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Oral health, Child, Quality of life, Factor analysis, Statistical, Parents, Early childhood oral health impact scale, What&,rsquo s Known The Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was designed to evaluate children&,rsquo s oral health-related quality of life. It is a useful scale for measuring the multidimensional impact of oral diseases. The hypothesized six domains of this questionnaire were merely based on theory. What&,rsquo s New The results from exploratory and confirmatory factor analyses suggested a 3-factor structure. The Persian version of ECOHIS is a 3-dimensional model rather than the hypothetical 6-dimensional model. The Child Oral Health-Related Quality of Life (C-OHRQoL) questionnaire, if suitably designed, can demonstrate nearly all aspects of the psychological, social, and family domains of children. IntroductionTraditional clinical indices can only describe oral health status and, as such, disregard broader psychosocial, emotional, and functional aspects, which can be affected by oral diseases. 1,, 2, Therefore, new oral health indices such as Oral Health-Related Quality of Life (OHRQoL) have emerged to represent not only oral health status but also emotional and psychosocial well-being. 2,, 3, In the literature, children&,rsquo s quality of life is slightly ignored in comparison with adults. 4,, 5, In recent years, several C-OHRQoL questionnaires have been developed. 6,, 7, The Early Childhood Oral Health Impact Scale (ECOHIS) was designed to evaluate children&,rsquo s OHRQoL. 6, Thereafter, versions of ECOHIS were translated into several languages. Indeed, Brazilian, 8, German, 9, Chinese, 10,, 11, Turkish, 12, Nigerian Pidgin English, 13, and Persian 14, versions were developed and validated in their respective populations.As there were no prior developed domains affected by oral health in children, Pahel and others, 6, who developed the ECOHIS questionnaire, used the domains introduced by Jokovic and colleagues 15, as a foundation. They suggested the following domains, the item of having oral/dental pain as the child symptoms domain the items of having difficulty eating some foods, having difficulty drinking hot or cold beverages, having difficulty pronouncing any words, and missing preschool as the child function domain the items of having trouble sleeping and being irritable or frustrated as the child psychological domain the items of avoiding smiling or laughing when around other children and avoiding talking with other children as the child self-image/social interaction domain the items of being upset and feeling guilty as the parent distress domain and the items of taking time off from work and financial impacts as the family function domain.These hypothetical dimensions of ECOHIS should be assessed in different populations. 6, Nonetheless, nearly all previous studies in this field have applied the questionnaire without assessing the aforementioned domains. 16,- 18, While several OHRQoL questionnaires have been previously evaluated, 19,- 24, no study to date has assessed the domains of the ECOHIS questionnaire in a given population. Only an investigation in China assessed the dimensional structure of the Chinese version of the ECOHIS questionnaire via confirmatory factor analysis (CFA) and concluded that ECOHIS was a 3-dimensional construct. 25, Children&,rsquo s oral health can be promoted by discovering the latent dimensions affected by oral health in practice, and not just by considering hypothetical domains. To the best of our knowledge, no study has assessed the factor structure of ECOHIS to explore and verify its dimensions worldwide yet. Accordingly, in the present study, we sought to assess the ECOHIS questionnaire amongst 6-year-old primary school children of Shiraz and its suburbs via an appropriate psychometric method to detect its dimensions of quality of life as affected by oral diseases.Subjects and MethodsThis analytical cross-sectional study was conducted between 2014 and 2015 in Shiraz, Iran. Ethical permission was obtained from the Postgraduate School of Shiraz University of Medical Sciences (1393.126808) and the Educational Head Office of Fars province. The study objectives were fully explained to the participants&,rsquo parents or their guardians, before written informed consent was obtained. A representative sample of six-year-old primary school children in Shiraz was selected through the application of a multistage stratified design. Shiraz was first divided into four educational districts, and then into urban and rural areas, and finally into public and private schools. Thirty-five