Validation of the internal structure of theBrazilian Dental Vulnerability Scale
DOI:
https://doi.org/10.11606/s1518-8787.2023057005360Keywords:
Oral Health, Primary Health Care, Population Health ManagementAbstract
OBJECTIVE: Th is s tudy a imed t o e valuate e vidence of v alidity of i nternal s tructure of t he Brazilian Dental Vulnerability Scale (EVO-BR) when applied in Brazil.
METHODS: This is a psychometric study that seeks to validate a scale elaborated by evidence of internal structure. Data collection was conducted in 18 basic health units that implement the Brazilian Healthcare Planning (PAS) methodology, across the five regions of Brazil. The initial version of the EVO-BR contained 41 items that measured dental vulnerability and was applied to users of the Brazilian Unified Health System (SUS) aged 18 years or older who were in basic health units for consultation with higher education professionals. To evaluate the evidence, the following statistical analyses were performed: exploratory factor analysis, confirmatory factor analysis, and network analysis.
RESULTS: A total of 1,753 users participated in the study. To adjust the sample, we considered the factorability obtained from Kaiser-Meyer-Olkin (KMO) test = 0.65, Bartlett sphericity test = 8019.7, and a matrix determinant of 0.008. The initial parallel analysis indicated a four-dimensional model and had the items adjusted according to factor loading (ranging from 0.38 to 0.99), common factors (0.13 to 0.89), and Pratt’s measure, until the model presented congruence in the statistical and interpretative principles simultaneously. The final model contained 15 items, maintaining the four dimensions indicated by the parallel analysis, and held an explained variance of 68.56%.
CONCLUSIONS: The EVO-BR is a validated scale to measure dental vulnerability and, thus, can contribute to the organization of access to the oral health team in primary health care (PHC) by stratifying the population, as recommended in the Brazilian Healthcare Planning.
References
Mendes EV. As redes de atenção à saúde. 2a ed. Brasília, DF: Organização Pan-Americana da Saúde; 2011.
Palacio DD, Rebustini F, Oliveira DB, Peres Neto J, Sanches TP, Mafra AC, et al. The concept of dental vulnerability in Brazil. Res Soc Dev. 2021;10(9):e30310917792. https://doi.org/10.33448/rsd-v10i9.17792.
Palacio DC, Rebustini F, Oliveira DB, Peres Neto J, Barbieri W, Sanchez TP, et al. Dental vulnerability scale in primary health care: evidence of content and structure internal validity. BMC Oral Health. 2021 Aug;21(1):421. https://doi.org/10.1186/s12903-021-01742-6
Cho SJ, Li F, Bandalos D. Accuracy of the parallel analysis procedure with polychoric correlations. Educ Psychol Meas. 2009;69(5):748-59. https://doi.org/10.1177/0013164409332229
Dobriban E, Owen AB. Deterministic parallel analysis: an improved method for selecting factors and principal components. J R Stat Soc Series B Stat Methodol. 2019;81(1):163–83. https://doi.org/10.1111/rssb.12301
Urbano L-S. Promin: a method for oblique factor rotation. Multivariate Behav Res. 1999;34(3):347-65. https://doi.org/10.1207/S15327906MBR3403_3
Quinn HC. Bifactor models, Explained Common Variance (ECV), and the usefulness of scores from unidimensional item response theory analyses [thesis]. Chapell Hill: University of North Carolina; 2019.
HAIR JR JF. et al. Multivariate data analysis. In: Multivariate data analysis. 2010; 785.
Wu AD, Zumbo BD, Marshall SK. A method to aid in the interpretation of EFA results: an application of Pratt’s measures. Int J Behav Dev. 2014;38(1):98-110. https://doi.org/10.1177/0165025413506143.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297-334. https://doi.org/10.1007/BF02310555.
Woodhouse B, Jackson PH. Lower bounds for the reliability of the total score on a test composed of non-homogeneous items: II: a search procedure to locate the greatest lower bound. Psychometrika. 1977;42(4):579-91.
https://doi.org/10.1007/BF02295980
McDonald RP. Test theory: a unified treatment. New York: Psychology Press; 2013.
Ferrando PJ, Lorenzo-Seva U. A note on improving EAP trait estimation in oblique factor-analytic and item response theory models. Psicologica (Valencia). 2016 Jan;37(2):235–47.
Mullarkey MC, Marchetti I, Beevers CG. Using network analysis to identify central symptoms of adolescent depression. J Clin Child Adolesc Psychol. 2019 Jul-Aug;48(4):656-68. https://doi.org/10.1080/15374416.2018.1437735.
