Page 21 - JCTR-10-2

Jangid et al. | Journal of Clinical and Translational Research 2024; 10(2): 112-118 115
cross-sectional study on 254 middle school students and reported Despite recent research advances in the field of health literacy,
that OHL level of 50.2% of the students was inadequate. specifically in the context of OHL, a notable gap remains in
We also identified a weak positive correlation between understanding the primary causes of poor oral health-related
OHL-AQ and HeLD, HeLD and REALMD-20, and between literacy skills, particularly in developing countries. Factors such
REALMD-20 and OHL-AQ, highlighting the distinct constructs as the scarcity of accessible oral health information resources,
measured by these instruments. Similar results were obtained the presence of complex oral health instructions and brochures,
in a study conducted by Devi [21] in 2011 in Bangalore city. and the lack of preparedness among dentists to assess patients’
The low correlation between the tested instruments can be literacy needs have not yet been widely recognized. In Iran, for
attributed to the fact that these three instruments possess distinct instance, a significant portion of oral health information materials,
constructs and measure different facets of OHL. REALMD-20 including medication labels, postdental treatment instructions,
is a word-recognition test [12], OHL-AQ evaluates listening and oral health guidance, are provided in a foreign language,
and decision-making skills [5], whereas HeLD accounts for the typically English. This linguistic barrier can pose considerable
multidimensionality of OHL by encompassing the domains of challenges for patients attempting to comprehend the information
communication, access, receptivity, understanding, utilization, provided to them. Furthermore, dentists often utilize specialized
support, and economic value [11]. dental jargon and numerous English terms, further complicating
In various research studies, a diverse set of assessment tools have communication between dentists and patients [25]. Individuals
been employed to gauge individuals’ OHL. For instance, in one with exceptionally low scores on health literacy assessments
study, researchers utilized the REALMD-20 word-recognition tool may encounter significant obstacles in their interactions with oral
along with the Comprehensive Measure of Oral Health Knowledge health providers. Thus, it is imperative to dedicate special efforts
to assess conceptual knowledge [22] and also incorporated the to developing culturally sensitive assessment tools tailored to the
Hong Kong OHL Assessment Task for pediatric dentistry as evaluation of OHL [7].
well as the Russian version of the OHL Instrument in separate Naghibi Sistani et al. introduced and conducted a pilot test of
investigations [23,24]. These instruments were chosen to evaluate the OHL Adults Questionnaire (OHL-AQ) to establish its validity
reading comprehension and numeracy skills. It is important to and reliability [5]. The OHL-AQ comprises four sections: reading
note that all these assessment tools determine OHL by aggregating comprehension, numeracy, listening, and decision-making. This
scores, where higher scores indicate a higher level of OHL. novel instrument was designed to overcome the shortcomings
However, contrasting results were obtained by Gong et al. [14], of current OHL assessments, which are often lengthy, lack
where they achieved strong evidence of a correlation between applicability to diverse populations, and primarily focus on
Test of Functional Health Literacy in Dentistry (TOFHLiD) and specific dental health terminologies or understanding oral health
Rapid Estimate of Adult Literacy in Dentistry-99 (REALD-99). information and numerical calculations [26,27]. The authors
This may be due to the difference in the scales used to measure concluded that the inclusion of two new measures (listening and
OHL. The reason for a strong correlation between TOFHLiD and decision-making) enhances the overall effectiveness and quality
REALD-99 may be due to the fact that both scales were derived of existing instruments. They suggest that future research should
from TOFHLA. involve a more extensive and diverse population, with a particular
Using REALD instruments, we only tested a person’s reading focus on exploring the factors influencing OHL, especially among
ability and could not capture comprehension, as reading is individuals with limited general literacy skills [28,29].
considered intermediate to decoding and comprehension [5]. This Jones et al. [11] introduced the HeLD, building on the Health
assessment tool lacks the capability to gauge word comprehension, Literacy Measurement Scale (HeLMS) [13]. The theoretical
posing challenges in discerning whether individuals who indicate constructs integrated into HeLD emphasize the significance of
English is not their primary language might be mispronouncing a person’s ability to seek, comprehend, and apply oral health
words they are familiar with and comprehend. It is known that information, which is crucial for accessing and benefiting from
there is a correlation between race, education, and considering oral health-care services. The researchers highlighted that studies
English as a secondary language. One strategy involves utilizing HeLD can be of interest to both those working with
emphasizing linguistically and culturally suitable communication marginalized and mainstream groups on OHL measurement. The
methods during all interactions between patients and providers. authors envision several potential applications for this instrument.
This approach can be beneficial for individuals whose main First, public dental services could employ it in health service
language is not English and who face challenges not necessarily evaluations to assess potential barriers to service delivery and
related to their knowledge of health terminology, but rather with service uptake, aiming to enhance attendance for oral care and
pronunciation. Additional research is needed to examine the full potentially improve oral health impacts within communities. In
array of literacy skills, including reading, writing, speaking, and addition, oral and allied health practitioners might use HeLD to
listening [4]. This study encompassed undergraduate students conduct oral health needs assessments, both for communities and
from diverse academic backgrounds, excluding those in the health potentially for individuals they serve. Finally, HeLD could find
sciences. To gain a comprehensive understanding, future research applications in research studies aimed at exploring the factors
is needed to explore a sample representative of all segments of influencing oral health and developing brief explanatory concepts
society [5]. for oral health outcomes. Charophasrat et al. [18] conducted
DOI: https://doi.org/10.36922/jctr.23.00100