Dental Public Health, University of Leeds School of Dentistry, Leeds, UK.
Dental School, Cork University, Cork, Ireland.
Community Dent Oral Epidemiol. 2023 Jun;51(3):547-556. doi: 10.1111/cdoe.12781. Epub 2022 Aug 18.
To develop a patient's attitude questionnaire regarding prevention in oral health for use internationally.
Using a mixed methods approach, a questionnaire was developed and refined as part of ADVOCATE (Added Value for Oral Care) study, involving partners in six countries: Netherlands, Hungary, Denmark, Ireland, Germany, and the UK. A literature review explored the history of oral healthcare delivery systems to develop a template for each of the six ADVOCATE countries. A systematic review identified the perceived barriers and facilitators to preventive oral healthcare and underpinned a topic guide and established the patient questionnaire domains. Focus groups in each ADVOCATE country developed the first version of the questionnaire. Patient and Public Involvement and Engagement (PPIE) in each ADVOCATE country tested the questionnaire and led to further refinement. The questionnaire was produced in five languages. Content validity and reproducibility used principal component analysis (PCA) and exploratory factor analysis (EFA) refined the questionnaire.
The literature review aided an understanding of each country's oral healthcare system, and the findings from the 25 studies identified in the systematic review found the main barriers/facilitators to preventive oral healthcare were cost, knowledge (preventive treatments and advice), and a patient awareness and adherence to preventive advice/treatments. Interviews and focus groups with 148 participants in the ADVOCATE study identified receiving the appropriate level of care/feeling valued, cost, level of motivation/priority, not feeling informed, knowledge, and skill mix as the main barriers/facilitators. Fifty-three PPIE members refined the questionnaire. The pilot questionnaire was tested with 160 participants. Non-essential or highly correlated variables were then removed, leaving 38 items, covering 6 domains (cost, advice received, advice wanted, message delivery, motivation, knowledge, and responsibility) within the questionnaire. A second pilot test-run was undertaken with 185 participants. The test-re-test reliability demonstrated strong consistency of responses between the two time points (kappa range 0.3-0.7, most p < .0011), which culminated with a final version of the Patient Attitudes to Prevention in Oral Health Questionnaire (PAPOH) questionnaire.
This mixed-methods approach enabled the development of a multi-language attitudinal questionnaire for use with patients (PAPOH) to compare attitudes to oral disease prevention internationally.
开发一种用于国际使用的口腔健康预防患者态度问卷。
采用混合方法，作为 ADVOCATE（口腔保健增值）研究的一部分，开发并完善了问卷，该研究涉及来自六个国家的合作伙伴：荷兰、匈牙利、丹麦、爱尔兰、德国和英国。文献回顾探讨了口腔保健服务提供系统的历史，为 ADVOCATE 研究中的六个国家的每个国家制定了模板。系统综述确定了预防性口腔保健的感知障碍和促进因素，为主题指南提供了依据，并确定了患者问卷的领域。在每个 ADVOCATE 国家进行的焦点小组制定了问卷的第一版。每个 ADVOCATE 国家的患者和公众参与（PPIE）测试了问卷，并进行了进一步的完善。问卷以五种语言制作。使用主成分分析（PCA）和探索性因素分析（EFA）进行内容有效性和可重复性，对问卷进行了完善。
文献回顾有助于了解每个国家的口腔保健系统，系统综述中确定的 25 项研究的结果发现，预防性口腔保健的主要障碍/促进因素是成本、知识（预防性治疗和建议）以及患者对预防性建议/治疗的意识和依从性。ADVOCATE 研究中对 148 名参与者的访谈和焦点小组发现，接受适当水平的护理/感到有价值、成本、动机/优先级水平、感觉没有得到通知、知识和技能组合是主要障碍/促进因素。53 名 PPIE 成员完善了问卷。对 160 名参与者进行了预试。然后删除非必要或高度相关的变量，留下 38 个项目，涵盖问卷中的 6 个领域（成本、收到的建议、想要的建议、信息传递、动机、知识和责任）。对 185 名参与者进行了第二次预试。两次测试之间的重测信度显示出响应的高度一致性（kappa 范围为 0.3-0.7，大多数 p <.0011），最终形成了口腔健康预防患者态度问卷（PAPOH）的最终版本。
这种混合方法使开发一种多语言态度问卷成为可能，用于国际上比较患者对口腔疾病预防的态度（PAPOH）。
