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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 1  |  Page : 44-48

Development of Valid and Reliable Tools for Pediatricians' Knowledge and Self-Perceived Competency Towards Oral Health of Children in Turkey


1 Department of Biostatistics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
2 Department of Pedodontics, Faculty of Dentistry, Bursa Uludag University, Bursa, Turkey
3 Department of Pediatrics, Special Medicana Bursa Hospital, Bursa, Turkey

Date of Submission16-Feb-2021
Date of Acceptance06-Aug-2021
Date of Web Publication19-Jan-2022

Correspondence Address:
Dr. G Ozkaya
Department of Biostatistics, Faculty of Medicine, Bursa Uludag University, Bursa
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_81_21

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   Abstract 


Background: This study aimed to develop a valid and reliable questionnaire of knowledge about oral health in childhood and a scale of self-perceived competency for pediatricians. In this way, the contributions of Turkish pediatricians on oral health in childhood and their effects on children's oral health and caregivers will be evaluated. Subjects and Methods: Items were generated from published scientific literature, other questionnaires, and interviewing notes with the pedodontists. The study group examined publications on the preventive oral health of children, and they included items related to children in the item pool. The initial knowledge questionnaire consisted of 23 items and 10 items for the self-perceived competency scale. The content validity of the questionnaire and scale were determined by the assessments of the expert team. The internal consistency of the knowledge questionnaire and test-retest reliability of the self-perceived competency scale was examined. Results: Thirty pediatricians took part in the study. The pediatricians were: 63.3% (n = 19) female and 36.7% (n = 11) male; their mean age was 37.97 ± 3.86 years. Most of the pediatricians were specialists with 83.4% (n = 25). The medical specialization of all pediatricians was university and the working year mean was 10.93 ± 4.28. The knowledge questionnaire had 10 items after content validity and internal consistency reliability investigations. The initial number of items for the self-perception level scale was 10. We excluded five items due to the content validity index. ICC value for 5-item self-perception level scale was calculated as 0.816 (95% CI: 0.606–0.914). Therefore, the scale has a good reliability level. Conclusion: Our knowledge questionnaire and self-perceived competency scale provide a validated and reliable tool in the assessment of pediatricians' knowledge and competency regarding oral health. Pediatricians can test themselves using this knowledge questionnaire and self-perceived competency scale.

Keywords: Knowledge, pediatricians, preventive oral health, reliability, validity


How to cite this article:
Ozkaya G, Cubukcu C E, E Ozdel Z G. Development of Valid and Reliable Tools for Pediatricians' Knowledge and Self-Perceived Competency Towards Oral Health of Children in Turkey. Niger J Clin Pract 2022;25:44-8

How to cite this URL:
Ozkaya G, Cubukcu C E, E Ozdel Z G. Development of Valid and Reliable Tools for Pediatricians' Knowledge and Self-Perceived Competency Towards Oral Health of Children in Turkey. Niger J Clin Pract [serial online] 2022 [cited 2022 Dec 3];25:44-8. Available from: https://www.njcponline.com/text.asp?2022/25/1/44/335995




   Introduction Top


Although, there was a reduction in the mean decayed/missing/filled primary teeth (dmft) index from 4.4 to 3.7 for 5- and 6-year-olds and 2.7 to 1.9 decayed/missing/filled permanent teeth (DMFT) index for 12-year-olds during the past 17 years in Turkey, dental caries is a disease which still has been considering as a real public health problem.[1],[2],[3],[4],[5],[6] It is believed that the frequency of caries contributes to limited knowledge of oral hygiene and preventive dental care, as well as difficulty accessing it. Wealthy white children are less likely to have untreated tooth decay than poor and minority children.[7] Untreated decay can cause problems, such as eating, speaking, and participating in learning. Poor children suffer 12 times the number of restricted activity days caused by dental problems, compared with more wealthy children.[8] Pediatricians can play a meaningful role in improving the dental health of their patients who have difficulty in accessing dental care by providing information on the protection of oral health during the examination. It will provide many advantages in cases where most children do not go to the dentist after the age of 3 and poor children cannot access dental services. Regular and early preventive visits to pediatricians or primary care providers, taking place in a recognized program in infancy, allow early assessment of oral health. Pediatricians and other primary care providers routinely discuss age-appropriate forward guidance on a range of issues other than the prevention and early identification of health problems. The counseling and support provided may include caries prevention counseling, assessment for dental problems, or even the provision of a caries control treatment such as the application of fluoride varnish. Fluoride varnish can be applied to children's teeth easily and quickly. According to a meta-analysis on fluoride varnish, it has been shown to lead to a 38% reduction in tooth decay when administered at least twice a year.[9] Counseling by pediatricians and primary care providers to families on basic oral hygiene is recommended by various sources on health supervision for children.[10],[11] However, the level of knowledge pediatricians have about preventive oral health is not clear. Besides, perspectives on prevention and evaluation may differ. In addition, little is thought about the incidence of dental issues in pediatric practice and whether pediatricians see boundaries to their patients' getting proficient dental consideration. At last, it is critical to know how pediatricians esteem the advancement of oral wellbeing and whether they would take on extra exercises focused on its improvement. We tended to these inquiries in a territorial study of pediatricians. The development of a valid and reliable tool to assess the knowledge level and self-perceived competency of pediatricians would prove valuable. To develop a questionnaire and/or scale which have validity and reliability to measure attributes a defined set of criteria needs to be met.[12] A planned process should be followed and a series of measures must be performed to examine questionnaire validity and reliability.[12],[13]

