Development of a scale for measuring university students’ attitudes toward oral health

Year 2024, Volume: 58 Issue: 3, 108 - 119, 20.09.2024

Muhammet Fidan , Ceren Mutluer , Mustafa Fidan

https://doi.org/10.26650/eor.20241312721

Abstract

Purpose: Valid and reliable scales which have been developed for assessing individuals’ attitudes toward oral health and are based on multiple theoretical views are limited in number in the literature. Hence, there is a need for more scale development studies for further evaluation of the psychometric properties of the oral and dental health attitudes of students. The aim of this study was to develop a scale for measuring college undergraduates’ attitudes toward oral and dental health.

Materials and Methods: A sample of 770 college undergraduates (241 male, 529 female) enrolled in various academic programs of three universities in Turkey participated in this study. We collected data from two separate samples. The data obtained from sample 1 (n = 470) were used for Exploratory Factor Analysis (EFA) and the data from sample 2 (n = 300) were utilized for undertaking Confirmatory Factor Analysis (CFA). To test the construct validity, EFA, CFA, convergent validity, and measurement invariance were used, respectively.

Results : In the first stage, EFA was conducted on a 48-item scale. EFA results showed that the final version of the Oral Health Attitude Scale (OHA-S) had a six-factor structure: sensitivity, importance, avoidance of harmful elements, tendency towards products and activities, awareness, and social impact. To confirm this structure, CFA was used. CFA results showed good model fit indexes. The final version of the scale consisted of 41 items with six factors. Moreover, Cronbach’s alpha and Spearman-Brown Split-Half coefficients showed a good level of reliability. Moreover, t-scores were statistically significant for 27% of the lower and upper groups.

Conclusion: The developed scale was found to be a potential tool for measuring and evaluating university students' attitudes toward oral and dental health.

Keywords

Attitude, oral and dental health, scale development, university

Üniversite Öğrencilerinin Ağız Sağlığına Yönelik Tutumlarının Belirlenmesi için Ölçek Geliştirilmesi

Abstract

Amaç: İlgili literatürde ağız sağlığına yönelik tutumu değerlendirmek için geliştirilen, çoklu teorik görüşlere dayanan geçerli ve güvenilir ölçekler sınırlı sayıdadır. Bu nedenle, öğrencilerin ağız ve diş sağlığına yönelik tutumların psikometrik özelliklerinin incelenmesine yönelik daha çok ölçek geliştirme çalışmasına ihtiyaç vardır. Mevcut araştırmanın amacı, üniversite öğrencilerinin ağız ve diş sağlığına yönelik tutumlarını ölçmek için geçerli ve güvenilir bir ölçme aracı geliştirmektir.

Gereç ve Yöntem: Araştırmaya Türkiye’deki üç üniversitenin çeşitli akademik programlarına kayıtlı 770 üniversite öğrencisi (241 erkek, 529 kadın) katılmıştır. Araştırmanın verileri iki ayrı örneklemden toplanmıştır. İlk örneklemden (n = 470) elde edilen veriler Açıklayıcı Faktör Analizi (AFA) için, ikinci örneklemden (n = 300) elde edilen veriler ise Doğrulayıcı Faktör Analizi (DFA) için kullanıldı. Ölçeğin yapı geçerliliğini test etmek için sırasıyla AFA, DFA, yakınsak geçerlilik ve ölçme değişmezliği kullanılmıştır.

Bulgular: İlk aşamada, 48 maddelik ölçek üzerinde AFA yapılmıştır. AFA sonuçları, Ağız Sağlığı Tutum Ölçeği›nin (AST-Ö) altı faktörlü bir yapıya sahip olduğunu göstermiştir: duyarlılık, önem, zararlı unsurlardan kaçınma, ürün ve faaliyetlere eğilim, farkındalık ve sosyal etki. Ölçeğin AFA sonucunda ortaya çıkan yapısını doğrulamak için DFA gerçekleştirilmiştir. DFA sonucunda elde edilen uyum indekslerinin kabul edilebilir olduğu görülmüştür. Ölçeğin son hali, altı faktörlü 41 maddeden oluşmaktadır. Ayrıca Cronbach’s alpha ve SpearmanBrown Split Half (yarıya bölme) değerleri iyi düzeyde güvenilirliğe sahip olduğunu göstermiştir. Ayrıca %27 alt-üst gruplar için t puanları istatistiksel olarak anlamlıdır.

