Higher-order exploratory factor analysis of the Dental Subscale of Children's Fear Survey Schedule in a Taiwanese population

Abstract

Objectives: The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is extensively used to assess the level of child dental anxiety. The present study aimed to explore the higher-order factor structure of the parental Chinese version of the CFSS-DS with a large sample of young children in Taiwan.

Design: The parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5 to 8- year-old children at kindergartens and elementary schools in Kaohsiung city, Taiwan. Subjects were selected by stratified random sampling. The stratification was done by geographic district, age group, and gender.

Participants: The sample was 1,819 children aged 5 to 8 years old.

Main outcome measures: A first-order factor analysis was performed using the principal components method with promax rotation, and a second-order factor was obtained by applying the Schmid-Leiman solution (SLS).

Results: The present study found three first-order factors, defined as: (1) fear of dental aspects, (2) fear of medical aspects, and (3) fear of potential victimization. The second-order factor defined as "dental fear" accounted for most of the variance in the second-order factor structure. The results of higher-order factor analysis according to different gender or age levels were identical.

Conclusions: A higher-order factor structure consisting of a single second-order factor and three first-order factors was extracted, giving a fuller understanding of the CFSS-DS. The second-order factor structure of Chinese version CFSS-DS was stable and reliable.