Barry Gibson

Is quality of life determined by expectations or experience

This is the first in a series of five articles The way we think about health and health care is changing. The two factors driving this change are the recognition of the importance of the social consequences of disease and the acknowledgement that medical interventions aim to increase the length and quality of survival. For these reasons, the quality, effectiveness, and efficiency of health care are often evaluated by their impact on a patients “quality of life.” There is no consensus on the definition of quality of life as it is affected by health (health related quality of life). Definitions range from those with a holistic emphasis on the social, emotional, and physical wellbeing of patients after treatment1 to those that describe the impact of a persons health on his or her ability to lead a fulfilling life.2 This article assumes it to be those aspects of an individuals subjective experience that relate both directly and indirectly to health, disease, disability, and impairment. The central concern of this paper is the tendency to regard the quality of life as a constant. We contend that perceptions of health and its meaning vary between individuals and within an individual over time. People assess their health related quality of life by comparing their expectations with their experience. We propose a model of the relation between expectations and experience and use it to illustrate problems in measuring quality of life. The implications of these concepts for the use of quality of life as an indicator of the need for treatment and as an outcome of care are discussed. #### Summary points Health related quality of life is the gap between our expectations of health and our experience of it Perception of quality of life varies between individuals and is dynamic within them People with different …

Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ)

AIM To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). MATERIALS AND METHODS Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). RESULTS An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbachs α=0.86). Intra-class correlation coefficient for test-retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. CONCLUSIONS DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

The everyday impact of dentine sensitivity: Personal and functional aspects

Research of oral health status and research of the impact of oral conditions on everyday life have been developed over the past 30 years. To date, the degree to which these measures can be applied to the problems and impacts associated with dentine sensitivity is not clear. Regarding research of dentine sensitivity, it appears that there has been very little research of its everyday impact. Objective: The aim of this study was to explore the impact of dentine sensitivity on everyday life. Method: Participants were purposively recruited from a general population with the specific aim of securing a range of experiences and views about the everyday impact of dentine sensitivity. Participants were currently experiencing sensitivity in their teeth and were adults (older than age 18 years) and were initially recruited using the research team’s contacts and through snowball sampling. Data were analyzed through the use of a framework generated from the data and informed by the literature on chronic illness, coping, and illness beliefs, along with the general literature on the biopsychosocial impact of oral health. Data analysis also focused on detailing the range of impacts associated with the condition. Results: A total of 23 interviews were conducted. Fifteen participants were female and eight were male. The principal impacts on everyday life were described as pain, impact on functional status, and impact on everyday activities such as eating, drinking, talking, toothbrushing, and social interaction in general. Impacts appeared to be related to a range of individual and environmental influences. Conclusions: The data indicate the depth and complexity of the pain experiences associated with dentine sensitivity. Accordingly, it is suggested that there is a relationship between factors such as the length of one’s illness and the degree of control one has over the condition. These findings confirm similar findings in the psychological literature on pain. The findings of this study confirm that further research into the everyday nature of dentine-sensitive pain would be beneficial.

Is the short‐form Child Perceptions Questionnaire meaningful and relevant to children with malocclusion in the UK?

Objective To explore the face and content validity of the 16‐item short‐form of CPQ11–14 (CPQ ISF‐16), an oral health‐related quality of life measure (OHRQoL) measure, with young people with malocclusion in the UK. Design Qualitative study. Setting Interviews about CPQ ISF‐16 were conducted in participants’ homes. Subjects and methods The sample included 10 participants aged 12–14 years attending an orthodontic clinic of a dental hospital in the UK. All participants were judged to be in definite need of orthodontic treatment. Interventions The interviews covered the impact of malocclusion on young peoples daily lives and participants were then asked to complete CPQ ISF‐16 and describe their interpretation of the meaning of questions, any ambiguities of wording and comment on the layout of the questionnaire and response format. Results Having a malocclusion ‘bothered’ young people to varying degrees. For those participants for whom having a malocclusion impacted on their lives, concerns were about self‐consciousness with dental appearance. On analysis of the content validity some items were felt to be relevant to the impact of malocclusion, particularly questions from the emotional and social well‐being subscales; however, other questions were felt not to be relevant. Concerns about face validity were expressed about several facets of the measure including the response format, the use of ‘double’ questions and interpretation of certain words. Conclusion Concerns were expressed by young people with malocclusions about the face and content validity of CPQ ISF‐16. Further consideration should be given to the need for a child‐centred malocclusion‐specific OHRQoL measure.

The effect of a domiciliary denture service on oral health related quality of life: a randomised controlled trial

Objectives To assess the effectiveness of a domiciliary denture service on the oral health related quality of life (OHQoL) of older patients requiring complete dentures.Design Community based single-blind randomised controlled trial.Subjects and methods 133 edentate adults aged 65 years and over referred to a community dental service for domiciliary care were assigned to study and control groups using block randomisation. Treatment to provide the study group with complete dentures commenced immediately. Treatment for the control group was deferred to the normal waiting list but in the interim participants received three home visits from the dental team. Follow up data were collected three months after dentures had been fitted in the study group.Outcome measures Prevalence, extent of impacts and total scores using Oral Impacts on Daily Performance (OIDP).Results The study and control groups (n = 65 and 68 respectively) had similar OHQoL at baseline. Two and five participants were lost to the study and control groups respectively. In ANCOVA and intention to treat analysis, the presence of impact, number of impacts and total scores for OIDP at follow up were predicted by group allocation (b = 0.28, b = 0.30, and b = 0.32 respectively. All p <0.001). In all cases the study group showed significantly improved OHQoL compared to the control group.Conclusion A domiciliary denture service improved oral health related quality of life of housebound edentulous older people.

