Development and Validation of Tamil Version of Ecohis Scale T Ecohis: A Cross Sectional Study
*Correspondence: Mahesh Ramakrishnan, Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical And Technical Sciences, Saveetha University Tamilnadu, India, Email:
The Early Childhood Oral Health Impact Scale (ECOHIS) has been developed in English for determining oral health-related quality of life (OHRQoL) in the children of age between 3-12years. It has been translated and validated in different languages to suit different Cultures. The ECOHIS is, till date, the only tool available for research in this field on children. A similar version of this tool is not available for use in the local language Tamil. This study aimed to develop and validate a Tamil version of the ECOHIS (T-ECOHIS). The ECOHIS was translated into Tamil by forward–backward translation and tested for face and content validity. The parents of 100 children were administered the T-ECOHIS. The children were examined for the presence of early childhood caries (ECC) which was recorded using the DMFS and PUFA index. Data were analysed by chi-squared test. The mean of dmft and pufa in children was 1.44 ± 1.21 and 0.10 ± 0.3 6 respectively. The internal consistency reliability of the ECOHIS was tested with the help of Cronbach’s alpha test and item total correlation. The cronbach’s alpha value of the ECOHIS scale was marked to be 0.735.
ECOHIS, Early Childhood Caries, Oral health, Quality of Life
The impacts of early childhood caries (ECC) in young kids amplify past the mouth affecting the quality of life these children . Tooth misfortune in some of the situations is unavoidable, and it can bring about not just orthodontic and tasteful issues, yet more critically, challenges in pronunciation. Aesthetic issues and pronunciation challenges may bring about mental and relationship issues. The concept of health has evolved thanks to contributions from researchers and successive declarations issued by world governments and international agencies .
The World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity . The status of oral health of a child plays a major role because oral health of a child will determine the child’s socialization, self- confidence, and learning abilities [4,5].
Numerous indices are available to evaluate the oral health-related quality of life (OHRQoL). In which one of them is the Early Childhood Oral Health Impact Scale (ECOHIS). ECOHIS is a successful questionnaire method used in this field . This questionnaire was given to parents and primary caretaker for evaluation. This questionnaire contains 13 questions which are disturbed under various sub-classes. Various sub- classes are: child symptom, child function, child psychology, child self-image, social interaction, parental distress, and family function. The scale has six options to respond and these recorded to know how often an event has occurred in a child’s life: 0-Never, 1-Hardly ever, 2-Occasionally, 3-Often, and 4-Very often, 5-Don’t know.
This questionnaire was first designed and used in the UK and USA to assess the impact of oral health problems on the quality of life in children and their families [4,6]. Later, it was translated in different languages in various regions of the globe to adapt their cultural background. Tamilnadu constitutes the southern part of India, in which the most commonly used language is Tamil. There is no validation of oral health scale in this local language. Our department is passionate about child care; we have published numerous high quality articles in this domain over the past 3 years [7-25]. With this inspiration we planned to pursue research on the impact of Early Childhood caries. Hence this study was aimed to develop and validate the Tamil version of the ECOHIS (T-ECOHIS).
Materials and Methods
A cross sectional outline was utilized as a part of the study. In this cross-sectional, 100 parents of 3-12 years old children who visited Saveetha Dental College for regular dental check- up were selected using random sampling. The inclusion criteria consisted of parents or care- taker of 3-12 years old children from both sexes who gave informed consent for the study. Children diagnosed with Early Childhood Caries, having one or more cavitated lesions were considered part of the study. The exclusion criteria were those who didn’t sign informed consent for the study. Informed consent was given and obtained from the parents and then the questionnaire was given.
The ECOHIS questionnaire contains 13 questions distributed between two categories: 1) Impact of oral health on child, and 2) Impact of oral health on family. Item scores are added and they have a score for both the categories. Impact of oral health on child and family will give a score that ranges from 0 to 36 and 0 to 16, respectively.
The ECOHIS questionnaire was given and was explained to parents and primary care- taker of the child and data were collected. Additionally, to evaluate the impact of dental health and the child’s oral cavity was examined on a dental unit with mouth mirror, and an explorer. The dmft (decay, missing, filling teeth) and pufa (pulpal inflammation, ulceration, fistula, and abscess) scores were recorded according to the WHO specification. Mean and standard deviation were calculated with the scores accordingly. After all the clinical examinations, and data collection, the collected data was tabulated using Microsoft Excel 2010, were analysed with IBM.SPSS statistics software 23.0 Version. To describe the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean & S.D was used for continuous variables.
