title: Oral Health Literacy Assessment: development of an oral health literacy instrument for Spanish speakers.
abstract: OBJECTIVE
  To develop an oral health literacy instrument for Spanish-speaking adults, evaluate its psychometric properties, and determine its comparability to an English version.
  
  
  METHODS
  The Oral Health Literacy Assessment in Spanish (OHLA-S) and English (OHLA-E) are designed with a word recognition section and a comprehension section using the multiple-choice format developed by an expert panel. Validation of OHLA-S and OHLA-E involved comparing the instrument with other health literacy instruments in a sample of 201 Spanish-speaking and 204 English-speaking subjects. Comparability between Spanish and English versions was assessed by testing for differential item functioning (DIF) using item response theory.
  
  
  RESULTS
  We considered three OHLA-S scoring systems. Based on validity and reliability comparisons, 24 items were retained in the OHLA-S instrument. OHLA-S was correlated with another health literacy instrument, Spanish Test of Functional Health Literacy in Adults (P < 0.05). Significant correlations were also found between OHLA-S and years of schooling, oral health knowledge, overall health, and an understanding of written health-care materials (P < 0.05). OHLA-S displayed satisfactory reliability with a Cronbach Alpha of 0.70-0.80. DIF results suggested that OHLA-S and OHLA-E scores were not comparable at a given level of oral health literacy.
  
  
  CONCLUSIONS
  OHLA-S has acceptable reliability and validity. OHLA-S and OHLA-E are two different measurement tools and should not be used to compare oral health literacy between English- and Spanish-speaking populations.
authors.affiliation: Pediatric Dentistry, UNC, Chapel Hill, NC 27599, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lee
authors.forename: Brian
authors.initials: B
authors.lastname: Stucky
authors.forename: Gary
authors.initials: G
authors.lastname: Rozier
authors.forename: Shoou-Yih
authors.initials: SY
authors.lastname: Lee
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Zeldin
mesh_terms: D000328:Adult; D032882:Comprehension; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006304:Health Status; D006630:Hispanic or Latino; D006801:Humans; D007802:Language; D008297:Male; D019303:Multilingualism; D009909:Oral Health; D011594:Psychometrics; D015203:Reproducibility of Results; D014175:Translating; D014705:Verbal Behavior