The RMS-Pictorial Scale: cross-cultural adaptation and validation for Brazilian children and adolescents

The aim of this study is to perform the cross-cultural adaptation and validation of the RMS-Pictorial Scale (RMS-PS) for use with Brazilian children and adolescents.

The RMS-PS was developed to measure self-perceived dental anxiety in children. The photographs of Brazilian children reproducing the faces of the original scale were taken and discussed by a Committee of Experts. The first step was to produce four versions of the scale (a white girl, a black girl, a white boy, and a black boy) to guarantee the representativeness of the population. The scale was tested in two pre-tests before the definition of the final version of each one. An original form (5 faces) for 7-14-year-old children and adolescents a short form (3 faces) for 4-6-year-old children were developed. Sixty children and adolescents (mean age = 7.67) responded to the RMS-PS, the Facial Image Scale (FIS) and the Children's Fear Survey Scale-Dental Subscale (CFSS-DS). Statistical analyses included a descriptive analysis, the Intraclass Correlation Coefficients (ICC), the Spearman correlation, and the Mann-Whitney test.

Test-retest reliability showed a good correlation for the children's self-reporting of the B-RMS-PS across the two-week interval (ICC = 0.791; 95% CI 0.673-0.870). Convergent validity was confirmed by the correlation between the B-RMS-PS and the FIS (r = 0.524, p < 0.001). The children with proxy-report dental anxiety had greater B-RMS-PS scores than those without anxiety (p = 0.010) supporting discriminant validity.

The B-RMS-PS showed good psychometric characteristics, being reliable and valid to be used with Brazilian children and adolescents.