| Abstract|| |
Background: The oral health impact profile-14 (OHIP-14) scale developed originally in English has been translated from time to time in different languages revealing to be valid and reliable instruments. Aim: The present study was carried out with an aim to translate and validate Hindi Version of OHIP-14 instrument among geriatrics to measure the oral health-related quality of life. Methodology: This was a descriptive cross-sectional study, which employed 400 individuals aged 60 years and above who were residents of Durg, Chhattisgarh India. Participants were selected through convenient sampling method. The English version of the OHIP-14 was translated into Hindi, pretested and subsequently administered to the participants by a trained interviewer. Each patient signed informed consent and responded to the Hindi version of the questionnaire. Result: Cronbach's alpha of the translated scale was 0.89–0.90 when words were deleted individually. Comparison of English and translated Hindi version of OHIP-14 by unpaired t-test showed no significant difference (P = 0.562). Pearson correlation coefficient test showed very strong positive correlation (0.892). Furthermore, a very strong positive correlation was observed between the recorded OHIP-14 scores and Decayed Missing Filled Teeth (DMFT) scores of examined geriatric individuals (Pearson correlation coefficient = 0.952 and P = 0.001). Conclusion: The Hindi translation of the OHIP-14 is a valid and reliable instrument to measure the oral health-related quality of life in older adults of India.
Keywords: Hindi, oral health impact profile-14, quality of life, questionnaire, reliability and validity
|How to cite this article:|
Verma S, Sharma H. Translation and validation of hindi version of oral health impact profile-14, a measure of oral health-related quality of life of geriatrics. Indian J Dent Res 2019;30:180-4
|How to cite this URL:|
Verma S, Sharma H. Translation and validation of hindi version of oral health impact profile-14, a measure of oral health-related quality of life of geriatrics. Indian J Dent Res [serial online] 2019 [cited 2019 Sep 20];30:180-4. Available from: http://www.ijdr.in/text.asp?2019/30/2/180/259235
| Introduction|| |
Health which was seen earlier solely as the absence of disease is no longer projected in the same aspect. An increased focus on multidimensional aspect of oral health had paved a path of the development of many theoretical concepts and measures to evaluate individual's quality of life. Health-related quality of life serves as an important aspect in the medical field by acting as a marker for priority setting, service guide to assess need. Besides this, it also serves to evaluate the effectiveness of intervention and forms a basis of index for economic evaluation. Socio-dental indicators which measure the extent to which oral and dental conditions hampers social life leading to vast spectrum of changes observed in individuals' behaviors such as the inability to lead a socially acceptable life, or undertake parental or household duties had raised the need to develop a regionally accepted index to assess individuals health-related quality of life.
Today both developing and developed countries are facing the common problem of aging population. Diminishing ability of geriatric population for proper compliance and concentration imparts a great challenge in assessing their oral health-related quality of life.
However, there is a scarcity of proper scales which serve as an appropriate tool for the assessment of health-related quality of life of the geriatric population. Enormous literature is available which shows problems with proper questionnaire's translation, validation, sensitivity, and responsiveness. The entire method of making an appropriate assessment scale depends on the method of making the questions. An easy to apply questionnaire saves both time, money, and individual respondent interest in answering them. Therefore, choice of questions in the questionnaire is an important issue which directly influences the outcome of the assessment.,
The oral health impact profile (OHIP) scale developed originally in English has been translated from time to time into different languages with various versions of this scale revealing to be valid and reliable instruments for assessing the oral health-related quality of life of different age and population.,, The original OHIP, which consisted of 49 items, was developed by Locker and Slade and based on Locker's conceptual model of oral health.,,, It includes seven domains, namely functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The validity and reliability of a short version of the questionnaire, the OHIP-14, has been documented in several different clinical conditions such as oral surgery, prosthetics rehabilitation.,
However, using the index in different countries implies its adaptation into different languages and cultures. A simple translation of an index into another language might be problematic in terms of losing the original meaning. Moreover, there are differences in the perception of quality of life and health problems in different places.
Until date, only one OHIP-14 index has been validated in Hindi for adults, the OHIP-14, but no such index has been validated for the geriatric population. Therefore, this study aimed to (1) to develop Hindi version of OHIP-14; (2) to determine the validity of the Hindi OHIP-14 in a Geriatric population of Durg, Chhattisgarh India.
| Methodology|| |
The project was approved by the Institutional Review Board of Rungta College of Dental Science and Research in Bhilai, India. A nonrandom, convenient sample of 400 geriatric individuals was selected for this study. Before commencement of the study, a written informed consent was obtained after explaining the objectives and methods involved in the study.