Is the oral health impact profile measuring up? Investigating the scale’s construct validity using structural equation modelling

OBJECTIVES The aim of the study was to provide an empirical test of the construct validity of the Oral Health Impact Profile as a measure of Lockers conceptual model of oral health. METHODS A secondary analysis of data from the Ontario Study of Older Adults was carried out using structural equation modelling to assess the degree to which scale items measured the construct they were supposed to measure (within-construct validity) and whether relations between constructs were as hypothesized by Lockers model (between-construct validity). RESULTS The findings indicated that the Oral Health Impact Profile as currently conceived does not have adequate within-construct validity. Scale items did not always measure the construct they were supposed to measure, some items within a construct were redundant, many measured more than one construct, and the scale did not represent seven separate constructs of oral health as originally devised. Following reconceptualization of the scale, the revised six-factor 22 item version was a better fit to the data. However, the scale did not have adequate between-construct validity. CONCLUSION The present findings do not provide support for the conceptual basis of the Oral Health Impact Profile as a measure of Lockers model of oral health. The need for further conceptual development of the scale, and Lockers model, are discussed.

Seen and heard: towards child participation in dental research

BACKGROUND There has been an increasing emphasis in many countries worldwide to capture the views of children on health services and research. A previous systematic review found that most oral health research from 2000 to 2005 was conducted on children and highlighted the need for greater research with children. AIM To describe the extent to which oral health research between 2006 and 2014 has been conducted with or on children. DESIGN Systematic review. Electronic databases were searched for the literature on child dental health. Each identified paper was examined by two researchers and categorised based on the extent to which children were involved in the research, the type of study (evaluative or otherwise), the country of origin, and the clinical discipline. RESULTS The search included 2950 papers after application of the exclusion criteria. Of these, 17.4% were with children, 18.3% involved the use of proxies (parents or clinician), and 64.2% were on children. CONCLUSIONS The proportion of studies from 2006 to 2014 involving research with children has increased from 7.3% in 2000-2005. This systematic review provides evidence for movement towards childrens involvement in dental research over the last 10 years. Future dental research must focus on incorporating childrens perspectives into the evaluation of dental treatments to improve outcomes for children.

Children's and Adolescents' Perspectives on Cleft Lip and/or Palate

Objective Childrens voices are being increasingly acknowledged in health care research. The aim of this study was to explore childrens and young peoples perspectives of being born with a cleft lip and/or palate. Design The research took a qualitative approach that consisted of two interviews with each child, drawing on child-centered methodologies and techniques. The initial interview focused on childrens general life stories, and these often encompassed a discussion about cleft lip and/or palate. The follow-up interview explored specific aspects of the condition and related treatment. Participants The self-selected sample consisted of 17 children and young people (eight boys, nine girls) with cleft lip and/or palate, aged 8 to 17 years, who received treatment at a dental hospital in the U.K. Results Childrens and young peoples accounts identified a number of themes including how they became aware that they had been born with the condition, their views of the treatment pathway, and how it related to who they are. Conclusions This study highlights the value of including young peoples perspectives in oral health–related research. It has allowed a deeper insight into cleft lip and palate and shows that young people can contribute their views and experiences about services which demonstrate that these could be incorporated into service evaluations.

Impairment effects, disability and dry mouth: Exploring the public and private dimensions

Existing accounts of dry mouth concentrate on the medical dimensions and almost completely neglect to consider its social dimensions. Simultaneously, debates on disability have highlighted an apparent split between the individual (medical) and social models of disability. The concept of ‘impairment effects’ aims to address this dichotomised approach. Impairment effects consider the everyday impact of people’s impairments on their lives in conjunction with the disabling impacts encountered through their relations with society, and society’s relations with them. This study indicates that identity and self became entangled with impairment effects and a form of disablism. The authors argue that impairment effects are, at times, a useful concept, but in some instances may actually overcomplicate things. By analysing the public and private dimensions of a chronic condition such as dry mouth, we have been enabled to explore the boundary between public and private lives. As a consequence, using public and private accounts may assist us to better locate the point where impairment ends and disability begins.

School-based health education programmes, health-learning capacity and child oral health–related quality of life

Objective: To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health–related quality of life (COHRQoL). Setting: Primary schools, high social deprivation, Ireland/Northern Ireland. Design: Cluster randomised controlled trial. Method: A total of 383, 7- to 8-year-old children were invited to participate and randomly allocated into intervention and control conditions. Baseline and 12-month follow-up assessments of COHRQoL, self-esteem, toothbrushing–fluoride toothpaste knowledge and unstimulated saliva samples were made. An 18-hour post-brushing, saliva fluoride concentration was used to assess toothbrushing with fluoride toothpaste (behaviour). The data were entered onto SPSSv22. Structural equation modelling was applied using AMOSv22 to test for the role of health-learning capacity (baseline self-esteem and COHRQoL) and simultaneous effects of Winning Smiles upon knowledge, behaviour and COHRQoL (at follow-up). Results: A total of 238 children participated at baseline and follow-up. A partial latent hybrid model fitted the data reasonably well (χ2 = 65.6, df = 50, p = .07) as shown in addition by a Comparative Fit Index of .97 and a Root Mean Square Error of Approximation (RMSEA) value of .042 (90% confidence interval [CI]: .00, .06). The intervention had a significant effect on toothbrushing–fluoride toothpaste knowledge (p < .03) and an effect on COHRQoL at the 6% level (p < .06). Knowledge was strongly associated with saliva fluoride concentration (p < .002). Conclusion: The model of health-learning capacity assisted in explaining the effect of a school-based intervention upon knowledge, toothbrushing behaviour and tentatively on COHRQoL.