Adaptação transcultural e validação dos instrumentos Oral Health Behavior Questionnaire for Adolescents Based on the Health Belief Model (OHBQAHBM) e Locus of Control Scale for Oral Health Behavior (LOCOH) para o Brasil.

Abstract

Individual beliefs about oral health influence behaviors and the quality of oral hygiene. Psychometric instruments focused on these constructs remain insufficient at the national level, despite the relevance of their measures for public health. The aim of the present study was to translate, cross-culturally adapt, and validate the Oral Health Behavior Questionnaire for Adolescents Based on the Health Belief Model (OHBQAHBM) in adolescents and the Locus of Control Scale for Oral Health Behavior (LOCOH) in adults for use in Brazil. Both instruments are fundamental for understanding the complex relationship between behaviors, beliefs, and locus of control in dentistry. The study, conducted in public and private schools in Campina Grande, Paraíba, was divided into two phases. The first phase focused on the cross-cultural adaptation of the instruments, involving forward translation, reconciliation, back-translation, back-translation review, pre-testing, expert committee discussion, and production of the final Portuguese version. The unified version of the translated instruments also underwent cognitive interview testing to assess item clarity and comprehension. Participants in the first phase were not included in the second phase. The second phase involved psychometric property analysis, including internal consistency (Cronbach’s alpha [α] and McDonald’s omega [ω]), reproducibility (Intraclass Correlation Coefficient [ICC]), convergent validity (correlation with the Oral Health Impact Profile 14 [OHIP-14]), predictive validity (association with dental caries and visible plaque index), and factor validity (Exploratory Factor Analysis [EFA]; Confirmatory Factor Analysis [CFA]). The BR-OHBQ sample consisted of 453 adolescents aged 12–17 years, while the BR-LOCOH was applied to an adult sample of 277 parents/caregivers of these adolescents. Data were analyzed descriptively and using Mann-Whitney, Kruskal-Wallis, Spearman correlation, EFA,and CFA (α = 5%). The BR-OHBQ and BR-LOCOH instruments showed, respectively: α = 0.651 / ICC = 0.735 (Part A), α = 0.835 / ICC = 0.805 (Part B), and α = 0.861 / ICC = 0.711 (Part C); α = 0.54 / ω = 0.54 / ICC = 0.71 (internal locus) and α = 0.63 / ω = 0.64 / ICC = 0.67 (external locus), with convergent validity (rs = -0.084; p > 0.05; rs = -0.144, p < 0.05). CFA demonstrated good model fit indices for both instruments, BR-OHBQ and BR-LOCOH: X² = 1267.547, df = 550, CFI = 0.903; RMSEA = 0.051 (95% CI: 0.047–0.055) / X² = 103.306, df = 102; CFI = 0.997; TLI = 0.996; RMSEA = 0.007 (95% CI: 0.000–0.032); SRMR = 0.054. Associations with predictive variables were as follows: dental caries (rs = -0.134; p < 0.05 / rs = 0.122; p > 0.05) and visible plaque (rs = -0.112; p < 0.05 / rs = 0.111; p > 0.05). The BR-OHBQ provided evidence of being a psychometrically sound and reliable scale for assessing oral health behaviors among adolescents, whereas the BR-LOCOH highlighted the need for improvement in structural validity when evaluating locus of control related to oral health in Brazilian adults.