Background
Method
Development of CARIES-QC
Stage 1: Item generation
Potential items following analysis of interviews | |
---|---|
• Pain (hurts) • Difficulty eating some foods • Having to eat on one side • Getting food stuck in teeth • Being kept awake by pain • Feeling annoyed • Having to take medicine • Pain during toothbrushing • Having to eat more slowly • Having to eat more carefully • Crying • Front teeth looking brown • Feeling tired • Not being able to do schoolwork • Difficulty talking • Feeling grumpy • Not been able to do normal activities |
Stage 2: Item reduction
Study stage | Gender | Mean (range) age (years) | Deprivation quintile | |||||
---|---|---|---|---|---|---|---|---|
Male | Female | 1 | 2 | 3 | 4 | 5 | ||
Item generation (n = 20) | 11 | 9 | 9.55 (5.5–13.9) | 1 | 2 | 4 | 2 | 11 |
Item reduction (n = 22) | 9 | 13 | 9.40 (4.8–15.7) | 3 | 1 | 4 | 2 | 12 |
Questionnaire design (n = 10) | 7 | 3 | 9.9 (6.4–15.5) | 4 | 3 | 3 | 0 | 0 |
Face validity only (n = 4) | 1 | 3 | 10.84 (8.8–11.96) | 2 | 2 | 0 | 0 | 0 |
Face and content validity (n = 4) | 4 | 0 | 9.45 (6.45–12.5) | 0 | 1 | 0 | 0 | 3 |
Content validity only (n = 21) | 8 | 13 | 8.24 (5.19–14.35) | 1 | 2 | 2 | 4 | 13 |
Overall (n = 81) | 29 | 32 | 9.17 (4.82–15.72) | 11 | 11 | 13 | 8 | 46 |
Stage 3: Questionnaire design
Stage 4: Face and content validity
Evaluation of the measure
Stages 5, 6 and 7: Validity, reliability and responsiveness
Recruitment
Questionnaires
-
Baseline (T0), for example, at a new patient clinic appointment
-
Prior to the start of dental treatment to allow test-retest reliability (T1)
-
Following a course of dental treatment for the management of dental caries (T2)
Baseline responses (T0)
Data analysis
Missing items
Analysis using the Rasch model
Interpretability
Internal consistency, reliability and construct validity
Responsiveness
Results
Stages 5, 6 and 7: Validity, reliability and responsiveness
Variable | Proportion | Number |
---|---|---|
Gender | ||
Male | 47.5% | 95 |
Female | 52.5% | 105 |
Ethnicity | ||
Asian background | 15.5% | 31 |
Black background | 2.5% | 5 |
Mixed background | 4.5% | 9 |
White British background | 65.0% | 130 |
Other background | 4.5% | 9 |
Unknown background | 8.0% | 16 |
Socioeconomic status | ||
Most deprived | 59.5% | 119 |
More deprived | 18.5% | 37 |
Average | 10.0% | 20 |
Less deprived | 6.5% | 13 |
Least deprived | 5.5% | 11 |
Minimum | Maximum | Mean (SD) | |
---|---|---|---|
dmft | 0 | 16 | 6.24 (3.45) |
Number of carious primary teeth | 0 | 14 | 5.74 (3.40) |
Number of missing primary teeth | 0 | 10 | 0.27 (1.15) |
Number of filled primary teeth | 0 | 4 | 0.22 (0.69) |
DMFT | 0 | 13 | 1.57 (2.18) |
Number of carious permanent teeth | 0 | 9 | 1.38 (1.77) |
Number of missing permanent teeth | 0 | 4 | 0.05 (0.38) |
Number of filled permanent teeth | 0 | 7 | 0.13 (0.74) |
Total number of carious teeth | 1 | 14 | 6.01 (3.27) |
Total number of missing teeth | 0 | 10 | 0.27 (1.12) |
Total number of filled teeth | 0 | 7 | 0.28 (0.89) |
Missing data
Analysis using the Rasch model
Raw score | Interval score |
---|---|
0 | 0 |
1 | 2.63 |
2 | 4.50 |
3 | 5.84 |
4 | 6.90 |
5 | 7.80 |
6 | 8.60 |
7 | 9.32 |
8 | 10.00 |
9 | 10.64 |
10 | 11.26 |
11 | 11.86 |
12 | 12.45 |
13 | 13.03 |
14 | 13.62 |
15 | 14.22 |
16 | 14.84 |
17 | 15.48 |
18 | 16.17 |
19 | 16.92 |
20 | 17.76 |
21 | 18.75 |
22 | 19.96 |
23 | 21.65 |
24 | 24.00 |
