Content and Face Validation of the Malay Questionnaire on Facilitators and Barriers for Primary Caregivers During Toothbrushing of Their Children with Cerebral Palsy
Abstract
Objective: This study aimed to assess the content and face validity index of the newly developed Malay language questionnaire on the facilitating factors and barriers for primary caregivers during the toothbrushing of their children with Cerebral Palsy (TB-CCP questionnaire).
Material and Methods: The development of the TB-CCP questionnaire was conducted in 2 stages. In stage 1, the items of the instrument were developed, and in stage 2, the items were performed by judgement and quantification. The content validity index (CVI) and face validity index (FVI) were evaluated by 6 experts and 10 caregivers of children with CP, respectively. Each index was analysed using Microsoft Excel.
Results: The TB-CCP (Draft 1) consisted of 29 items across 2 domains (environmental context and behaviour regulation) under both facilitating factors and barriers to toothbrushing. Content validation confirmed the acceptability of all domains, with the scale-level CVI (S-CVI/Ave) above 0.9, leading to TB-CCP Draft 2. Face validation results showed I-FVI values exceeding 0.83 and scale-level FVI (S-FVI/Ave) above 0.9, confirming its acceptability. Following these validation analyses, the final 29-item TB-CCP questionnaire was established.
Conclusion: The process of developing the questionnaire, along with ensuring content and face validity, was lengthy and involved multiple iterations. Content experts and respondents evaluated the items in order to confirm the instrument’s validity. The newly developed TB-CCP questionnaire achieved acceptable content and face validation. This version of the TB-CCP is ready for the next stage of validation through Exploratory and Confirmatory Factor Analysis.
Keywords
Full Text:
PDFReferences
Dougherty NJ. A review of cerebral palsy for the oral health professional. Dent Clin N Am 2009;7;53:329–38. doi: 10.1016/j.cden.2008.12.001.
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2007;47:571. doi: 10.1111/j.1469-8749.2005.tb01195.x.
Stavsky M, Mor O, Mastrolia SA, Greenbaum S, Than NG, Erez O. Cerebral Palsy—Trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Front Pediatr 2017;5. doi: 10.3389/fped.2017.00021.
Department of Statistics Malaysia. Person With Disability Statistics [homepage on the Internet]. Department of Statistics Malaysia; 2024 [cited 2025 Feb 7]. Available from: https://www.dosm.gov.my/portal-main/release-content/person-with-disability-2022
Bakar MAA, Samat N, Yaacob NS. Spatial accessibility to health care services among children with cerebral palsy in Johor, Peninsular Malaysia. Geospat Health 2021;16. doi: 10.4081/gh.2021.987.
UNICEF. Children with disability in Malaysia [hompage on the Internet]. UNICEF; 2014 [cited 2025 Jan 15]. Available from: https://www.unicef.org/malaysia/reports/children-disabilities-malaysia-2014
Cui S, Akhter R, Yao D, Peng XY, Feghali MA, Chen W, et al. Risk factors for dental caries experience in children and adolescents with cerebral palsy—a scoping review. Int J Environ Res Public Health 2022;19. doi: 10.3390/ijerph19138024.
Karaseridis K, Dermata A. Cerebral palsy: Oral manifestations and dental management. Balk J Dent Med 2023;27:1–7. doi: 10.5937/bjdm2301001k.
Hegde AM, Babu AA, Mohammed A, John A, Singh K, Shetty, S. Special needs of special children-parental view. NUJHS 2015;05:38–44. doi: 10.1055/s-0040-1703887.
Lansdown K, Smithers-Sheedy H, Coulton KM, Irving M. Oral health outcomes for people with cerebral palsy: a scoping review protocol. JBI Database System Rev Implement Rep 2019;17:2551–8. doi: 10.11124/jbisrir-2017-004037.
Campanaro M, Huebner CE, Davis BE. Facilitators and barriers to twice daily tooth brushing among children with special health care needs. Spec Care Dent 2013;34:185–92. doi: 10.1111/scd.12057.
Ahmad R, Rahman NA, Hasan R, Yaacob NS, Ali SH. Oral health and nutritional status of children with cerebral palsy in northeastern peninsular Malaysia. Spec Care Dent 2019;40:62–70. doi: 10.1111/scd.12436.
Yusoff MSB. ABC of content validation and content validity index calculation. Educ Med J 2019;11:49–54. doi: 10.21315/eimj2019.11.2.6.
Aliakbari E, Gray-Burrows KA, Vinall-Collier KA, Edwebi S, Salaudeen A, Marshman Z, et al. Facilitators and barriers to home-based toothbrushing practices by parents of young children to reduce tooth decay: a systematic review. Clin Oral Investig 2021;25:3383–93. doi: 10.1007/s00784-021-03890-z.