Validity of questionnaire
The validity of an instrument refers to the process of determining whether the instrument measures what it intends to measure. There are four main aspects of validity as follows: translation, face validity, content validity, and reliability testing.
Translation of English version of OHIP-14 into Hindi Version was based on criteria's set by Guillemin et al. In the current process, two bilingual individuals, whose first language was Hindi, carried out the translation of OHIP-14 from English to Hindi, which was followed by a reverse translation from Hindi to English by remaining two individuals whose first language was English. After proper translation, a preliminary version of Hindi OHIP-14 was obtained, which was thoroughly discussed with members of above group before pilot testing it [Figure 1].
|Figure 1: Translated Hindi Version of Original Oral Health Impact Profile-14 Questionnaire|
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Assessment of face validation of prepared Hindi OHIP-14 was assessed by authors in relation to check the clarity of understanding, logic and reflection of oral health and disease patterns in all questionnaire components in the geriatric population residing in Durg, Chhattisgarh India. It was qualitatively assessed in the pilot study in which the index was administered to 100 geriatric adults. The results showed that the geriatric individuals had a high level of understanding of the questionnaire with ease. The suggestions obtained from the pilot testing were discussed with the experts that were involved in translation process which was considered to bring slight changes in the wording of some questions. On re-administration of the questionnaire after corrections, all geriatric individuals agreed that the questionnaire was much more simple and understandable. All necessary changes were introduced before the main study.
Content validity of a questionnaire is an intrinsic part of the questionnaire which is not affected by the adaptation or translation into any other language. However, properly translated and adapted questionnaire was assessed using two specialty experts from the field of public health dentistry and was found to be satisfactory.
The translated Hindi version of OHIP-14 was administered to 400 selected participants.
- Individuals who were able to read and understand Hindi and English language
- Individuals who were above the age of 65 years and consented to participate in the study.
- Patients who were unwilling to take part in the study.
The same subjects were also provided with English OHIP-14 questionnaire. The Decayed Missing Filled Teeth (DMFT) was examined in each individual. The data collected were subjected to statistical analysis for validity and reliability of the questionnaire.
Reliability refers to the process of determining whether a measurement can yield consistent and reproducible results. It was assessed using test-retest reliability (intra-class correlation coefficient).
During reliability testing, all the individuals were provided with a self-administered Hindi version of OHIP-14. Participants were told to choose one option from the mentioned responses that immediately came into mind and that aptly represented their oral health. The same questionnaire was re-administered at 2 week interval, to evaluate the test–retest reliability of the Hindi version of OHIP-14.
The calibration of the examiner was tested using Cohen's kappa. Unpaired t-test was used to check the difference in the translated questionnaire as compared to original questionnaire. Further, Cronbach's α was used to determine the internal consistency of the questionnaire. This value was considered desirable and rated as good if it was at least 0.80. Correlation between both instruments was assessed using Pearson correlation coefficient. P < 0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS software vs. 23 for windows (New York, USA).
| Results|| |
In the present study, a pilot testing for Hindi version of OHIP-14 was carried out on 400 geriatric individuals (>65 years) who belonged to Durg, Chhattisgarh India. The mean age of the study population was 67.8 years. Out of 400 individuals, 200 were male and 200 were female, thus making a gender ratio of 1:1. Majority of individuals, i.e., 316 (79%) individuals were retired and stayed at home while the remaining 84 (21%) individuals were self-employed or in salaried jobs. Nearly 63% of the participating individuals had undergone previous dental treatment. Out of 400 participants, all the individuals were literate, had at least a high school education and had knowledge of both English and Hindi. Participant selection was based upon their ability to understand the questionnaire well and respond appropriately. Considering education level, 216 (54%) individuals had attended at least high school while the percentage of individuals attaining diploma and postgraduate level education were 71 (17.75%) and 113 (28.30%), respectively.
