Abstract
Background
The impact of Early Childhood Caries (ECC) and its treatment on the quality of life (QoL) of family members (especially the parents) has not been explored comprehensively. ECC is highly prevalent in NZ and especially in Malaysia, and the study offers an unprecedented opportunity to study the impact of the disease on children and their families in two quite distinct cultures and settings.
The Likert response format is the most frequently used method in QoL studies because it is easy to complete and has a minimal burden for respondents. However, the meaning of words in the response options may remain somewhat unclear. Inexact and ill-defined words might confused respondents, and the validity of the data collected could be affected. This study intended to explore definitive meaning of response options in the two scales (short-form P-CPQ and FIS) used in the study.
Methods
This study used a mixed-methods sequential explanatory design. The design utilized the quantitative method as the primary approach supported by qualitative method to assist in interpreting the quantitative findings.
A longitudinal study was conducted using short-form P-CPQ-16 and FIS-8 (along with the collection of socio-demographic and clinical data) for 310 parents with a child aged 2-5 years old; they were recruited from two distinct settings (hospital-based and community-based) in Malaysia and New Zealand. The translated version of the questionnaires was utilised for participants in Malaysia. The questionnaires were self-administered, and were collected immediately after participants had completed them. An intensity sampling method was applied to identify information-rich participants for the interview stage. In-depth interviews were carried out face-to-face and audio-recorded. Scoring and analysis of the data used both quantitative and qualitative approaches. The quantitative analysis used SPSS version 21, and the qualitative analyses were carried out using content and thematic analysis, both manually and computer-assisted using NVivo 10.
Results
The construct validity of the P-CPQ-16 and FIS-8 was confirmed in the Malaysia and New Zealand samples. There was a similar pattern in both countries, in which the highest score was the Hospital ECC group followed by the Community ECC and then the Caries-free group. The mean overall P-CPQ-16 score of the Hospital ECC and Community ECC group was three times than that the Caries-free group in both countries. This pattern was apparent for the subscales too, with the exception of the Emotional well-being subscale, where the two ECC groups did not differ. The mean overall FIS-8 score of the Hospital ECC group in Malaysia was higher than that for their New Zealand counterparts. The score of the Community ECC group was similar in both countries. However, for the Caries-free group, the score in Malaysia was lower than that seen in New Zealand.
The prevalence of impacts decreased with treatment. Large reduction in impact was recorded with large effect sizes across groups in the two settings (hospital-based and community-based) in Malaysia and New Zealand. A small effect size was measured in the Caries-free group in Malaysia, but it was large in their counterparts in New Zealand.
Participants’ responses on the meaning of the options were general and not specific. Most of them used information on specific ECC-related events in their strategy (recall-and-extrapolate) to select the appropriate response option. Participants used the frequency of events and severity of the ECC-related experiences as their frame of reference in the decision-making process for selecting the appropriate response option. There was evidence of differences in respondents’ interpretation of the response options. Use of the MID in interpreting the data helped in providing a benchmark for the analysis process.
The mixed-methods design used is a strength of the study. The design provided an opportunity to explore the subject in-depth from another perspective, to enhance understanding of the impacts of ECC on parents, and to explore the definite meaning of the option from participants’ perspective. This study had some unique features. The samples were taken from two different settings (hospital-based and community-based) and from two different countries. The sampling approach provided an unprecedented opportunity to study the impact of the disease (ECC) on children and their families in two quite distinct cultures and settings, and at the same time allowed a comparison between them.
Conclusions
ECC has a pervasive impact on the QoL of the affected children’s families, and especially on the parents. The treatment carried out for the children’s ECC, successfully improved their OHRQoL and reduced the negative impacts on their parents’ QoL. There is evidence of an association between ECC and parents’ QoL. Emphasise should be given to parents’ psychosocial aspects in designing oral ill-health prevention programmes.
Researchers and clinicians using the P-CPQ-16 and FIS-8 scales need to view the scale scores cautiously because of possible differences in respondents’ interpretation of the response options. This underlines the necessity to know and use the minimally important difference (MID).