Results and Discussion
The results showed that of 100 children participating in the study, 62% boys and 38% girls. In which the questionnaires were filled 82% by mothers and 18% by fathers. The majority of the parents were high school and college graduates. The reliability of the T-ECOHIS was established using internal consistency reliability, inter-rater reliability. The mean of dmft and pufa in children was 1.44 ± 1.21 and 0.10 ± 0.36 respectively. The internal consistency reliability of the ECOHIS was tested with the help of Cronbach’s alpha test and item total correlation. The cronbach’s alpha value of the ECOHIS scale was marked to be 0.735. The item corrected–total correlations ranged from 0.104 to 0.582. In which, the lowest value was related to “oral/ dental pain” (0.104) followed by “taken time off from work “(0.137) and so on (Table 1).
|Variables||Corrected Item-Total Correlation||Cronbach's Alpha if Item Deleted|
|Difficulty in drinking||0.236||0.731|
|Difficulty in eating||0.179||0.746|
|Difficulty in pronouncing||0.515||0.698|
|Missed school or playschool||0.478||0.704|
|Frustrated or irritated||0.475||0.71|
|Taken time off from work||0.137||0.742|
Table 1: Internal consistency reliability of the T-ECOHIS: Item- total statistics.
Inter-rater reliability (IRR) was verified by Cohen's Kappa, Inter-observer reliability of the tool was determined with the help of intra-class correlation coefficient (ICC). Cohen's kappa value was found to be 0.608. The interclass correlation coefficient was found to be 0.735 with 95% confidence interval, 0.606-0.836. The article describes ECOHIS to assess the impact of oral health problems. With the help of health professionals and parents this study showed relationship between children’s well- being and oral health . The reliability of a test instrument concerns the extent to which the instrument yields the same result on repeated trials. Though unreliability is present to a certain extent, there will generally be a good deal of consistency in the results of a quality instrument gathered at different times. The tendency towards consistency found in repeated measurements is referred to as reliability. Internal consistency reliability, interrater reliability is all measures of reliability of a tool.
Internal consistency of the tool is measured by estimating the Cronbach’s alpha coefficient and the item total correlation. Cronbach’s alpha is a coefficient (a number between 0 and 1) that is used to rate the internal consistency or homogeneity or correlation of the items in a test. A good test is one that assesses different aspects of the trait being studied. If a test has a strong internal consistency it should show only moderate correlation among items (0.7-0.9) . If the correlations between items are too low, it is likely that they are measuring different traits, and therefore, should not all be included in a test that is supposed to measure one trait. If item correlations are too high, it is likely that some items are redundant and should be removed from the test. The results of this validation process indicated that Cronbach’s alpha was 0.735, which was above the recommended value of 0.70 . Indicating that all items possess good internal consistency.
The mean of dmft in this study was 1.44 ± 1.21, while in a study in Brazil it was 2.1 ± 3.1, with 54% of children in that study having a dmft value of zero . In addition, in the study by Pani et al. the mean of dmft was 2.7 ± 4 . The results indicated that in this study, compared with the two studies mentioned above, the children’s oral and dental health status was better.
In this study, the impact of oral and dental health on children’s quality of life exhibited a significant relationship with age, i.e. an increase in age resulted in a decrease in quality of life, consistent with the results of a study by Li et al, in which the quality of life exhibited a significant relationship with age, i.e. an increase in age increased the impact of oral health on quality of life .
The aim of this study was to validate the ECOHIS questionnaire, which was subject to the variable “living conditions” in order to determine the sensitivity. One of the drawbacks of this study was the unequal population of children’s age groups. By considering the fact that parents were included in the study, whose children were at the age range of 3-12 years old, the unequal distribution of children’s age was unpredictable. By considering the small sample size in this study, it does not seem that unequal distribution of age disrupts the study validity. Such a limitation exists in similar studies that had larger sample sizes compared to this study .
Oral hygiene is necessary for the overall wellbeing of the children. Although various scales are available to quantify the impact of oral health, language barriers yield in inconsistent results. The study proves that Tamil version of ECOHIS can be used as a valuable tool to evaluate the impact of Early childhood caries in Children.
- Sharna N, Ramakrishnan M, Samuel V, et al. Association between early childhood caries and quality of life: Early childhood oral health impact scale and pufa index. Dent J 2019; 7.
- World Health Organization. Regional office for Europe. The challenge of obesity in the WHO European Region and the strategies for response: Summary. World Health Organization 2007.
- Sartorius N. The meanings of health and its promotion. Croat Med J 2006; 47:662–664.
- Petersen PE. The world oral health report 2003: Continuous improvement of oral health in the 21st century-the approach of the WHO global oral health programme. Community Dent Oral Epidemiol 2003; 3–24.
- Mahesh R, Muthu MS, Rodrigues SJL. Risk factors for early childhood caries: A case-control study. Eur Arch Paediatr Dent 2013; 14:331–337.
- Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health 1992; 82:1663–1668.
- Ravikumar D, Ramakrishna M, Sharna N, et al. Evaluation of McNamara’s analysis in South Indian (Tamil Nadu) children between 8-12 years of age using lateral cephalograms. J Oral Biol Craniofac Res 2019; 9:193–197.
- Ravikumar D, Gurunathan D, Gayathri R, et al. DNA profiling of Streptococcus mutans in children with and without black tooth stains: A polymerase chain reaction analysis. Dent Res J 2018; 15:334.
