mathur et al 2016 gerodontology

8/16/2019 Mathur Et Al 2016 Gerodontology

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O r i g i n a l a r t i c l e

Translation and validation of Hindi version of Geriatric Oral

Health Assessment Index

Vijay Prakash Mathur1, Veena Jain2, Rajath Sasidharan Pillai2 and Sandeep Kalra2

1

Department of Pedodontics and Preventive dentistry, Centre for Dental Education & Research, All India Institute of Medical Sciences,New Delhi, India; 2Department of Prosthodontics, Centre for Dental Education & Research, All India Institute of Medical Sciences,

New Delhi, India

doi: 10.1111/ger.12099

Translation and validation of Hindi version of Geriatric Oral Health Assessment Index

Objective: The aim of the study was to translate and validate the oral health-related quality of life

assessment tool named Geriatric Oral Health Assessment Index (GOHAI) into Hindi language for use in

the Indian population.

Methodology: The 12-item GOHAI questionnaire was translated into Hindi, back-translated and com-

pared with the original English version. After pilot testing and appropriate changes, the Hindi versionwas administered to a group of 500 patients visiting the geriatric medicine clinic in All India Institute of

Medical Sciences, New Delhi. The questionnaire was re-administered to 29 participants after a gap of

minimum 7 days. The measures for reliability and validity were also assessed.

Results: Cronbach’s a score (0.79) showed excellent internal consistency. Item-scale correlations varied

from 0.06 to 0.75. Test – retest correlation on the 29 patients showed excellent results (ranging from

0.748 to 0.946). Lower GOHAI scores were associated with patient’s self-perception of nutritional status,

perceptive need for prosthesis, number of posterior occluding pair of teeth. Higher GOHAI scores were

seen with patients with removable prosthesis than with edentulous or partially edentulous participants.

Age group was also found to be a significant factor for GOHAI scores.

Conclusion: The Hindi version of GOHAI exhibits acceptable validity and reliability and can be used in

the elderly Indian population as a measure of oral health-related quality of life.

Keywords: elderly, validity, reliability, oral health.

Accepted 5 November 2013

Introduction

Clinicians have long known that the absence of

diseases or suffering is not the only indicator of

health. Quality of life is a multidimensional con-

struct involving physical functioning, emotionaland social well-being and has been an integrated

part of the definition of health for decades1. Oral

health plays an important role in the determina-

tion of the quality of life. With an increase in

patient awareness about oral health, clinicians as

well as researchers are becoming increasingly

interested in assessing patients’ perception of the

social and functional impacts of oral conditions.

The concept of oral health-related quality of life

(OHrQoL) is not new2. For the past several dec-

ades, several studies have been reported on

health-related quality of life3. Efforts have been

invested in developing instruments to measure

OHRQoL4 – 6. There are various instruments specif-

ically developed to measure the effect that oral

health has on a person’s daily activities and qual-

ity of life7

. One of such instrument, Geriatric OralHealth Assessment Index (GOHAI) was originally

developed for assessing self-reported oral health

status in elderly8. It was developed to assess oral

health on the individual level as well as the popu-

lation level. On individual level, it could be used

to indicate the need for dental treatment, psycho-

social and functional problems that affect the

individual. On the population level, it could be

used to gather information about the population’s

oral health problems and planning for delivery of

healthcare services.

© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd,

Gerodontology 2016; 33: 89–96 89


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Since its development, GOHAI has been trans-

lated for use in various languages and cultures

such as German9, Swedish10, French11, Malay12,

Chinese13 and Arabic14 and has been shown to be

an effective and reliable means to assess OHrQOL

among population. One aspect of GOHAI that

needs to be studied is its validity in relation to thevarious cultural backgrounds throughout the

world. In a country like India with a vast popula-

tion and numerous cultural and linguistic varia-

tions, it is important to determine the robustness

of any OHrQOL tool in assessing quality of life on

a population level. The objective of this study was

to evaluate the effectiveness of Hindi-translated

version of GOHAI as a survey instrument for

research or for clinical purposes in India.

Methods

This study was conducted as a part of a larger

hospital study on the effect of dental prosthesis

need and its relation to nutritional status and sys-

temic health of the elderly funded by the Indian

Council of Medical Research.

GOHAI

The Geriatric Oral Health Assessment Index (GO-

HAI), developed by Atchison and Dolan8, is a 12-

item questionnaire consisting of three hypotheti-

cal dimensions of OHrQOL that covers:

1. physical function which includes eating, speak-ing and swallowing (four items);

2. psychosocial function which includes worry or

concern about oral health, dissatisfaction with

appearance, self-consciousness about oral

health, avoidance of social contacts because of

oral problems (five items) and

3. pain and/or discomfort, which includes use of

medication to relieve pain or oral discomfort

(three items).

The English version of GOHAI consisted of six

options for each item, namely ‘Always’, ‘Very

Often’, ‘Often’, ‘Sometimes’, ‘Seldom’ and‘Never’.

Participants

Approval was obtained from the Institutional Eth-

ical Committee. Questionnaires were filled for

500 elderly (60 years and above) participants of

both the gender reporting to the Geriatric Medi-

cine department of All India Institute of Medical

Sciences, New Delhi. The participants were first

informed in detail about the study, and a written

informed consent was obtained from all the par-

ticipants. Individuals who were not in good

enough physical and/or mental condition to par-

ticipate in the collection of data, for example,

those confined to wheelchairs, amputees, or those

to problems of understanding/hearing loss that

would prevent the measurements used in thestudy from being taken and those who did not

consent for the study, were excluded from the

study.