primary schools were randomly selected (about 4% of the primary schools in each district). Inside each selected school, with the aid of the school&,rsquo s records, simple random sampling was applied to select a proportionate number of children. Ultimately, the study participants consisted of 830 parents or guardians of 6-year-old first-grade primary school children.All six-year-old first-grade children in the mentioned primary schools, except for schools for children with special needs, were included in this study. Children with mental or physical disabilities, caregivers who did not live with their child for a period of more than 6 months during the child&,rsquo s life, and parents or guardians who were not willing to participate in the study were excluded.The ECOHIS questionnaire has six conceptual domains and 13 items. It is comprised of the following dimensions, the child symptoms domain (one item), the child function domain (four items), the child psychological domain (two items), the child self-image/social interaction domain (two items), the family function domain (two items), and the parent distress domain (two items). The Farsi version of the Early Childhood Oral Health Impact Scale (F-ECOHIS) was used to evaluate C-OHRQoL. Data on the children&,rsquo s OHRQoL were collected through interviews with the parents or guardians individually. Their responses to questions (nine questions on child impact and four questions on family impact) were coded, from one (never) to five (very often). All the scores were then summed to calculate a total score, within the range of 13 to 65, with higher scores reflecting worse OHRQoL. The validity of F-ECOHIS was previously confirmed by Jabarifar and colleagues. 14, They revealed that Cronbach&,rsquo s alpha coefficient for the whole F-ECOHIS was 0.93 and for the child and family impact sections were 0.89 and 0.85, respectively. The concurrent validity and convergent validity (P&,lt 0.001) of the F-ECOHIS were also acceptable.The factor structure of the ECOHIS questionnaire was extracted and evaluated by performing both exploratory factor analysis (EFA) and CFA based on the hypothesis that EFA could demonstrate the latent dimensions of ECOHIS. EFA was performed by extracting factors from principal component analysis and orthogonal rotation (varimax with the Kaiser normalization). An item loading value of 0.5 or higher on a single factor was followed by varimax rotation. CFA is most commonly used to assess the construct validity of the dimensions of questionnaires (in this study, ECOHIS). Construct validity assesses the hypothesized dimensions to demonstrate the actual domains. It was hypothesized that CFA could verify the latent dimensions obtained from EFA, the dimensions proposed by Pahel, and the 1- and 2-dimensional models (child and family domains). CFA was conducted in Mplus. According to the Kline factor, a loading value of less than 0.5 should be eliminated from the model. 26, The goodness-of-fit model indices consisted of the root mean square error of approximation (RMSEA), the ratio of &,chi 2 to degrees of freedom (&,chi 2/df), the Tucker&,ndash Lewis index (TLI), and the comparative fit index (CFI). A &,chi 2/df of less than 2 or 3, an RMSEA of less than 0.1, and CFI and TLI of greater than 0.90 were considered within the acceptable range. 27, Mplus, version 7, was used for the descriptive and analytical analyses in the present study. To analyze categorical data in a structural equation model, Mplus applies a robust weighted least squares estimator using a diagonal weight matrix (WLSMV). The WLSMV approach performs well when the sample size is 200 or higher. 28, ResultsA total of 801 out of the 830 invited parents or their guardians participated in this study. The response rate was 96.5%. The mean ECOHIS score was 21.95, with a standard deviation of 7.45. The mean child impact score and the mean family impact score were 14.25&,plusmn 5.72 and 7.70&,plusmn 3.62, correspondingly. Table 1, depicts the distribution of responses to the F-ECOHIS questions. The parents or the guardians reported missing school to be the least frequent item and having oral/dental pain to be the most frequent item within the child impact domain, while they reported being upset to be the most frequent item and financial impacts to be the least frequent item within the family impact domain.ImpactNeverHardly EverOccasionallyOftenVery Oftenn (%)n (%)n (%)n (%)n (%)Child Impact1. How often has your child had pain in the teeth, mouth, or jaws?246 (30.71)208 (25.97)181 (22.60)125 (15.60)41 (5.12)How often has your child &,hellip because of dental problems or dental treatments? |