title: Psychometric assessment of the short-form Child Perceptions Questionnaire: an international collaborative study.
abstract: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ11-14) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts.
  
  
  
  Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ11-14across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted.
  
  
  
  Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings.
  
  
  
  The CPQ11-14performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy.
authors.affiliation: Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand. murray.thomson@otago.ac.nz.
authors.forename: W M
authors.initials: WM
authors.lastname: Thomson
authors.affiliation: Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
authors.forename: L A
authors.initials: LA
authors.lastname: Foster Page
authors.affiliation: School of Oral and Dental Sciences, The University of Bristol, Bristol, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Robinson
authors.affiliation: Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: L G
authors.initials: LG
authors.lastname: Do
authors.affiliation: Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Traebert
authors.affiliation: Department of Dental Services, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam.
authors.forename: A R
authors.initials: AR
authors.lastname: Mohamed
authors.affiliation: Department of Dentistry, University of Puthisastra, Phnom Penh, Cambodia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Turton
authors.affiliation: Periodontology & Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: C
authors.initials: C
authors.lastname: McGrath
authors.affiliation: Department of Paediatric Dentistry, University Dental Clinic, Medical University of Vienna, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Bekes
authors.affiliation: Department of Paediatric Dentistry, University of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hirsch
authors.affiliation: Department of Public Health, National Autonomous University of Mexico León Unit, León, Guanajuato, México.
authors.forename: F
authors.initials: F
authors.lastname: Del Carmen Aguilar-Diaz
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Marshman
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
authors.forename: P E
authors.initials: PE
authors.lastname: Benson
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D002648:Child; D005163:Factor Analysis, Statistical; D005260:Female; D014943:Global Health; D006801:Humans; D007391:International Cooperation; D008297:Male; D009909:Oral Health / Q000706:statistics & numerical data; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Child Perceptions Questionnaire; children; oral-health-related quality-of-life measures; psychometric properties; psychosocial aspects of oral health