Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents

Abstract The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).

Resumo O estudo teve o objetivo de adaptar transculturalmente o Digital Health Literacy Instrument (DHLI) para adolescentes nativos do idioma português do Brasil (DHLI-BrA). O estudo de adaptação transcultural consistiu nas seguintes etapas: tradução, avaliação e adequação de equivalência cultural da tradução por comitê de especialistas; retrotradução e síntese das retrotraduções. Foi realizada a testagem cognitiva em pré-teste com adolescentes, utilizando-se entrevistas cognitivas com perguntas de sondagem sobre a compreensão e interpretação dos itens e opções de resposta. O alfa de Cronbach e ômega de McDonald's foram utilizados para estimar a confiabilidade do instrumento. Participaram do pré-teste 42 adolescentes brasileiros com média de idade de 16,0 ± 2,0 (variação de 13-19) anos. Os itens com dificuldade de compreensão foram adaptados ao contexto dos adolescentes brasileiros. O coeficiente alfa de Cronbach e o ômega de McDonald's, para os 21 itens do DHLI-BrA foi respectivamente, 0,79 e 0,80. O coeficiente alfa de Cronbach para as subescalas do instrumento de autorrelato foi de 0,53-0,79 (variação), demonstrando boa confiabilidade no instrumento total e confiabilidade moderada nas subescalas. Este estudo fornece a versão adaptada transculturalmente do Digital Health Literacy Instrument (DHLI), um instrumento de mensuração do letramento digital em saúde, para utilização em adolescentes brasileiros (DHLI-BrA).

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

Abstract The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Fatores associados à autoavaliação de saúde bucal por adultos em hemodiálise / Factors associated with self-rated oral health in adults with hemodialysis

Resumo Introdução Pacientes com insuficiência renal crônica podem apresentar prejuízos em sua saúde bucal em decorrência da própria doença, do tratamento e das alterações de estilo de vida associadas. Objetivo Avaliar os fatores associados à autoavaliação de saúde bucal ruim entre adultos com insuficiência renal crônica submetidos à hemodiálise. Método Estudo transversal com 243 adultos submetidos à hemodiálise em um hospital do sul de Minas Gerais nos anos de 2013 e 2014. O desfecho foi avaliado pelo autorrelato da condição bucal dicotomizada em boa (ótima/boa) e ruim (regular/ruim/péssima). As variáveis independentes incluíram condições sociodemográficas, saúde geral, saúde bucal e uso de serviços odontológicos, a partir de informações coletadas por meio de questionário. A associação entre o desfecho e as variáveis independentes foi testada por meio de modelos logísticos múltiplos com inclusão hierarquizada de variáveis. Resultados A prevalência de autoavaliação de saúde bucal ruim foi de 35,4%. Os mais jovens (p = 0,015), os que se submetem à hemodiálise há menos tempo (p = 0,016), têm halitose (p <0,001), necessitam de tratamento odontológico (p <0,001) e tiveram a última consulta odontológica por motivo diferente de dor (p = 0,027) expressaram maiores chances de autoavaliação de saúde bucal ruim, independentemente de condições sociodemográficas e de saúde. Conclusão Condições sociodemográficas, tempo em hemodiálise, agravos à saúde bucal e uso de serviços odontológicos influenciaram a autoavaliação da saúde bucal dos adultos submetidos à hemodiálise.

Abstract Background Patients with chronic renal failure may have their oral health impaired as a result of the disease itself, its treatment, and its associated lifestyle alterations. Objective To assess the factors associated with poor self-rated oral health among adults with chronic renal failure treated by hemodialysis. Method This is a cross-sectional study with 243 adults undergoing hemodialysis in a hospital in Minas Gerais, Brazil in 2013-2014. The outcome was assessed by the self-report of oral health categorized into good (excellent/good) and bad (fair/bad / very bad). The independent variables included sociodemographic conditions, general health, oral health, and the use of dental services were collected through a structured questionnaire. The association between the outcome and the independent variables was tested using multiple logistic models with hierarchical inclusion of variables. Results The prevalence of poor self-rated oral health was 35.4%. The youngest (p = 0.015), those who have undergone hemodialysis in the shortest time (p = 0.016), have halitosis (p <0.001), need dental treatment (p <0.001), and had their last dental appointment not for pain (p = 0.027) expressed higher odds of poor self-rated oral health, independently of sociodemographic and health conditions. Conclusion Sociodemographic conditions, time on hemodialysis, oral impairments, and use of dental services affected the oral health self-assessment among adults undergoing hemodialysis.