Sonuç: Geliştirilen ölçeğin üniversite öğrencilerinin ağız ve diş sağlığına yönelik tutumlarını ölçmek ve değerlendirmek için potansiyel bir araç olduğu görülmüştür.

Keywords

Tutum, ağız ve diş sağlığı, ölçek geliştirme, üniversite

References

• Mekhemar M, Conrad J, Attia S, Dörfer C. Oral health attitudes among preclinical and clinical dental students in Germany. Int J Environ Res Public Health 2020;17:1-11. google scholar
• Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. Lancet 2019;394:249-60. google scholar
• Bashiru BO, Omotola OE. Oral health knowledge, attitude and behavior of medical, pharmacy and nursing students at the University of Port Harcourt, Nigeria. J Oral Res Rev 2016;8:66. google scholar
• Gündogdu Ozdal TP, Duruk G. Oral health attitude and status of Turkish dentistry students. Eur J Res Dent 2019;3:14-9. google scholar
• Mulla M. Impact of Oral diseases and conditions on oral health-related quality of life: a narrative review of studies conducted in the Kingdom of Saudi Arabia. Cureus 2021;13: e18358. google scholar
• Al-Darwish MS. Oral health knowledge, behaviour and practices among school children in Qatar. Dent Res J (Isfahan) 2016;13:342. google scholar
• Khan S, Alqannass N, Alwadei M, et al. Assessment of the relationship between dental anxiety and oral health-related quality of Life. J Pharm Bioallied Sci 2021;13:359. google scholar
• Schuller AA, Willumsen T, Holst D. Are there differences in oral health and oral health behavior between individuals with high and low dental fear? Community Dent Oral Epidemiol 2003;31:116-21. google scholar
• Baiju R, Peter E, Varghese N, Sivaram R. Oral health and quality of life: Current concepts. J Clin Diagn Res 2017;11:ZE21. google scholar
• Kwak SH, Bae SM, Shin SJ, Shin BM. Factors affecting preventive dental treatment of adolescents in Korea. Int J Environ Res Public Health 2020;17:1-21. google scholar
• Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and ımplications for public health priorities. Am J Public Health 2012;102:411. google scholar
• Allport GW. Attitudes. In Murchison C, Ed., Handbook of Social Psychology, Clark University Press, Worcester, MA. 1935; 798–844. google scholar
• Brown LA, Sleik RJ, Polych MA, Gage WH. Is the prioritization of postural control altered in conditions of postural threat in younger and older adults? Journals Gerontol Ser A 2002;57:785-92. google scholar
• Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991;50:179-211. google scholar
• Oskamp S, Schultz PW. (2005). Attitudes and opinions (3rd ed.). Lawrence Erlbaum Associates Publishers. https://doi.org/10.4324/9781410611963 google scholar
• Kothandapani V. Validation of feeling, belief, and intention to act as three components of attitude and their contribution to prediction of contraceptive behavior. J Pers Soc Psychol 1971;19:321–33. google scholar
• Fredrickson BL. The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. Am Psychol 2001;56:218-26. google scholar
• Setiawan AS, Zubaedah C. Application of health belief model on child’s dental visit postponement during the COVID-19 pandemic. Eur J Dent 2020;14:7-13. google scholar
• Iqbal MZ, Rathi R, Prajapati SK, et al. Knowledge, attitude, and practice of oral hygiene among students of a private university. J Pharm Bioallied Sci 2021;13:123. google scholar
• Kawamura M. Dental behavioral science. The relationship between perceptions of oral health and oral status in adults. Hiroshima Daigaku Shigaku Zasshi 1988;273:20-2. google scholar
• DeVellis, R. F. (2017). Scale Development: Theory and Applications (4th ed.). Thousand Oaks, CA: Sage. google scholar
• Selvaraj S, Naing NN, Wan-Arfah N, Prasadh S. Confirmatory factor analysis of knowledge, attitude, and behaviour questionnaire towards oral health among Indian adults. J Pers Med 2021;11:320. google scholar
• Kirtiloǧlu T, Yavuz ÜS. An assessment of oral self-care in the student population of a Turkish university. Public Health 2006;120:953–7. google scholar
• Peker I, Alkurt MT. Oral health attitudes and behavior among a group of Turkish dental students. Eur J Dent 2009;3:24. google scholar
• Boehmer U, Kressin NR, Spiro A. Preventive dental behaviors and their association with oral health status in older white men. J Dent Res 1999;78:869–77. google scholar
