Adaptation and Validation of the Malay Version of the Index of Dental Anxiety and Fear (IDAF-4C+) for Malaysian Secondary School Children

ABSTRACT

Background: Many questionnaires have been developed to measure dental anxiety andfear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of adental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module(IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children.Methods: This was a cross‑sectional validation study. The original English version of theIDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via anexpert validation and face validation by the target student population. Three hundred and seventyquestionnaires were then distributed among 16-year-old school children. Confirmatory factoranalysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihoodestimator. Spearman’s rank correlation was used to assess the relationship between the IDAF‑Sand IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of theIDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module.Results: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed theexistence of only one factor with a reliability estimate of 0.921, obtained via Raykov’s procedure.All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P <0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed modelwith absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showedsatisfactory stability, as assessed via kappa values.Conclusion: The Malay version of the IDAF-4C+ is valid and reliable in measuring dentalanxiety and fear among Malaysian secondary school children.