Liu HY, Chen JR, Hsiao SY, Huang ST. Caregivers’ oral health knowledge, attitude and behavior toward their children with disabilities. J Dent Sci 2017;12:388–95. doi: 10.1016/j.jds.2017.05.003.
Poornima U, Luke AM, Mathew S. Parents’ attitude toward assisted oral hygiene care for their children. J Glob Oral Health 2022;5:69–74. doi: 10.25259/jgoh_40_2020.
Zaihan O, Normastura AR, Azizah Y, Mohd Khairi M. Plaque maturity and problems encountered by mothers during toothbrushing among Down Syndrome children in the northeast of peninsular Malaysia. Int J Med Sci Public Healt Clin Sci 2015;2:159–73.
Gehlbach H, Brinkworth ME. Measure twice, cut down error: a process for enhancing the validity of survey scales. Rev Gen Psychol 2011;15:380–7. doi: 10.1037/a0025704.
Hinkin TR. A brief tutorial on the development of measures for use in survey questionnaires. Organ Res Methods 1998;1:104–21. doi: 10.1177/109442819800100106.
Artino A, Gehlbach H. Avoiding four visual-design pitfalls in survey development. Acad Med: J Assoc American Med Col 2012;87:1452. doi: 10.1097/ACM.0b013e31826a06b2.
Yusoff MSB. ABC of response process validation and face validity index calculation. Edu Med J 2019;11:55–61. doi: 10.21315/eimj2019.11.3.6.
Davis LL. Instrument review: getting the most from a panel of experts. Appl Nurs Res 1992;5:194-7. doi: 10.1016/s0897-1897(05)80008-4.
Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health 2007;30:459–67. doi: 10.1002/nur.20199.
Hadie SNH, Hassan A, Ismail ZIM, Asari MA, Khan AA, Kasim F, et al. Anatomy education environment measurement inventory: a valid tool to measure the anatomy learning environment. Anat Sci Educ 2017;10:423–32. doi: 10.1002/ase.1683.
Ozair MM, Baharuddin KA, Mohamed SA, Esa W, Yusoff MSB. Development and validation of the knowledge and clinical reasoning of acute Asthma Management in Emergency Department (K-CRAMED). Educ Med J 2017;9:1–17. doi: 10.21315/eimj2017.9.2.1.
Likert R. A technique for the measurement of attitudes. Arc Psychol 1932;22:5-55
Welie J. Is dentistry a profession? Part 1. Professionalism defined. J Canadian Dent Assoc 2004;70;529-32.
Hunter ML, Hunter B, Thompson SA, Mclaughlin WS. Special care dentistry: attitudes of specialists in paediatric dentistry practising in the UK to the creation of a new specialty. Int J Pediatr Dent 2004;14:246–50. doi: 10.1111/j.1365-263x.2004.00566.x.
Hardin AP, Hackell JM, AAP Committee on practice and ambulatory medicine. Age limit of pediatrics. Pediatrics. 2017;140. doi: https://doi.org/10.1542/peds.2017-2151.
Krol DM, Whelan K. Maintaining and improving the oral health of young children. Pediatrics 2023;151:1-8. doi: 10.1542/peds.2022-060417.
Inglis NJ, Malhotra N, Hothersall E, Fowler T. The public health specialist and access to public health advice. InnovAiT Educ Inspiration Gen Prac 2011;4:719–28. doi: 10.1093/innovait/inr177.
Hoagland A, Kipping S. Challenges in promoting health equity and reducing disparities in access across new and established technologies. Can J Cardiol 2024;40:1154-67. doi: 10.1016/j.cjca.2024.02.014.
Tomar S, Garcia A. Dental public health: the “big picture” specialty. J American Col Dent 2009;76:31.
Daly B, Watt RG, Batchelor PB, Treasure ET. Essential dental public health. 2nd ed. Oxford University Press; 2013.
Allen MS, Robson DA, Iliescu D. Face validity. Eur J Psychol Assess 2023;39:153–6. doi: 10.1027/1015-5759/a000777.
Connell J, Carlton J, Grundy A, Buck ET, Keetharuth AD, Ricketts T, et al. The importance of content and face validity in instrument development: lessons learnt from service users when developing the Recovering Quality of Life measure (ReQoL). Qual Life Res 2018;27:1893–902. doi: 10.1007/s11136-018-1847-y.
Orji R, Vassileva J, Mandryk R. Towards an effective health interventions design: an extension of the health belief model. Online J Public Health Inform 2012;4. doi: 10.5210/ojphi.v4i3.4321.
Rozenkowska K. Theory of planned behavior in consumer behavior research: a systematic literature review. Int J Consum Stud 2023;47. doi: 10.1111/ijcs.12970.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.