Satisfaction with orthodontic treatment: cross-cultural adaptation and validation of an instrument for the Brazilian Portuguese language

ALVARENGA, Renata Negreiros; PAIVA, Saul Martins; FLORES-MIR, Carlos; BERNABÉ, Eduardo; ABREU, Lucas Guimarães

doi:10.1590/2177-6709.27.6.e2220471.oar

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Dental Press Journal of Orthodontics

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ORIGINAL ARTICLE • Dental Press J. Orthod. 27 (06) • 2022 • https://doi.org/10.1590/2177-6709.27.6.e2220471.oar copy

Satisfaction with orthodontic treatment: cross-cultural adaptation and validation of an instrument for the Brazilian Portuguese language

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To cross-culturally adapt into the Brazilian Portuguese and evaluate the psychometric properties of an instrument for assessing the satisfaction of parents/guardians regarding their sons’/daughters’ orthodontic treatment.

Methods:

Translations of the instrument from English, pre-test and evaluation of validity and reliability of the Brazilian Portuguese version were performed. The questionnaire has 25 items distributed across 3 subscales (process, psychosocial effect and outcome). Eighty-three parents/guardians of children/adolescents who had completed orthodontic treatment participated. Descriptive statistics and floor and ceiling effects were calculated. Internal consistency, stability (interval of three weeks), convergent construct validity and discriminant construct validity were determined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed dimensionality.

Results:

Among the 83 parents/guardians, 58 (69.9%) were mothers and 25 (30.1%) were fathers of children/adolescents. In the questionnaire’s total score and the three subscales scores, an acceptable percentage (≤15%) of participants achieved the maximum score (ceiling effect). In the total questionnaire score and in the three subscales scores, no participant achieved the minimum score (floor effect). Cronbach’s α coefficient for the total score was 0.72 (internal consistency). Intra-class correlation coefficient for the total score was 0.71 (stability). The questionnaire’s total score presented large Pearson correlation coefficient (>0.50) with the three subscales too (construct validity). Female parents/guardians had significantly higher scores in the psychosocial effect (p=0.013) and in the treatment outcome (p=0.037) subscales, compared to male parents/guardians (discriminant validity). EFA and CFA confirmed dimensionality in a three-factor solution.

Conclusions:

The final obtained version is valid and reliable to be used in Brazilian populations.

Keywords:
Orthodontics; Malocclusion; Patient satisfaction; Validation study; Surveys and questionnaires

	n (%)
SEX OF PARENTS/GUARDIANS
Male	25 (30.1)
Female	58 (69.9)
SEX OF CHILDREN/ADOLESCENTS
Male	41 (49.4)
Female	42 (50.6)
FAMILY INCOME (BASED ON THE MINIMUM WAGE)
≤2 minimum wages	31 (37.3)
=3 minimum wages	25 (30.2)
≥4 minimum wages	27 (32.5)
NUMBER OF PEOPLE WHO LIVE FROM THIS INCOME
≤3 people	32 (38.6)
>3 people	51 (61.4)
NUMBER OF CHILDREN/ADOLESCENTS IN THE HOUSEHOLD
=1 child	20 (24.1)
=2 children	45 (54.2)
≥3 children	18 (21.7)
PARENTS’/GUARDIAN’S SCHOOLING
≤9 years of education	33 (39.8)
>9 years of education	50 (60.2)
CHILDREN’S/ADOLESCENTS’ DAI (BEFORE TREATMENT)
≤25 (mild malocclusion)	11 (13.3)
=26-30 (defined malocclusion)	25 (30.1)
=31-35 (severe malocclusion)	22 (26.5)
≥36 (very severe malocclusion)	25 (30.1)
TREATMENT RECEIVED BY THE CHILDREN/ADOLESCENTS
Interceptive	33 (39.7)
Corrective	32 (38.6)
Interceptive and Corrective	18 (21.7)

	Treatment process	Psychosocial effect of treatment	Treatment outcome	Total questionnaire score
Treatment process	1	0.41*	0.19	0.87*
Psychosocial effect of treatment		1	0.37*	0.76*
Treatment outcome			1	0.51*
Total questionnaire score				1

	Sex of parents/guardians who answered the questionnaire		p value*
	Male Mean (SD)	Female Mean (SD)
Treatment process	56.88 (5.46)	57.17 (5.28)	0.819
Psychosocial effect of treatment	26.96 (3.97)	29.40 (4.02)	0.013
Treatment outcome	21.04 (2.63)	22.16 (1.98)	0.037
Total questionnaire score	104.88 (9.97)	108.72 (8.89)	0.085

	Number of items	Score range	Mean (SD)	Ceiling effect %	Cronbach α	ICC
Treatment process	13	13 - 65	57.28 (6.44)	4.8	0.75	0.76
Psychosocial effect of treatment	7	7 - 35	29.46 (3.99)	2.4	0.69	0.68
Treatment outcome	5	5 - 25	22.08 (2.25)	15.6	0.68	0.68
Total questionnaire score	25	25 - 125	108.82 (9.82)	1.2	0.72	0.71

	EFA			Error variance		CFA
	Factor I	Factor II	Factor III	Estimate	SE
Subscale 1
Item 1	0.573	-0.367	0.004	0.285	0.045	0.323
Item 2	0.936	-0.101	-0.250	0.116	0.020	0.805
Item 3	0.897	0.005	-0.211	0.176	0.030	0.814
Item 4	0.165	-0.258	0.680	0.870	0.136	0.240
Item 5	0.848	0.087	0.021	0.061	0.011	0.893
Item 6	0.868	-0.064	0.178	0.056	0.011	0.909
Item 7	0.894	0.001	0.013	0.073	0.015	0.928
Item 8	0.730	0.063	0.211	0.066	0.011	0.791
Item 9	0.520	0.114	0.027	0.371	0.059	0.477
Item 10	0.735	0.147	-0.196	0.406	0.066	0.692
Item 11	0.489	-0.144	0.107	0.922	0.145	0.420
Item 12	0.823	-0.011	0.166	0.219	0.039	0.861
Item 13	0.529	0.377	-0.082	0.284	0.045	0.626
Subscale 2
Item 14	0.199	0.265	0.481	0.414	0.068	0.585
Item 15	0.103	0.710	0.298	0.125	0.026	0.855
Item 16	-0.084	0.732	0.187	0.231	0.040	0.738
Item 17	0.039	0.850	0.063	0.112	0.024	0.867
Item 18	-0.011	0.853	-0.124	0.174	0.031	0.759
Item 19	0.005	0.878	-0.341	0.311	0.052	0.652
Item 20	-0.140	0.874	-0.055	0.379	0.066	0.722
Subscale 3
Item 21	-0.282	0.164	0.463	0.875	0.140	0.321
Item 22	0.015	-0.087	0.839	0.126	0.030	0.745
Item 23	-0.037	0.317	0.592	0.099	0.035	0.827
Item 24	0.150	0.096	0.437	0.290	0.048	0.467
Item 25	-0.155	-0.199	0.682	0.644	0.101	0.195

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