• Büyüköztürk Ş, Kılıç Çakmak E, Akgün ÖE, Karadeniz Ş, Demirel F. (2008). Bilimsel araştırma yöntemleri (1st ed.). Ankara: Pegem google scholar
• Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: A primer. Front Public Health 2018;6:149. google scholar
• Selvaraj S, Naing NN, Wan-Arfah N, Karobari MI, Marya A, Prasadh S. Development and validation of oral health knowledge, attitude and behavior questionnaire among Indian adults. Medicina (Kaunas) 2022;58:68. google scholar
• Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio. Meas Eval Couns Dev 2013;47:79-86. google scholar
• Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health 2006;29:489-97. google scholar
• Shrotryia VK, Dhanda U. Content validity of assessment instrument for employee engagement. SAGE Open 2019;9. google scholar
• Tavşancıl, E. (2014). Tutumların ölçülmesi ve SPSS ile veri analizi. (5th ed.) Ankara:Nobel. google scholar
• Adelson JL, McCoach DB. Measuring the Mathematical attitudes of elementary students: The effects of a 4-point or 5-point likert-type scale. Educ Psychol Meas 2010;70:796–807. google scholar
• Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online 2003;8:23-74. google scholar
• Hu LT, Bentler PM. Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychol Methods 1998;3:424-53. google scholar
• Hair J. Multivariate Data Analysis: A Global Perspective. 7th ed. Upper Saddle River: Prentice Hall,. In: ; 2010. google scholar
• Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 1981;18:50. google scholar
• Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. Eur Bus Rev 2019;31:2-24. google scholar
• Chung H, Kim J, Park R, Bamer AM, Bocell FD, Amtmann D. Testing the measurement invariance of the University of Washington Self-Efficacy Scale short form across four diagnostic subgroups. Qual Life Res 2016;25:2559. google scholar
• Büyüköztürk Ş. (2002). Sosyal Bilimler için veri analizi el kitabı. Ankara: Pegem. google scholar
• Churchill GA. A Paradigm for developing better measures of marketing constructs. J Mark Res 1979;16:64. google scholar
• Pallant J. (2011). SPSS survival manual: a step by step guide to data analysis using SPSS. Crow’s Nest: Allen & Unwin Pub. google scholar
• Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81-92. google scholar
• Myers-Wright N, Lamster IB. A new practice approach for oral health professionals. J Evid Based Dent Pract 2016;16 Suppl:43-51. google scholar
• Nawal Lutfiyya M, Gross AJ, Soffe B, Lipsky MS. Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health 2019;19:265. google scholar
• Cheng L, Zhang L, Yue L, et al. Expert consensus on dental caries management. Int J Oral Sci 2022;14:17. google scholar
• Selvaraj S, Naing NN, Wan-Arfah N, Henrique M, Guimarães De Abreu N. Assessment on oral health knowledge, attitude, and behaviour and its association with sociodemographic and habitual factors of south ındian population. Pesqui Bras Odontopediatria Clin Integr 2021;21:e0135. google scholar
• Malik S, Kamra S, Bhardwaj A. Knowledge, attitude and behavior towards oral health among teaching staff members of non-medical faculties in higher education ınstitution with multiple faculties. Ann Rom Soc Cell Biol 2021;25:13281. google scholar
• Edwards CB, Randall CL, McNeil DW. Development and validation of the oral health values scale. Community Dent Oral Epidemiol 2021;49:454-63. google scholar
• Yildiz S, Dogan B. Self reported dental health attitudes and behaviour of dental students in Turkey. Eur J Dent 2011;5:253. google scholar
• Kawamura M, Yip HK, De Hu Y, Komabayashi T. A cross-cultural comparison of dental health attitudes and behaviour among freshman dental students in Japan, Hong Kong and West China. Int Dent J 2001;51:159-63. google scholar
• Bandura A. Social foundations of thought and action: A social cognitive theory. Psychology. 1986. google scholar
• Ajzen I. Nature and operation of attitudes. Annu Rev Psychol 2001;52:27-58. google scholar
• Eagly AH, Chaikan S. The psychology of attitudes. Fort Worth, TX: Harcourt Brace Jovanovich College Publishers. Fort Worth, TX: Harcourt Brace Jovanovich College Publishers. google scholar