量低收入成年人牙科家庭观念的工具，该工具具有三个领域（可及性-全面性、同情心和健康素养护理），具有良好的有效性和可靠性。