Comparative results of individual 14 questions from the English and Hindi version of OHIP-14 showed no significant difference. Similarly, comparative results of an entire questionnaire of original English OHIP-14 and Translated Hindi version of OHIP-14 showed no significant difference in an unpaired t-test (0.562) [Table 1].
|Table 1: Comparison of English and translated Hindi version of Oral Health Impact Profile-14 by unpaired t-test (group statistics)|
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The translated Hindi version of OHIP-14 revealed good internal reliability with a value of Cronbach's alpha ranging from 0.89 to 0.90 when words were deleted individually. The value of alpha and standardized alpha was 0.905 and 0.906, respectively [Table 2]. Moreover, results of Pearson correlation coefficient test showed very strong positive correlation (0.892) [Table 3].
|Table 2: Psychometric properties of the translated Hindi version of Oral Health Impact Profile-14 index in the pilot study; internal reliability analysis: Corrected item-total correlation, alpha, standardized alpha and alpha if item deleted (n=400)|
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|Table 3: Correlating English and translated Hindi version of Oral Health Impact Profile-14 by Pearson correlation coefficient|
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A very strong positive correlation was observed between the recorded OHIP-14 scores and DMFT scores of examined geriatric individuals (Pearson correlation coefficient = 0.952 and P = 0.001) [Table 4]. It was seen that the OHIP-14 scores were higher for those individuals who had higher DMFT scores.
|Table 4: Correlation between the examined oral health status and the Decayed Missing Filled Teeth scores|
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The present pilot testing of the translated Hindi version of OHIP-14 showed it is a valid tool for assessing the oral health-related quality of life in geriatric individuals.
| Discussion|| |
The present study revealed that the translated Hindi version of OHIP-14 is a valid and reliable instrument for assessing the oral health-related quality of life of geriatric individuals as that of the original version. In this study, the proper translation was achieved by forward and backward translation which was verified to be a genuine and appropriate translation of Hindi version of OHIP-14 by two experts in the field of public health dentistry well versed in both English and Hindi language.
Geriatric population imparts challenges for assessing their oral health-related quality of life by presenting difficulties in the lack of patience and understanding due to older age. Hence to measure the oral health-related quality of life of geriatric Indians, ideally, an instrument that is well understood and adapted has to be developed. However, it is time-consuming as well as a costly process. This practical difficulty can be overcome by translating and adapting already existing instrument in the local language (Hindi) which can be used to assess the oral health-related quality of life of geriatrics. The authors hereby attempted to translate English version of OHIP-14 to the Hindi language to achieve a Hindi version of OHIP-14 which can be used in the geriatric population.
Translation and adaption of OHIP-14 from English to the Hindi language was relatively simple and did not exhibit difference in meaning or context. Enormous literature is present which shows the reliability and validity of tested instruments to measure the oral health-related quality of life in adults, but there are only a few studies which had used this instrument and only one study which demonstrated translation and adaptation of this instrument.,,, To the author's best knowledge and belief, only one Indian study had translated and adapted OHIP-14 in Hindi Language and found to be a valid and reliable instrument to measure the oral health-related quality of life of adults.
In the present study, the results were tabulated and analyzed for an English and Hindi version of OHIP-14, and the authors found that the there was no statistical difference between the original English version of OHIP-14 and translated Hindi version of OHIP-14 (unpaired t-test results P = 0.562). This proved translated Hindi version of OHIP-14 to be a valid tool to measure the oral health-related quality of life of geriatrics.
Pearson correlation coefficient (0.892) was also high for both the versions of the instrument. Furthermore, a very strong positive correlation was observed when OHIP-14 score was compared with recorded DMFT scores of the study participants.
The criteria are that at least 80% correlation is needed for a translated instrument to be a valid version of the original instrument. However, correlation found between the original English version of OHIP-14 and translated Hindi version of OHIP-14 fulfilled this criteria (Pearson correlation = 0.892, i.e., 89.2%). Hence, unpaired t-test and very strong positive correlation showed the validity of translated Hindi version OHIP-14.
The translated Hindi version of OHIP-14 has been demonstrated to be a simple, valid, and reliable tool to measure the oral health-related quality of life of geriatric population who speak Hindi language. The translated Hindi version of OHIP-14 may be used for assessing the oral health-related quality of life and will help to identify patients with low degree quality of life, thereby allowing oral health-care policymakers to modify and plan oral health-care services to improve oral health-related quality of life of geriatric population by knowing the reason which predisposes such conditions.
| Conclusion|| |
The present study revealed a positive outcome by suggesting that Translated Hindi version OHIP-14 is a valid, reliable instrument and can be used for practical measurement of oral health-related quality of life in geriatric population. This study gives an idea about validity and reliability of translated Hindi version of OHIP-14. However, the outcome of the present study is preliminary and is based on a convenience sample, and further researches involving geriatric population is necessary to confirm the findings of our study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Swati Verma
W/o Sh. Ravi Baghel, 67 Arcadia Rd Apt B Hackensack, New Jersey - 07601, US
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]