Liang Y, Li F, Zhou Y, Liu Z. Evolution of the network pattern of posttraumatic stress symptoms among children and adolescents exposed to a disaster. J Anxiety Disord. 2021 Jan;77:102330. https://doi.org/10.1016/j.janxdis.2020.102330
Haws JK, Brockdorf AN, Gratz KL, Messman TL, Tull MT, DiLillo D. Examining the associations between PTSD symptoms and aspects of emotion dysregulation through network analysis. J Anxiety Disord. 2022 Mar;86:102536. https://doi.org/10.1016/j.janxdis.2022.102536
Borsboom D. Possible futures for network psychometrics. Psychometrika. 2022 Mar;87(1):253-65. https://doi.org/10.1007/s11336-022-09851-z
Yeung AW, Leung WK. Citation network analysis of dental implant literature from 2007 to 2016. Int J Oral Maxillofac Implants. 2018;33(6):1240-6. https://doi.org/10.11607/jomi.6727
Newman M. Networks: an introduction. Oxford: Oxford University Press; 2010.
https://doi.org/10.1093/acprof:oso/9780199206650.001.0001
Zhao T, Liu H, Roeder K, Lafferty J, Wasserman L. The huge package for high-dimensional undirected graph estimation in R. J Mach Learn Res. 2012 Apr;13(1):1059–62. PMID:26834510
Friedman J, Hastie T, Tibshirani R. Sparse inverse covariance estimation with the graphical lasso. Biostatistics. 2008 Jul;9(3):432-41. https://doi.org/10.1093/biostatistics/kxm045
Fruchterman T, Reingold E. Graph drawing by force-directed placement. Software: Practice and Experience.1991;21(1):1129-64. https://doi.org/10.1002/spe.4380211102
Fonseca-Pedrero E, Ortuño J, Debbané M, Chan RC, Cicero D, Zhang LC, et al. The network structure of schizotypal personality traits. Schizophr Bull. 2018 Oct;44 suppl_2:S468-79. https://doi.org/10.1093/schbul/sby044
Robinaugh DJ, Millner AJ, McNally RJ. Identifying highly influential nodes in the complicated grief network. J Abnorm Psychol. 2016 Aug;125(6):747–57. https://doi.org/10.1037/abn0000181
Hu Z, Lin L, Wang Y, Li J. The integration of classical testing theory and item response theory. Psychology. 2021 Sep;12(9):1397-409. https://doi.org/10.4236/psych.2021.129088
Schlechter P, Wilkinson PO, Knausenberger J, Wanninger K, Kamp S, Morina N, et al. Depressive and anxiety symptoms in refugees: insights from classical test theory, item response theory and network analysis. Clin Psychol Psychother. 2021 Jan;28(1):169-81. https://doi.org/10.1002/cpp.2499
Alvarenga WA, Nascimento LC, Rebustini F, Santos CB, Muehlan H, Schmidt S, et al. Evidence of validity of internal structure of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions. Front Psychol. 2022 Sep;13:991771. https://doi.org/10.3389/fpsyg.2022.991771
Palma PV, Leite IC, Greco RM. Associação entre a qualidade de vida relacionada à saúde bucal e a capacidade para o trabalho de técnicos administrativos em educação: um estudo transversal. Cad Saude Colet. 2019;27(1):100–7. https://doi.org/10.1590/1414-462x201900010089
Gonçalves AJ, Pereira PH, Monteiro V, Silva MF Junior, Baldani MH. Estrutura dos serviços de saúde bucal ofertados na Atenção Básica no Brasil: diferenças regionais. Saúde Debate. 2020;44(126):725–38. https://doi.org/10.1590/0103-1104202012610
Lynch J, Smith GD, Harper S, Hillemeier M, Ross N, Kaplan GA, et al. Is income inequality a determinant of population health? Part 1. A systematic review. Milbank Q. 2004;82(1):5-99. https://doi.org/10.1111/j.0887-378X.2004.00302.x
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Copyright (c) 2023 Daniele Boina de Oliveira, Flávio Rebustini, Danielle da Costa Palacio, Marcio Cardozo Paresque, Ilana Eshriqui Oliveira, Wander Barbieri, Danielle Viana Ribeiro, Debora Heller, Daiana Bomfim, Tamara Kerber Tedesco
This work is licensed under a Creative Commons Attribution 4.0 International License.