This study was conducted with designing and evaluation of the validity and reliability of knowledge questionnaire and self-perceived competency. The aim of this study was to develop a valid and reliable questionnaire of knowledge about oral health in childhood and a scale of self-perceived competency for pediatricians. In this way, the contributions of Turkish pediatricians on oral health in childhood and their effects on children's oral health and caregivers will be evaluated.


   Material and Methods Top


We conducted a cross-sectional study by means of a self-administered questionnaire and scale in our Faculty of Dentistry, Department of Pedodontics. The study was voluntary, with no identifiable information such as pediatricians' or institutions' name collected. Ethical approval was taken from the Bursa Uludag University, Faculty of Medicine, Clinical Researches Ethics Committee (Date 30 September 2020; Number: 2020-17/11). We conducted this study according to the principles of the Declaration of Helsinki.

Our study group generated items from published scientific literature, other questionnaires, and interviewing notes with the pedodontists. Study group examined publications on the preventive oral health of children and they included items related to children in the item pool. At the interview with the pedodontists, the opinions about the important information that should be known about child's oral health were included in the item pool. The initial knowledge questionnaire consisted of 23 items and 10 items for self-perceived competency scale. The knowledge questionnaire items have three response options: “yes”, “no” and “I don't know”. “I don't know” option was included to be an option in case of indecision, to differentiate false knowledge from lack of knowledge, and reduce the probability of respondents giving correct answers by chance.[14] The self-perceived competency scale consisted of 10 items. Likert scale (1: “not competent,” 2: “little competence,” 3: “somewhat competent,” 4: “competent,” and 5: “very competent”) was used for scoring each of the competency item.

The content validity of questionnaires can be determined using the assessments of the expert team. The recommended number of experts to review an instrument varies from 2 to 20 individuals.[15] At least 5 expert were suggested to review the instrument to have sufficient control over chance agreement.[16] Content validity was determined using a number of experts (n = 10). Expert team of this study consisted of two senior academician pedodontist, three pedodontist, two senior academician pediatrician, two pediatrician and a biostatistician. Experts were asked to rate knowledge questionnaire and self-perceived competency items in terms of clarity and its relevancy to the construct underlying study on a 4-point ordinal scale (1: Not relevant/clear, 2: Somewhat relevant/clear, 3: Quite relevant/clear, 4: Highly relevant/clear). The experts were also asked to make recommendations for improving the questionnaire. Many rounds were conducted as necessary until consensus was reached on all items. The experts also contributed to making suggestions for improving the questionnaire. The content validity index (CVI) is the mostly given index for content validity in instrument development. The CVI measures the proportion of experts who are agree on items and can be computed using the Item-CVI (I-CVI). I-CVI is processed as the quantity of experts giving a rating of “highly relevant” for each item divided by the number of experts. I-CVI range from 0 to 1 where I-CVI > 0.79, the item is relevant, somewhere in the range of 0.70 and 0.79, the item needs updates, and if I-CVI is underneath 0.70 the item is omitted.[16],[17],[18]

The internal consistency of the knowledge questionnaire was calculated Kuder–Richardson formula 20 (KR-20) and the minimum acceptable value was considered at 0.70.[19] We aimed to assess whether our knowledge questionnaire could measure pediatricians' dental health knowledge, the scores were considered as dichotomic “True/False”, an “I don't know” answer was considered as incorrect. Missing data were also considered as incorrect because it was not possible to assess the pediatrician's knowledge. Also, test–retest reliability was used to measure the stability of the of the self-perceived competency scale using an intraclass correlation coefficient (ICC) estimate.[20] Pediatrician filled the self-perceived competency scale twice with three weeks interval. ICC > 0.75 indicates a good agreement for intra-observer reliability.[17],[21],[22]

Reliability analysis was performed with IBM SPSS ver. 23.0 (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). The internal consistency of questionnaire was calculated KR-20. Intraclass correlation coefficient (ICC) estimate with 95% confidence interval (95% CI) was calculated for the test–retest reliability. Corrected item-total correlation (ITC) were calculated to define the relation of items with the total scores. Corrected ITC > 0.20 were considered satisfactory.[23],[24],[25] In the first test, we sent the knowledge questionnaire and self-perceived competency scale to 45 pediatricians. The number of pediatricians who responded the questions in retest application 3 weeks later was 30. Descriptive statistics for socio-demographic characteristics were given as mean ± standard deviation and frequency with percentage.


