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Jangid et al. | Journal of Clinical and Translational Research 2024; 10(2): 112-118 113
and diverse health situations [4]. Oral health literacy (OHL) different scales in a selected population of university students in
represents a comprehensive concept, encapsulating proficiencies Jaipur, India.
in reading, writing, numeracy, effective communication, attentive
listening, and sound decision-making skills [5]. Globally, the surge 2. Methods
in interest surrounding OHL is fueled by disparities in oral health, This comparative study aimed to assess and compare the OHL
particularly among vulnerable populations where conditions such levels of university students using three different scales: OHL-
as dental caries and periodontal disease substantially contribute to AQ, REALMD-20, and HeLD scales. This study was conducted
the global disease burden [6-10]. in the Department of Public Health Dentistry at NIMS Dental
To assess an individual’s health literacy, various tools have College in Jaipur, India. The study involved 180 students from
been developed, with a significant focus on the overall health NIMS University, who were divided into three groups based on
commonly utilized in research investigations. The Health Literacy their course of study. Students who were 18 years or older and
in Dentistry (HeLD) tool has emerged as a reliable, valid, and able to communicate in English were recruited and included in
culturally acceptable instrument specifically designed to assess this study, while medical and paramedical students and those with
OHL among vulnerable populations. HeLD has demonstrated incomplete questionnaires were excluded from the study. Ethical
discriminative capabilities, revealing significant differences in clearance was obtained before the study from the Institutional
three oral health perception factors—self-rated general health, Ethics Committee of NIMS Medical College (protocol no.:
self-rated oral health, and oral health impact [11]. In addition, NIMSUNI/IEC/2017/14). Written informed consent was obtained
the OHL-Adult Questionnaire (OHL-AQ) serves as a dependable from all participants.
tool for evaluating the functional aspect of adults’ OHL within A pilot study was conducted with 10% of the population to test
communities or populations [5]. the feasibility of the study. The study pro forma was administered
The OHL-AQ, a pioneering instrument, assesses two crucial
OHL-related skills—‟listening” and ‟decision-making.” It stands to 180 students, who had been divided into three groups: Group 1
(commerce, science, and humanity courses), Group 2 (engineering
out for its brevity and ease of use and is applicable in both clinical
and research settings to enhance oral health-related literacy skills and architecture courses), and Group 3 (management courses).
and dentist-patient communication. Another noteworthy tool, Sociodemographic information, such as name, age, sex, and
REALMD-20, a concise screener for dental and medical health course of study, was collected from each participant.
literacy, consists of 20 items featuring satisfactory psychometric Three scales were used to measure students’ OHL: OHL-AQ,
characteristics [12]. The validity of this tool has been confirmed REALMD-20, and HeLD. OHL-AQ is a 17-item questionnaire
by correlating it with the Rapid Estimate of Adult Literacy in that assesses adults’ OHL in community-based studies. The
Medicine (REALM) [13] and the Test of Functional Health questionnaire had four sections: reading comprehension,
Literacy in Adults (TOFHLA) [14], which are widely accepted numeracy, listening, and decision-making. Scores were divided
instruments for assessing medical health literacy. into three categories: inadequate (0–9), marginal (10–11), and
As poor OHL emerges as a new public health challenge, the adequate (12–17).
imperative for a dependable, valid, and culturally appropriate REALMD-20 is a 20-item reading recognition test that screens
tool for its evaluation becomes evident. Within the past decade, basic dental health literacy and reading ability. The interviewer
advancements in defining health literacy have spurred the asked participants to read each word aloud. Scores were divided
development of a diverse range of measurement instruments, into three categories: inadequate (0–11), marginal (12–13), and
encompassing a broad spectrum of abilities from reading adequate (14–20).
comprehension to numerical proficiency. Notably, a study in HeLD is a 29-item questionnaire that assesses OHL based on the
Rajasthan revealed low OHL among children and teenagers, constructs identified in the HeLMS. The questionnaire has seven
emphasizing the need for comprehensive interventions [15]. domains: receptivity, understanding support, economic barriers,
The rationale for the present research stems from the recognition access, communication, and utilization. Scores were divided
that the university student population comprises individuals from into three categories: inadequate (0–61), marginal (62–77), and
diverse rural and urban backgrounds. By investigating their OHL, adequate (78–116).
we aim to garner insights into their comprehensive oral health- The completed questionnaires were collected and the data were
related knowledge, acknowledging potential variations between entered into Microsoft Excel worksheets. The collected data were
students. The outcomes of this study will not only contribute to analyzed using IBM SPSS software for Windows, version 20
a better understanding of oral health needs specific to university (IBM Corp., Armonk, N.Y., USA), and the results are expressed as
students but will also facilitate comparisons between different means, standard deviations, and descriptive statistics. Independent
scales used to measure OHL. Furthermore, these findings could sample t-tests and one-way ANOVA were performed to compare
inform educational interventions and public health strategies to OHL levels between groups and between categories of scores on
promote better oral health outcomes among students from diverse the literacy scales. Pearson’s correlation coefficient was used to
regions. At present, there is a dearth of studies comparing different correlate the scores from the different literacy scales. Normality
OHL scales, making this study pivotal in addressing this gap. The of the data was tested using the Shapiro–Wilk test. Data were
primary objective of this study is to compare OHL outcomes from normally distributed.
DOI: https://doi.org/10.36922/jctr.23.00100