Department of Paediatric Dentistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands.
Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2023 Aug 3;18(8):e0289337. doi: 10.1371/journal.pone.0289337. eCollection 2023.
The health action process approach (HAPA) model is promising to increase the frequency of brushing children's teeth by parents to improve their children's oral health. A validated HAPA questionnaire is needed as one of the measures of the effects of such an intervention.
The aim of this study was to evaluate whether our data, based on a translated and adopted version of the Health Action Process Approach (HAPA)-based questionnaire on dental flossing, supported the constructs of the HAPA model. If so, a next aim was to assess whether these constructs could be measured reliably.
In this cross-sectional study, 269 questionnaires filled out in dental offices by parents of children 1-10 years old were analysed. Scale validation was performed according to the 6-step protocol of Dima, including Mokken scale analyses (MSA), graded response model (GRM), factor analyses and reliability measures. Pearson correlation coefficients were calculated to identify divergent validity and test-retest reliability.
MSA showed a unidimensional, medium total scale. Three items were removed based on this analysis. The total scale with the remaining 26 items did not fit the GRM. Factor analysis extracted five factors and two components for the total scale. The separate subscales, except the 'intention' construct, fitted the MSA and did not fit the GRM. The data fitted a seven-factor model better than a one-factor model. Reliability measures varied from acceptable to excellent, but were poor for 'action control'. Test-retest reliability (r's 0.60-0.83) was questionable to good.
Our results did not fully support the constructs of the HAPA model. To support the HAPA constructs, modification to the subscales risk perceptions, intention, action planning, action control and self-reported behaviour are suggested. With these adjustments, the reliability and validity of the questionnaire could be significantly improved".
健康行动过程方法（HAPA）模型有望通过提高父母给孩子刷牙的频率来改善孩子的口腔健康。作为干预效果的措施之一，需要使用经过验证的 HAPA 问卷。
本研究旨在评估我们的数据是否基于经过翻译和采用的基于 HAPA 的牙线使用问卷，支持 HAPA 模型的结构。如果是这样，那么下一个目的是评估这些结构是否可以可靠地测量。
在这项横断面研究中，分析了在牙科诊所由 1-10 岁儿童的父母填写的 269 份问卷。根据 Dima 的 6 步方案进行量表验证，包括莫肯量表分析（MSA）、等级反应模型（GRM）、因子分析和可靠性测量。计算 Pearson 相关系数以确定发散有效性和测试 - 重测信度。
MSA 显示出一维、中等总尺度。基于此分析，删除了三个项目。剩余 26 个项目的总量表不符合 GRM。因子分析从总量表中提取了五个因素和两个成分。除“意图”结构外，单独的分量表符合 MSA，但不符合 GRM。数据更适合七因素模型而不是单因素模型。可靠性测量从可接受到优秀不等，但“行动控制”较差。测试 - 重测信度（r's 0.60-0.83）从可疑到良好。
我们的结果并没有完全支持 HAPA 模型的结构。为了支持 HAPA 结构，建议对风险感知、意图、行动计划、行动控制和自我报告行为等分量表进行修改。通过这些调整，可以显著提高问卷的可靠性和有效性。