   Results Top


Thirty pediatricians took part in the study. The pediatricians were: 63.3% (n = 19) female and 36.7% (n = 11) male; their mean age was 37.97 ± 3.86 years. Most of the pediatricians were specialists with 83.4% (n = 25). The medical specialization of all pediatrician was university and the working year mean was 10.93 ± 4.28. Also, pediatricians' responses to other questions like the current institution, presence of a dentist at the current institution, “Regarding tooth development, dental caries, and oral care…” and routine information about oral and dental health patients were given in [Table 1].
Table 1: Socio-demographic characteristics

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The initial number of items for the knowledge questionnaire was 23. For the content validity of the knowledge questionnaire, we excluded 6 items from the questionnaire because the I-CVI of items was below <0.70. The knowledge questionnaire has validity as the remaining 17 items have I-CVI greater than 0.80 [Table 2]. The clarity of the 17-item questionnaire was evaluated by an expert team on a 4-point ordinal scale. Each of 17 items was found highly clear (>0.80). The internal consistency of the 17-item knowledge questionnaire was calculated with KR-20. Seven items were omitted due to low corrected ITC < 0.2. The reliability of the retained 10-items was computed as KR-20 > 0.70 and their relatedness as corrected ITC > 0.2 were considered satisfactory. One of the main reasons for developing the knowledge questionnaire is to have an instrument that will give a single score to quantify knowledge of pediatricians about preventive oral health. In the knowledge questionnaire items are scored + 1 if the correct answer is given and 0 otherwise. Therefore, it ranges from 0 to 10. The final version of knowledge questionnaire was presented as supplementary material.
Table 2: Pediatricians' item-content validity index of knowledge questionnaire

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Besides, the initial number of items for self-perception level scale was 10. Five items were excluded from the scale due to the lower I-CVI [Table 3]. The final version of self-perception level scale had 5 items. The 5-item scale has validity with high I-CVI. Also, the clarity of the 5-item scale was evaluated by an expert team like knowledge questionnaire. Each of 5 items was found highly clear (>0.80). Test–retest reliability for the self-perception level scale was examined with ICC. ICC value for 5-item self-perception level scale was calculated as 0.816 (95% CI: 0.606-0.914). Therefore, the scale has good reliability level. Total self-perceived competency scale ranged from 5 to 25, with higher scores reflecting greater self-perceived competence. reflecting greater self-perceived competence. The last version of self-perception level scale was presented as supplementary material. Reflecting greater self-perceived competence. The last version of self-perception level scale was presented as supplementary material.
Table 3: Pediatricians' item-content validity index of self-perception level scale

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   Discussion Top


The aim of the present study was to develop a valid and reliable knowledge questionnaire and self-perceived competency scale which can be used as a practical tool to assess pediatricians' knowledge and self-perceived competency. The knowledge, attitudes and professional experiences of pediatricians about oral health have been the subject of various publications with different perspectives. Lewis et al.[26] discussed the results of a national survey in the USA in their article published in 2000. They used a survey instead of scales to measure physicians' knowledge of oral health. Similarly, Rabiei et al.[27] used a questionnaire to discuss the opinions of pediatricians in their study in Iran in 2012. In another study, Sánchez et al.[28] compared the knowledge, attitudes, and beliefs of pediatricians and family physicians in Alabama.

In addition, some studies have been conducted on oral health knowledge in our country. Erdem et al.[21] evaluated Turkish dental students' knowledge, attitude, and self-perceived competency towards preventive dentistry in their study. They developed a valid and reliable scale for dental students. Ozveren et al.[29] examined the knowledge, attitude, training, and practices of pediatricians about the prevention of oral diseases in the Thrace region. Unlike our study, they used a survey instead of developing a valid and reliable tool. The relationship of each question was examined in their study.

In summary, we developed a tool to measure the level of knowledge and self-efficacy of pediatricians, while many publications evaluate the oral health of children differently. This study should be interpreted carefully because it is a cross-sectional study conducted mostly in one region. Future studies will need to extend the sample to other regions, institutions, and degrees to verify its validity and reliability. We planned to carry out these studies in future work. Longitudinal studies should also be conducted to determine how the pediatricians' level of knowledge develops and to include an assessment of self-perceived competency level.

In conclusion, oral health is an important part of the health and wellbeing of children. Oral health should be considered in routine health screenings, prospective guidance and physical examination of all children. Pediatricians can increase their knowledge and skills in oral health and can incorporate oral health into pediatric primary care. Our knowledge questionnaire and self-perceived competency scale provides validated and reliable tool in the assessment of pediatricians' knowledge and competency regarding oral health. The included questions cover a broad range of preventive oral health topics. Pediatricians can evaluate themselves using these scales knowledge questionnaire and self-perceived competency scale.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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