Evaluation of the reliability and validity of the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire translated into Malagasy

The Early Childhood Oral Health Impact Scale (ECOHIS) was developed to assess the impact of oral health conditions on the quality of life of preschool children and theirs families. The ECOHIS was originally developed in English language, translated and validated in several countries but no validated transcultural version of this questionnaire is currently available in Madagascar. The objectives of this cross-cultural study were to translate, validate and analyse the psychometric properties of the Malagasy version of ECOHIS. Method The translation followed the forward-backward translation process. The Malagasy version obtained was pre-tested on ten mothers. Then, the questionnaire was administered by interview to 150 parents/guardians of children aged 3 to 5 years old frequenting two nursery schools in the town of Mahajanga to evaluate the reliability and validity of its psychometric characteristics. Reliability was assessed by the test-retest procedure with an interval of 15 days by using the intra-class correlation (ICC). Internal consistency was tested by Cronbach's alpha coefficient. The validity of construct, discriminant and criterion were evaluated. Construct validity was evaluated by Spearman rank correlation and tested using exploratory factor analysis and partial confirmatory factor analysis. Discriminant validity was tested between groups of children presenting consequences of untreated decayed teeth. Clinical examination was performed using the decayed, missing, filled teeth (dmft) and the pulpal involvement, ulceration, fistula, abscess (pufa) indices for assessing dental caries and consequences of untreated decayed teeth. Results The cultural adaptation showed that the respondents understood the questions. The intraclass correlation coefficient for test retest was 0.91. The internal consistency demonstrated a good reliability of the Malagasy-ECOHIS version with a Cronbach's alpha coefficient of 0.88. The convergent validity evaluated by Pearson correlation coefficients provided positive and significant correlation values between all the items ranging from 0.26 to 0.72. Significant associations between the ECOHIS scores and the global rating of oral health supported the validity of the construct. Convergent and discriminant validity were obtained by testing the association of ECOHIS scores on the child and family sections with poor parental ratings of their child's oral health, high caries experience and untreated decayed teeth consequences which were to be statistically significant. Conclusion The results showed that this Malagasy version of ECOHIS questionnaire has shown good psychometric properties and could be used on Malagasy parents of preschool children to measure the impact of oral health status on the child and family quality of life.