Adaptação transcultural e avaliação das propriedades psicométricas de dois instrumentos de letramento digital em saúde para adolescentes brasileiros: eHealth Literacy Scale e Digital Health Literacy Instrument / Cross-cultural adaptation and evaluation of the psychometric properties of two digital health literacy instruments for brazilian adolescents: eHealth Literacy Scale and Digital Health Literacy Instrument

Com a ampliação do acesso à internet e digitalização dos serviços de saúde, os usuários adolescentes devem apresentar um conjunto de habilidades para seu uso adequado, o chamado Letramento Digital em Saúde (LDS). O objetivo deste estudo foi adaptar transculturalmente e avaliar as propriedades psicométricas de dois instrumentos de LDS, eHealth Literacy Scale (eHEALS) e Digital Health Literacy Instrument (DHLI), para adolescentes brasileiros. O instrumento eHEALS é uma medida de oito itens que mensura a autopercepção relacionada ao LDS. O instrumento DHLI é composto por 21 itens de autorrelato e por sete itens de habilidades que avaliam o desempenho prático do indivíduo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais. A amostra foi composta por indivíduos de 13 a 19 anos, matriculados em escolas públicas de Belo Horizonte, MG, Brasil. Os instrumentos eHEALS e DHLI foram previamente traduzidos e adaptados para adultos brasileiros. Utilizamos as versões brasileiras dos intrumentos e foram realizadas as seguintes etapas metodológicas: comitê de especialistas; retro-tradução; síntese das retrotraduções; avaliação dos autores originais; pré-teste com 42 adolescentes utilizando-se entrevistas cognitivas com perguntas de sondagem e produção da versão final em português direcionada para adolescentes. Um total de 260 adolescentes participaram do teste e responderam aos instrumentos de LDS, eHEALS e DHLI direcionados para adolescentes do Brasil (eHEALS-BrA e DHLI-BrA), aos instrumentos de letramento em saúde, Newest Vital Sign (NVS-BR) e Rapid Estimate Adult Literacy in Medicine and Dentistry (REALMD-20), um instrumento de qualidade de vida, World Health Organization Quality of Life-Bref (WHOQOL-bref), e um questionário sociodemográfico, de acesso à internet e uso de eSaúde. Além disso, após 15 dias, 67 adolescentes responderam novamente ao eHEALS-BrA e ao DHLI-BrA. A confiabilidade do instrumento foi testada através da consistência interna (alfa de Cronbach e Ômega de McDonald's) e da confiabilidade teste-reteste. Análise fatorial confirmatória (AFC) avaliou a dimensionalidade do instrumento e a validade foi testada pelas associações entre os scores do eHEALS-BrA e DHLI-BrA com as variáveis de interesse (p<0,05). O eHEALS-BrA demonstrou boa confiabilidade interna (α e ω=0,71) e boa estabilidade (ICC=0.82, 95% CI:0,70-0,89). Testes preliminares mostraram que os dados eram adequados para análise dos componentes principais: KMO=0,78 e teste de esfericidade de Barlett (p<0,001). O modelo mais bem ajustado na AFC foi composto por um fator único (χ²=49,884 (p=0,0002), CFI=0,934, TLI=0,908, RMSEA=0,076 e RMSR=0,045). O DHLI-BrA autorrelatado demonstrou confiabilidade interna satisfatória (α e ω = 0,83) e boa estabilidade (ICC=0,906 (IC 95%: 0,75-0,95). Na AFC, o modelo mais bem ajustado foi composto por seis fatores (χ²=229,173 (p=0,0032), CFI=0,944, TLI=0,933, RMSEA=0,035 e RMSR=0,047). O DHLI-BrA baseado em desempenho demonstrou confiabilidade interna satisfatória (α=0,57 e ω =0,58) e boa estabilidade (ICC=0,86; IC 95%: 0,76-0,92). Na AFC o modelo mais bem ajustado foi composto por um fator único (χ²=17,901 (p=0,2113), CFI= 0,952; TLI= 0,927; RMSEA=0,033; RMSR=0,038). Conclui-se que as versões produzidas dos instrumentos eHEALS-BrA e DHLI-BrA demonstraram boas propriedades psicométricas para a mensuração do LDS em adolescentes do Brasil.

