Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 10:11:e16106.
doi: 10.7717/peerj.16106. eCollection 2023.

Validation of the HeLD-14 functional oral health literacy instrument in a general population

Priscilla Flynn  1 , Aparna Ingleshwar  2 , Xing Chen  3 , Leah Feuerstahler  3 , Yvette Reibel  1 , Mike T John  2
Affiliations

Validation of the HeLD-14 functional oral health literacy instrument in a general population

Priscilla Flynn et al. PeerJ. .

Abstract

Background: Oral health literacy (OHL) is recognized as an important determinant of oral outcomes. Measuring OHL with a valid and reliable instrument that accurately captures the functional nature of this construct across cultures is needed. The short version of the Health Literacy in Dentistry scale (HeLD-14) shows promise as an appropriate instrument due to its inclusion of comprehensive domains hypothesized to comprise OHL. While studies validating the instrument in several languages have occurred, the number of dimensions in the various analyses range from one to seven. Validation of the HeLD-14 in a general English-speaking population is also lacking. The purpose of this study was to explore and confirm the dimensionality of the HeLD-14 in a general US English-speaking population.

Methods: The psychometric properties of HeLD-14 were evaluated in a sample of 631 participants attending the Minnesota State Fair. Construct validity was assessed using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) on the data set split into two groups. Internal consistency reliability was assessed using the Cronbach's alpha coefficient. Concurrent validity was established between the HeLD-14 and the Oral Health Inventory Profile (OHIP-5) using Pearson's correlation.

Results: EFA found, and CFA reinforced, a unidimensional structure of the HeLD-14. Cronbach's alpha was acceptable at 0.92. Fit assessment also supported a unidimensional structure, comparative fit index = 0.992, Tucker-Lewis index = 0.991, root mean square error of approximation = 0.065, and standardized root mean square residual = 0.074. Concurrent validity analyses showed that the HeLD-14 correlated with the OHIP-5.

Conclusions: The HeLD-14 is a unidimensional reliable and valid instrument for measuring the oral health literacy in the general US English-speaking adult population.

Keywords: Functional oral health literacy; Health literacy; Oral health; Oral health literacy; Psychometrics; Survey research.

PubMed Disclaimer

Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Scree plot of HeLD-14 EFA results.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Babyak MA, Green SB. Confirmatory factor analysis: an introduction for psychosomatic medicine researchers. Psychosomatic Medicine. 2010;72(6):587–597. doi: 10.1097/PSY.0b013e3181de3f8a. - DOI - PubMed
    1. Bado FMR, De Checchi MHR, Cortellazzi KL, Ju X, Jamieson L, Mialhe FL. Oral health literacy, and health, self-ratedoral and oral health-related quality of life in Brazilian adults. European Journal of Oral Sciences. 2020;128(3):218–225. doi: 10.1111/eos.12695. - DOI - PubMed
    1. Baskaradoss J. Relationship between oral health literacy and oral health status. BMC Oral Health. 2018;18:172. doi: 10.1186/s12903-018-0640-1. - DOI - PMC - PubMed
    1. Collins JR, Elias AR, Brache M, Ogando G, Toro M, Rivas-Tumanyan S, Rajendra AB. Association between gingival parameters and oral health-related quality of life in Caribbean adults: a population-based cross-sectional study. BMC Oral Health. 2019;19:234. doi: 10.1186/s12903-019-0931-1. - DOI - PMC - PubMed
    1. Dickson-Swift V, Kenny A, Farmer J, Larkins S. Measuring oral health literacy: a scoping review of existing tools. BMC Oral Health. 2014;14:148. doi: 10.1186/1472-6831-14-148. - DOI - PMC - PubMed