Development of Bilingual Oral Health Behavior Social Support Scales

Objectives: Describe the development of new bilingual Oral Health Behavior Social Support (OHBSS) scales.
Methods: A three-phase, mixed-method study recruited self-identified Mexican-origin young adult men and women, ages 21-40, living along the California-Arizona-Mexico border. Three cross-classified independent samples (balanced by language, sex, marital status) were enrolled, in partnership with three Federally-Qualified Health Centers. Content from 72 qualitative interviews informed item co-creation in both languages by the expert panel. Online surveys were deployed for the Pilot (N=309). Exploratory factor analysis of Pilot data, cognitive interviews (N=39) and expert panel reviews informed item reduction for the Validation Survey (N=502). Descriptives, model fit and confirmatory factor analyses were performed on the Validation dataset.
Results: Of 502 Validation participants, 79% were women, 63% single, 40% Spanish-language dominant, with mean±standard deviation(SD) age=30±5 years. Half visited the dentist in the past year, and brushed and flossed, on average, 12±7 and 6±6 times/week, respectively.

The final three OHBSS scales assess social support received for toothbrushing, flossing, and dental care utilization (12,12,14 required items, respectively). Scores for perceived social support for each behavior were averaged for each support group (0=never,4=always).

Young adults reported more oral health-specific social support from family and health providers, less from friends, for all behaviors. Brushing mean±SD social support scores were: 2.2±1.3(Family), 2.8±1.1(Providers), 0.9±1.1(Others/Friends).
Flossing social support scores were:
1.8±1.3(Family), 2.7±1.2(Providers), and 0.7±1.1(Others/Friends).
Dental Care social support scores were:
2.1±1.2(Family), 2.9±1.1(Providers), and 1.0±1.1(Others/Friends).
Many also identified social support needs for translation, transportation, payment, and dental-related worries.

Final OHBSS scales demonstrated acceptable model fit indices, and high Cronbach’s alphas and McDonald’s omegas (all>0.95), overall and by language.
Conclusions: The OHBSS scales demonstrate structural validity and reliability in English and Spanish. The scales can identify levels of social support from different source groups, to aid promoting oral health behaviors among Mexican-origin adults.