The impact of oral health and socioenvironmental conditions on general and oral- health related quality of life and convergent validity of two instruments

Background: The objective of this study was to evaluate the convergent validity between the domains of the Autoquestionnaire Qualité de Vie Enfant image (AUQUEI) and the Child Perceptions Questionnaire instrument (CPQ11-14) among schoolchildren and to assess the impact of socioenvironmental and clinical variables on their scores. Methods: An analytical cross-sectional study was conducted in Juiz de Fora, Minas Gerais, Brazil, with 515 schoolchildren aged 12 years from 22 public and private schools, selected according a random multistage sampling design. They were clinically examined for dental caries experience (DMFT and dmft index) and orthodontic treatments needs (DAI index) and were asked to complete the Brazilian versions of Child Perceptions Questionnaire (CPQ11-14) and Autoquestionnaire Qualité de Vie Enfant image (AUQUEI). In addition, a questionnaire was sent to their parents inquiring about their socioeconomic status and home characteristics. The convergent validity of the Brazilian versions of CPQ11-14 and AUQUEI instruments was analyzed by Spearman’s correlation coefficients. For comparison between the summarized scores of each questionnaire with regard to the schoolchildren’s socio-environmental and clinical aspects the nonparametric Mann-Whitney was used at level of significance of 5 %. Results: The mean DMFT index was 1.09 and 125 (24.3%) children had orthodontic treatment needs (DAI ≥ 31). There was a correlation between the scores of the domains of CPQ11-14 and AUQUEI with a low magnitude value (r-value ranged from -0.006 to 0.0296). In addition, we found a statistically significant difference between the scores in of each instrument according to socioenvironmental variables (p<0.05) and presence of carious lesions (p<0.05). Conclusion: The general and oral health-related quality of life instruments AUQUEI and CPQ11-14 presented correlation, and socioenvironmental and clinical variables were associated with both instruments. Key-words: quality of life, oral health, children, AUQUEI, CPQ11-14 Background The study of quality of life in populations has become common in recent decades [1,2], motivated by a broader conception of the health and disease process, which takes into account the perception of individuals within the context of their values, expectations, and concerns [3]. Thus, the normative clinical evaluation alone has become inadequate to enable professionals to provide the best diagnosis and treatment plan for their patients, because patients’ self-reports with regard to their health outcomes do not always coincide with clinical evaluation of the professionals [1]. Thus, it is essential to incorporate the physical, social and psychological variables of patients into clinical management in in order to promote the therapeutic process that is best for them [4,5,6,7,8]. To achieve these goals, the aim of several studies has been to evaluate the healthrelated quality of life (HRQoL) in a generic manner, using the questionnaires of the Group of Quality of Life of the World Health Organization [1,3,9]. As regards measurement of the perception of health-related quality of life in children and adolescents, several instruments have been developed. There are generic instruments that evaluate measures quality of life in general, with no link to a specific disease, and others related to specific conditions [10-13]. The generic HRQoL instruments are focused on general living conditions, and the specific types target certain health condition and are able to detect special situations, for example, the impact of oral diseases on the quality of life of children and adolescents [14]. Among the generic HRQoL questionnaires for children and adolescent, there is the Autoquestionnaire Qualité de Vie Enfant image (AUQUEI), a quality of life scale developed in France by Manificat and Dazord [10]. The AUQUEI instrument evaluates the point of view of the child's satisfaction associated with various domains of life and consists of 26 questions related to family and social relationships, leisure, autonomy, among others. It is considered a complete tool for evaluating aspects related to quality of life defined in theoretical models [1,10,14,15] but has rarely been used in the literature to up to date. However, given the growing interest of public health managers and professionals in assessing the quality of life of children and adolescents for planning health interventions, it is increasingly necessary to test and define the possibilities and advantages of using these instruments for this purpose. In addition, Solans et al [16] have emphasized the importance of use generic and specific questionnaires to assess the conditions of quality of life of children and adolescents in clinical practice and the need to investigate the psychometric properties of the instrument. Therefore, in view of the inseparable association between oral health and systemic health, we must consider that the oral health status of children and adolescents can have great impact on their quality of life as a whole [16]. Thus, specific and generic measures could be used as tools to assess the impact of oral conditions on the quality of life of this population [17]. Given the peculiar advantages and disadvantages of each of these instruments, it is important to evaluate the relationship between self-reports presented in response to a specific health-related quality of life instrument (i.e. oral health conditions) and a generic instrument. In the field of oral health, specific instruments have been developed to evaluate the impact of clinical factors and social determinants of health in oral health-related quality of life [18,19,20]. Among them, there is the Child Perceptions Questionnaire instrument (CPQ11-14) developed by a group of Canadian researchers, with the purpose of assessing the oral health-related quality of life (OHRQoL) in children and adolescents between 11-14 years of age, and measures their OHRQoL in four domains: oral symptoms, functional limitations, emotional wellbeing and social welfare [18,21-26]. In order to better understand the impact that certain oral conditions cause on the overall quality of life, some researchers have conducted researches evaluating associations between the results of specific with generic health-related quality of life (HRQoL) instruments [17,27-31]. However, there are very few published studies that have investigated these associations, and to our knowledge, so far no study comparing the results of the CPQ11-14 (OHRQoL) and AUQUEI (HRQoL) instruments has been published. Therefore, although the psychometric properties of both questionnaires have been previously tested and validated in a Brazilian population [32,33], the objective of this study was to evaluate the convergent validity that exists between the two instruments. In the literature, it is clear that the social determinants of health influence the disease process, health of populations and their subjective perceptions of OHRQoL and HRQoL [20,25,26,34]. Thus, in quality of life studies, it is necessary for social determinants to be considered important confounding variables in the models evaluated. Therefore, the aims of this study were: 1) to assess the convergent validity between the domains of AUQUEI and CPQ11-14; 2) to assess the impact of socioenvironmental and clinical variables in HRQoL and OHRQoL of schoolchildren. Methods Ethical Aspects The research Project was submitted to the Research Ethics Committee of the Piracicaba Dental School, University of Campinas, Brazil, and approved under Protocol No.