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      Development and evaluation of CARIES-QC: a caries-specific measure of quality of life for children

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          Abstract

          Background

          Existing paediatric oral health-related quality of life (OHRQoL) measures are generic instruments designed to evaluate a range of oral conditions. It has been found that disease-specific measures may be more adept at detecting subtle changes which occur following treatment of the condition in question. Furthermore, existing self-report OHRQoL measures have not involved children at all stages of development of the measure. The aim of this study was to develop a caries-specific measure of quality of life for children.

          Methods

          The first stage of the study involved a qualitative enquiry with children, aged 5–16 years, to inform the development of the measure. Children generated the potential items, contributed to item reduction and questionnaire design and participated in the testing of face and content validity. The resulting measure was evaluated in a cross-sectional validation study. Ethical approval was granted for the study.

          Results

          The qualitative study found that children discussed a number of caries-related impacts which affected their daily lives. These were incorporated into a draft measure which was further refined following testing of face and content validity. This resulted in the production of the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC), comprising 16 items and one global question. Two hundred participants with a mean (range) age of 8.1 (5–16) years took part in the further evaluation of CARIES-QC. Four items, which did not fit the Rasch model, were removed from further analysis. The remaining 12 items demonstrated good internal consistency (alpha = 0.9) and the total score showed significant correlations with the number of decayed teeth, presence of pain, pulpal involvement, the Child Perceptions Questionnaire (16-item short form) and the global score ( p < 0.01, Spearman’s rho).

          Conclusion

          In conclusion, children’s input allowed the development of a valid and reliable child-centred caries-specific quality of life measure. CARIES-QC can now be used to evaluate which interventions for dental caries are most effective in reducing impacts from the child’s perspective.

          Electronic supplementary material

          The online version of this article (10.1186/s12903-018-0662-8) contains supplementary material, which is available to authorized users.

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          Most cited references56

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          Qualitative data analysis for applied policy research

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            What do measures of 'oral health-related quality of life' measure?

            The terms 'health-related quality of life' and 'quality of life' are now in common use to describe the outcomes of oral health conditions and therapy for those conditions. In addition, there has been a proliferation of measures designed to quantify those outcomes. These measures, which were initially designated as socio-dental indicators or subjective oral health indicators are now more usually referred to as measures of oral health-related quality of life (OH-QoL). This is based on the assumption that the functional and psychosocial impacts they document must, of necessity, affect the quality of life. While this assumption has been subject to critical scrutiny in medicine, this is not the case with dentistry. Consequently, exactly what is being measured by indexes of OH-QoL is somewhat unclear. Based on the debate between Gill and Feinstein and Guyatt and Cook, we outline a number of criteria by means of which the construct addressed by measures of OH-QoL may be assessed. These are concerned with how the measures were developed and validated. These criteria are then used to appraise five of the many measures that have been developed over the past 20 years--the GOHAI, OHIP, OIDP, COHQoL and OH-QoL. The main conclusion is that while all document the frequency of the functional and psychosocial impacts that emanate from oral disorders they do not unequivocally establish the meaning and significance of those impacts. Consequently, the claim that oral disorders affect the quality of life has yet to be clearly demonstrated. Verifying this claim requires further qualitative studies of the outcomes of oral disorders as perceived by patients and persons, and the concurrent use of measures that more explicitly address the issue of quality of life.
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              Validity and reliability of a questionnaire for measuring child oral-health-related quality of life.

              Oral-health-related quality of life measures that exist are designed for adults. This study aimed to develop and evaluate the CPQ(11-14), a self-report measure of the impact of oral and oro-facial conditions on 11- to 14-year-old children. An item pool was generated with the use of a literature review and interviews with health professionals, parents, and child patients. The 36 items rated the most frequent and bothersome by 83 children were selected for the CPQ(11-14). Validity testing involved a new sample of 123 children. Test-retest reliability was assessed in a subgroup of these children (n = 65). Mean CPQ(11-14) scores were highest for oro-facial (31.4), lower for orthodontic (24.3), and lowest for pedodontic (23.3) patients. There were significant associations between the CPQ(11-14) score and global ratings of oral health (p < 0.05) and overall well-being (p < 0.01). The Cronbach's alpha and intraclass correlation coefficient for the CPQ(11-14) were 0.91 and 0.90, respectively. These results suggest that the CPQ(11-14) is valid and reliable.
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                Author and article information

                Contributors
                0114 275 9326 , f.gilchrist@sheffield.ac.uk
                h.d.rodd@sheffield.ac.uk
                c.deery@sheffield.ac.uk
                z.marshman@sheffield.ac.uk
                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                4 December 2018
                4 December 2018
                2018
                : 18
                : 202
                Affiliations
                ISNI 0000 0004 1936 9262, GRID grid.11835.3e, School of Clinical Dentistry, , University of Sheffield, ; Claremont Crescent, Sheffield, S10 2TA England
                Author information
                http://orcid.org/0000-0002-0418-6274
                Article
                662
                10.1186/s12903-018-0662-8
                6280387
                30514353
                773c5cdd-0c80-4ebe-bba5-865e32f70bfd
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 April 2017
                : 12 November 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000659, Research Trainees Coordinating Centre;
                Award ID: DRF-2012-05-466
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Dentistry
                child,dental caries,quality of life,qualitative research,outcome assessment
                Dentistry
                child, dental caries, quality of life, qualitative research, outcome assessment

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