Related Experiment Video
Updated: Nov 8, 2025
Oral Health Assessment by Lay Personnel for Older Adults
Published on: February 2, 2020
Developing an early childhood oral health impact-specific health-state classification system for a new
Sanjeewa Kularatna1, Uttara Amilani1, Sameera Senanayake1
1Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
Insights
A new preference-based health classification system, the ECOHIS-4D, was developed from the Early Childhood Oral Health Impact Scale (ECOHIS). This tool will enable economic evaluations of pediatric oral health interventions.
Area of Science:
- Health Economics
- Oral Health Research
- Psychometrics
Background:
- Most pediatric quality-of-life instruments lack preference-based measures, limiting their use in economic evaluations.
- The Early Childhood Oral Health Impact Scale (ECOHIS) assesses oral health's impact on quality of life in young children but is not preference-based.
- Economic evaluations require outcome metrics that capture preferences for resource allocation in oral health care.
Purpose of the Study:
- To develop a preference-based health-state classification system from the existing ECOHIS instrument.
- To create a new metric suitable for economic evaluations in pediatric oral health.
Main Methods:
- Applied the 13-item ECOHIS to carers of 280 preschoolers in Perth, Western Australia.
- Utilized exploratory factor analysis for dimensionality assessment and Rasch analysis for item selection and response option reduction.
- Determined the final classification system using psychometric analysis and expert input.
Main Results:
- Factor analysis identified four dimensions. Rasch analysis selected three items from the first dimension (child functional/psychological impact) and one from the second (child social interaction impact).
- The third dimension (parental distress/family function) was excluded as it was not a direct measure of child impact.
- The resulting ECOHIS-4D classification system features four dimensions, each with three levels.
Conclusions:
- The ECOHIS-4D is a novel preference-based instrument derived from the ECOHIS.
- Future valuation studies will establish utility values for ECOHIS-4D health states.
- This system will facilitate economic evaluations of oral health interventions.
Objectives:
Most of the paediatric quality-of-life instruments in oral health research are not preference-based measures, thus cannot be used in economic evaluations. The Early Childhood Oral Health Impact Scale (ECOHIS) is one such instrument which assesses oral health impact on children's quality of life among three- to five-year-olds. With increasing demands for more resource allocation in oral health care, there is a need for an outcome metric which can be used as the outcome in economic evaluations. The aim of this study was to develop a preference-based, health-state classification system from the existing ECOHIS instrument.
Methods:
The 13-item ECOHIS instrument was applied to the carers of 280 preschoolers who participated in a clinical trial in metropolitan Perth, Western Australia. Exploratory factor analysis was conducted to assess the dimensionality of the ECOHIS. Rasch analysis was used to eliminate and select items per determined dimensions and to reduce the number of response options for each item, because six levels were not amenable to valuation. The final classification system was determined through a combination of psychometric and expert advice.
Results:
Items loaded on to four dimensions with the factor analysis. Using Rasch analysis, three items were selected from the first dimension (child functional and psychological impact) and one item from the second dimension (child social interaction impact). None were selected from the third dimension (parental distress and family function impact) as it is not an appropriate proxy method of measuring the level of impact on a child. The final classification system has four dimensions with three levels in each, and so it has been named the ECOHIS-4D.
Conclusions:
The ECOHIS-4D classification system is a new preference-based instrument derived from the existing ECOHIS instrument. Future valuation studies will develop a utility value set for the health states defined by this classification system, and this will guide economic evaluations related to oral health interventions.
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