Interpretability
Participants/subgroups | CARIES-QC interval score | |||
---|---|---|---|---|
Participants | Number (%) | Mean score | Range | SD |
Overall | 197 | 9.34 | 0–24 | 4.44 |
Gender | ||||
Female | 103 | 9.71 | 0–24 | 4.59 |
(52.3%) | ||||
Male | 94 | 9.05 | 0–18.75 | 4.28 |
(47.7%) | ||||
Age group | ||||
5–7 years | 114 | 9.82 | 0–24 | 4.51 |
(57.9%) | ||||
8–11 years | 66 | 8.91 | 0–18.75 | 4.55 |
(33.5%) | ||||
12–16 years | 17 | 8.90 | 2.63–16.17 | 3.49 |
(8.6%) | ||||
Pain | ||||
Yes | 142 | 10.49a** | 0–24 | 4.09 |
(72.1%) | ||||
No | 55 | 6.57 | 0–17.76 | 4.10 |
(27.9%) | ||||
Pulpal involvement | ||||
Yes | 157 | 9.86b* | 0–24 | 4.26 |
(79.7%) | ||||
No | 40 | 7.56 | 0–17.76 | 4.72 |
(20.3%) | ||||
Anterior caries | ||||
Yes | 41 | 10.72c* | 0–24 | 4.71 |
(20.8%) | ||||
No | 156 | 9.04 | 0–19.96 | 4.32 |
(79.2%) | ||||
Ethnicity | ||||
White British background | 130 | 8.91 | 0–18.75 | 4.29 |
(66.0%) | ||||
Other background | 53 | 10.57d* | 0–24 | 4.82 |
(34.0%) | ||||
Deprivation | ||||
Deprivation group 1 (lowest) | 67 | 9.20 | 0–24 | 4.92 |
(34.0%) | ||||
Deprivation group 2 (middle) | 65 | 9.93 | 0–19.96 | 4.35 |
(33.0%) | ||||
Deprivation group 3 (highest) | 65 | 9.04 | 0–17.76 | 4.02 |
(33.0%) |
Internal consistency, reliability and construct validity of CARIES-QC
Responsiveness
Item and response | Proportion (number) with impact at baseline (n = 197) | Proportion (number) with impact at follow-up (n = 43) |
---|---|---|
Food stuck |
87.8% (173)
|
62.8% (27)
|
A bit | 55.3% (109) | 51.2% (22) |
A lot | 32.5% (64) | 11.6% (5) |
Hurts |
68.5% (135)
|
39.5% (17)
|
A bit | 51.3% (101) | 37.2% (16) |
A lot | 17.3% (34) |
2.3% (1)
|
Eating on one side |
62.4% (123)
|
32.6% (14)
|
A bit | 36.5% (72) | 16.3% (7) |
A lot | 25.9% (51) | 16.3% (7) |
Cried |
61.4% (121)
|
32.6% (14)
|
A bit | 47.7% (94) | 27.9% (12) |
A lot | 13.7% (27) | 4.7% (2) |
Annoyed |
59.9% (118)
|
18.6% (8)
|
A bit | 40.6% (80) | 16.3% (7) |
A lot | 19.3% (38) |
2.3% (1)
|
Eating carefully |
56.3% (111)
|
37.2% (16)
|
A bit | 38.1% (75) | 30.2% (13) |
A lot | 18.3% (36) | 7.0% (3) |
Difficult to eat some foods |
56.3% (111)
|
37.2% (16)
|
A bit | 46.7% (92) | 34.9% (15) |
A lot | 9.6% (19) | 2.3% (1) |
Eating slowly |
44.2% (87)
|
27.9% (12)
|
A bit | 33.5% (66) | 18.6% (8) |
A lot | 10.7% (21) | 9.3% (4) |
Brushing teeth |
42.6% (84)
|
18.6% (8)
|
A bit | 32.0% (63) | 18.6% (8) |
A lot | 10.7% (21) | 0 |
Feeling cross |
40.6% (80)
|
13.9% (6)
|
A bit | 28.4% (56) | 11.6% (5) |
A lot | 12.2% (24) | 2.3% (1) |
Kept awake |
32.5% (64)
|
11.6% (5)
|
A bit | 27.4% (54) | 9.3% (4) |
A lot | 5.1% (10) | 2.3% (1) |
Interfering with schoolwork |
17.3% (34)
|
11.6% (5)
|
A bit | 14.7% (29) | 7.0% (3) |
A lot | 2.5% (5) | 4.7% (2) |
Global question |
64.5% (127)
|
30.2% (13)
|
A bit | 49.0% (96) | 27.9% (12) |
A lot | 15.7% (31) | 2.3% (1) |
Reported condition at follow-up | Mean (range) CARIES-QC interval score at baseline | Mean (range) CARIES-QC interval score at follow-up | Mean (range) change score |
---|---|---|---|
All follow-up participants (n = 43) | 9.46 (2.63–19.96) | 5.99 (0–5.48) | −3.48 (minus 12.45–4.10) |
Improved (n = 34) | 9.33 (2.63–19.96) | 4.89 (0–13.62) | −4.42 (minus 12.45–2.76) |
Unchanged (n = 6) | 8.32 (4.5–12.45) | 8.74 (4.5–12.45) | 0.42 (minus 1.52–4.10) |
Deteriorated (n = 3) | 13.44 (11.86–14.84) | 12.86 (10.64–15.48) | −0.58 (minus 1.22–0.64) |