With the expansion of internet access and digitization of health services, adolescent users must have a set of skills for their proper use, called Digital Health Literacy (DHL). The objective of this study was to cross-culturally adapt and evaluate the psychometric properties of two DHL instruments, eHealth Literacy Scale (eHEALS) and Digital Health Literacy Instrument (DHLI), for Brazilian adolescents. The eHEALS instrument is an eight-item measure that assesses DHL self-perception. The DHLI instrument consists of 21 self-report items and seven skill items that assess the individual's practical performance. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais. The sample consisted of individuals aged 13 to 19 years, enrolled in public schools in Belo Horizonte, MG, Brazil. The eHEALS and DHLI instruments were previously translated and adapted for Brazilian adults. We used the Brazilian versions of the instruments and the following methodological steps were performed: expert committee; back-translation; synthesis of back-translations; evaluation by original authors; pre-test with 42 adolescents using cognitive interviews with probing questions and production of the final Portuguese version directed at adolescents. A total of 260 adolescents participated in the testing phase and answered DHL instruments, eHEALS and DHLI directed at Brazilian adolescents (eHEALS-BrA and DHLI-BrA), health literacy instruments, Newest Vital Sign (NVS-BR) and Rapid Estimate Adult Literacy in Medicine and Dentistry (REALMD-20), a quality-of-life instrument, World Health Organization Quality of Life-Bref (WHOQOL-bref), and a sociodemographic questionnaire, internet access and use of eHealth. In addition, after 15 days, 67 adolescents responded again to eHEALS-BrA and DHLI-BrA. The instrument's reliability was tested through internal consistency (Cronbach's alpha and McDonald's omega) and test-retest reliability. Confirmatory factor analyses (CFA) evaluated the instrument's dimensionality and the validity was tested by associations between the eHEALS-BrA and DHLI-BrA scores and variables of interest (p<0.05). eHEALS-BrA demonstrated good internal reliability (α and ω=0.71) and good stability (ICC=0.82, 95% CI:0.70-0.89). Preliminary tests showed that the data were adequate for principal component analysis: KMO=0.78 and Barlett's sphericity test (p<0.001). The best-fitting model in CFA consisted of a single factor (χ²=49.884 (p=0.0002), CFI=0.934, TLI=0.908, RMSEA=0.076, and RMSR=0.045). The self-report items of DHLI-BrA demonstrated satisfactory internal reliability (α and ω = 0.83) and good stability (ICC=0.906 (IC 95%: 0.75-0.95). In CFA, the best-fitting model consisted of six factors (χ²=229.173 (p=0.0032), CFI=0.944, TLI=0.933, RMSEA=0.035, and RMSR=0.047). Performance-based DHLI-BrA demonstrated satisfactory internal reliability (α=0.57e ω =0.58) and good stability (ICC=0.86; IC 95%: 0.76-0.92). In CFA the best-fitting model consisted of a single factor (χ²=17,901 (p=0,2113), CFI= 0,952; TLI= 0,927; RMSEA=0,033; RMSR=0,038). It is concluded that the versions of eHEALS-BrA and DHLI-BrA instruments produced demonstrated good psychometric properties for measuring DHL in Brazilian adolescents.