Persian Oral Health Literacy Scale Development: eDelphi and Cognitive Interviews

Objectives: Developing oral health literacy scales in various languages enables evaluating functional oral health literacy associated with oral health outcomes. Aim: To develop a Persian Oral Health Literacy assessment (POHLA) scale through the eDelphi method and to validate the scale via semi-structured cognitive interviews.
Methods: In this cross-sectional study, the POHLA scale was developed through 3 eDelphi rounds; in the 1st round, nine experts commented anonymously on 90 Persian translated Oral Health Literacy Assessment (OHLA) scale (Lee et al. 2013) terms (i.e., 3 sets of 30 stem, similar, and distractor terms). The expert panel included five bilingual Iranian-born Persian-speaking dentists (who moved to US after age 18+ with 2+ years as a dental practitioner), four bilingual laypeople, and one American-born, Persian reader and speaker. The agreement criterion to accept the translated terms was 75%. In 2nd and 3rd rounds, panelists utilized a five-point Likert Scale (strongly agree-strongly disagree). The scale was validated via semi-structured cognitive interviews; the 4th round refined a few Persian terms.
Results: eDelphi: In the 1st round, the panel reached consensus on 79 of 90 Persian terms, but disagreed on 11 terms which were queried in the 2nd round; in the 3rd round, over 75% agreement was obtained on all 90 Persian terms.
Cognitive Interviews: Interviewees implemented prior knowledge, logic, word-matching/word-root, having a dentist in family, and personal dental issues to complete the OHLA/POHLA. The interviewees suggested alternative Persian words for the terms sealant, hypoplasia, cellulitis, and restoration which were confirmed by the expert panel in the 4th round of the eDelphi.
Conclusions: The POHLA scale was developed and validated via the eDelphi method and cognitive interviews. The POHLA scale will be used to assess the oral health literacy of English-Persian bilingual adults in San Francisco/San Jose in the next phase.