- Ravikumar D, Jeevanandan G, Subramanian EMG. Evaluation of knowledge among general dentists in treatment of traumatic injuries in primary teeth: A cross-sectional questionnaire study. Eur J Dent 2017; 11:232–237.
- Ravindra V, Rekha V, Annamalai S, et al. A comparative evaluation between dermatoglyphic patterns and different terminal planes in primary dentition. J Clin Exp Dent 2018; 10:e1149–54.
- Ravindra V, Rekha CV, Annamalai S, et al. A comparative evaluation between cheiloscopic patterns and the permanent molar relationships to predict the future malocclusions. J Clin Exp Dent 2019; 11:e553–7.
- Govindaraju L, Jeevanandan G, Subramanian EMG. Comparison of quality of obturation and instrumentation time using hand files and two rotary file systems in primary molars: A single-blinded randomized controlled trial. Eur J Dent 2017; 11:376–379.
- Govindaraju L, Jeevanandan G, Subramanian EMG. Knowledge and practice of rotary instrumentation in primary teeth among Indian dentists: A questionnaire survey. J Int Oral Health 2017; 9:45.
- Nair M, Jeevanandan G, Vignesh R, et al. Comparative evaluation of post-operative pain after pulpectomy with k-files, kedo-s files and mtwo files in deciduous molars -a randomized clinical trial. BDS 2018; 21:411.
- Jeevanandan G, Ganesh S, Arthilakshmi. Kedo file system for root canal preparation in primary teeth. Indian J Dent Res 2019; 30:622–624.
- Panchal V, Jeevanandan G, Subramanian E. Comparison of instrumentation time and obturation quality between hand K-file, H-files, and rotary Kedo-S in root canal treatment of primary teeth: A randomized controlled trial. J Indian Soc Pedod Prev Dent 2019; 37:75–79.
- Subramanyam D, Gurunathan D, Gaayathri R, et al. Comparative evaluation of salivary malondialdehyde levels as a marker of lipid peroxidation in early childhood caries. Eur J Dent 2018; 12:67–70.
- Vignesh R, Sharmin D, Rekha CV, et al. Management of complicated crown-root fracture by extra-oral fragment reattachment and intentional reimplantation with 2 years review. Contemp Clin Dent 2019; 10:397–401.
- Ramadurai N, Gurunathan D, Samuel AV, et al. Effectiveness of 2% articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig 2019; 23:3543–3550.
- Panchal V, Gurunathan D, Shanmugaavel AK. Smartphone application as an aid in determination of caries risk and prevention: A pilot study. Eur J Dent 2017; 11:469–474.
- Panchal V, Jeevanandan G, Subramanian EMG. Comparison of post-operative pain after root canal instrumentation with hand K-files, H-files and rotary Kedo-S files in primary teeth: a randomised clinical trial. Eur Arch Paediatr Dent 2019; 20:467–472.
- Jeevanandan G, Govindaraju L. Clinical comparison of Kedo-S paediatric rotary files vs manual instrumentation for root canal preparation in primary molars: A double blinded randomised clinical trial. Eur Arch Paediatr Dent 2018; 19:273–278.
- Samuel SR, Acharya S, Rao JC. School interventions-based prevention of early-childhood caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent 2020; 80:51–60.
- Ramakrishnan M, Dhanalakshmi R, Subramanian EMG. Survival rate of different fixed posterior space maintainers used in paediatric dentistry-A systematic review. Saudi Dent J 2019; 31:165–172.
- Vishnu Prasad S, Kumar M, Ramakrishnan M, et al. Report on oral health status and treatment needs of 5-15 years old children with sensory deficits in Chennai, India. Spec Care Dent 2018; 38:58–59.
- Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993; 118:622–629.
- Makower J, Pike C. Strategies for the green economy: Opportunities and challenges in the new world of business. McGraw hill professional 2008; 256.
- Freeman J. The handbook of psychological testing. By paul kline. London: Routledge. Br J Psychiatr 1993; 164:864–864.
- Scarpelli AC, Oliveira BH, Tesch FC, et al. Psychometric properties of the Brazilian version of the early childhood oral health impact scale (B-Ecohis). BMC Oral Health 2011; 11:19.
- Pani SC, Badea L, Mirza S, et al. Differences in perceptions of early childhood oral health-related quality of life between fathers and mothers in Saudi Arabia. Int J Paediatr Dent 2012; 22:244–249.
- Li S, Veronneau J, Allison PJ. Validation of a French language version of the early childhood oral health impact scale (ECOHIS). Health Qual Life Outcomes 2008; 6:9.
- Lee GHM, McGrath C, Yiu CKY, et al. Translation and validation of a Chinese language version of the early childhood oral health impact scale (ECOHIS). Int J Paediatr Dent 2009; 19:399–405.
Citation: Krittika R, Mahesh Ramakrishnan, Development and Validation of Tamil Version of Ecohis Scale T Ecohis: A Cross Sectional Study, J Res Med Dent Sci, 2021, 9 (2): 187-190.
Received: 23-Sep-2020 Accepted: 02-Feb-2021