title: Validation of the Arabic Version of the Early Childhood Oral Health Impact Scale (ECOHIS).
abstract: BACKGROUND
  Assessment of the adverse effects of oral health problems on oral health-related quality of life (OHRQoL) is essential to ensure the well-being of children. The Early Childhood Oral Health Impact Scale (ECOHIS) is an instrument that was designed to assess caregivers' perceptions of OHRQoL in preschool children. Although it has been translated into many languages, it has yet to be validated in Arabic. Therefore, this study aimed to translate this questionnaire to Arabic (A-ECOHIS) and test its psychometric properties.
  
  
  METHODS
  Questionnaire responses from three samples of caregivers of preschool children ≤ 6 years of age were collected: (i) community-based (n = 422), from preschools selected as a stratified random sample; (ii) clinic-based, from those seeking pediatric dental care at a university clinic (n = 246); and (iii) a test-retest sample (n = 68), a clinic-based group of caregivers who completed questionnaires twice about siblings who were not receiving dental care. Children received a dental examination to assess their decayed, missed, filled teeth (dmft) scores. Convergent validity was evaluated by assessing the A-ECOHIS scores in relation to the response to a global question. Discriminant validity was evaluated by comparing the scores of children with varying levels of oral disease. Internal consistency was assessed by calculating Cronbach's alpha, and the test-retest reliability was assessed using intra-class correlation coefficients (ICCs).
  
  
  RESULTS
  The A-ECOHIS scores of the questionnaire sections and the global oral health rating were significantly correlated; Spearman correlation coefficients were, r = 0.55, P ≤ 0.01 (overall score), r = 0.54, P ≤ 0.01 (child section), and r = 0.51, P ≤ 0.01 (family section). The mean A-ECOHIS scores were also statistically significantly higher in children with higher dmft scores compared with lower dmft, and in the clinic-based sample compared with the community sample. The Cronbach's alpha value of the the child, family sections and overall questionnaire were, 0.80, 0.78, and 0.85, respectively. The intra-class correlation coefficient (ICC) of A-ECOHIS was 0.86.
  
  
  CONCLUSIONS
  The A-ECOHIS performed well on all psychometric tests to which it was applied. Thus, it is a valid and reliable instrument that can be used in Arabic-speaking caregivers of preschoolers aged 2 to 6 years.
authors.affiliation: Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589, Saudi Arabia. njfarsi@kau.edu.sa.
authors.forename: Nada J
authors.initials: NJ
authors.lastname: Farsi
authors.affiliation: Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.|Department of Pediatric Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
authors.forename: Azza A
authors.initials: AA
authors.lastname: El-Housseiny
authors.affiliation: Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Deema J
authors.initials: DJ
authors.lastname: Farsi
authors.affiliation: Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Najat M
authors.initials: NM
authors.lastname: Farsi
mesh_terms: D002648:Child; D000067576:Child Health; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D009909:Oral Health; D011788:Quality of Life; D012529:Saudi Arabia; D011795:Surveys and Questionnaires; D014177:Translations
keywords: ECOHIS; Preschool children; Quality of life; Validation