Translation

The forward translation of the questionnaire was

carried out by two accredited bilingual profes-

sional translators whose first language was Hindi.

A group of five investigators and other clinicians

revised and scrutinised the Hindi translation for

the scientific terms, and minor corrections weremade to retain the flow and the understandability

of each question. Special attention was paid to

preserve the semantic equivalence of the English

version and maintaining the colloquial expres-

sions of the local culture. The revised question-

naire was then back-translated to English by a

different group of professional English language

translators. Minor grammatical differences were

seen (attributing to the changes made during the

forward translation), but no change in the ques-

tion structure or its meaning was found.

In the next phase, the GOHAI-Hi (Hindi ver-

sion) was applied to 23 participants in the pres-ence of a trained and calibrated dentist, and the

areas where the participants seemed to be con-

fused were noted down. The major cause for con-

cern was the number of options (Always, Very

often, Sometimes, Seldom and Never), which

many participants found confusing and difficult to

answer. It was therefore decided to convert the

scale to a simple 3-point likert scale. The feedback

received was discussed by the group of investiga-

tors and translators, and appropriate corrections

made to the GOHAI-Hi, and this version was fina-

lised. This finalised version was then administeredto 500 participants. In order to check intraexam-

iner variability, the questionnaire was re-adminis-

tered to 29 participants ( 6%) of the sample of

500 after a minimum gap of 1 week.

General information

Apart from GOHAI, socio-demographic informa-

tion (age, gender, health status, nutritional index,

income, education, marital status, height and

weight etc.) and clinical information (denture

90 V. P. Mathur et al.


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wearer/not wearer, crowns, Community peri-

odontal index (CPI), denture need) were recorded

by two calibrated dentists maintaining sterilisation

protocols. A single weighing machine was used

for every participant. Mid-arm circumference and

calf circumference were measured. Third molars

were excluded from the recording for the intra-oral examination.

Data analysis

The data obtained were fed into computer using

MS Excel (Microsoft Office 2007) after coding each

question and the options in a numerical value. The

negatively phrased questions were reverse coded

during data analysis. Statistical Software for Social

Sciences (SPSS Ver. 13.1; SPSS, Inc., Chicago, IL,

USA) was used to analyse the data. Frequency dis-

tributions were produced, and the means and stan-dard deviation of the dependent variables were

estimated and compared within the study popula-

tion using independent t -test or one-way ANOVA, as

appropriate. ‘Always’ was scored as 1, ‘Sometimes’

as 2 and ‘Never’ as 3 (Higher score, better GOHAI).

Reliability

The Cronbach’s a score was calculated to assess

the internal consistency and homogeneity

between the items. Item-scale correlation coeffi-

cients were used to assess the correlation between

the individual items with the GOHAI score.Assessment of test – retest reliability was carried

out using Cohen’s kappa and Spearman’s rank

correlation coefficient by repeating 29 participants

GOHAI 1 week after the questionnaire was first

administered to detect and eliminate interviewer

effect on the responses under supervision.

Validity

To examine the concurrent validity, assessment of

the degree to which the GOHAI scores were

related to scores of general items such as gender,age group, education level, socio-economic status.

Confidence interval was set at 95%. Convergent

validity was assessed by determining the relation

between the GOHAI scores and the objective

assessment of variables such as number of poster-

ior occluding teeth, prosthetic status and CPI

score for each sextant. Discriminant validity was

evaluated by examining the association of GOHAI

scores with adverse oral habits such as smoking

and chewing tobacco. The variables that did not

reach the predetermined statistically significant

level were discarded, and the significant variables

were retained.

Results

A total of 500 participants (322 male, 178 female)

participated and completed the GOHAI question-naire. Their socio-economic characteristics are

shown in the Table 1. Socio-economic status for

the Indian population was categorised in accor-

dance with Kuppuswamy index (2011 update)15.

Demography

The mean age (SD) of the participants was 66.9

(5.39) years with the maximum age being

94 years. More patients of the age group 60 –

69 years (n = 359; 71.8%) attended the geriatric

clinic than those aged 70 –

79 years (n =

117;23.4%) and 80 years and above (n = 24; 4.8%).

There was a significant difference in the total GO-

HAI scores among the age groups ( p = 0.004). The

socio-economic class of the participants according

to the Kuppuswamy index showed that most par-

ticipants were in the upper-lower class (n = 214;

42.8%) followed by lower-middle-class (n = 136:

27.2%), upper-middle-class (n = 103:20.6%),

lower class (n = 46:9.2%) and upper class (n = 1:

0.2%). Of the 500 participants, 461 (92.2%) were

married, 37 (7.4%) were widowed/divorced and 2

(0.4%) were unmarried. Monthly income was less

than INR 10 554 for 274 (54.8%) and higher thanINR 10 554 for 197 (39.4%) participants. The rest

of the 29 (5.8%) participants were not earning any

income. The number of patients with education

level of high school or less – including illiterate, pri-

mary and middle school levels (n = 363:72.6) –

was higher than those with education level higher

than high school levels (n = 137:27.4%). A signifi-

cant difference in the mean GOHAI scores was seen

among the age group, the calf circumference

( p = 0.001) and the presence or absence of remov-

able denture in the participants ( p = 0.02).

Responses to the GOHAI items tended towards‘Never’ followed by ‘Sometimes’ and ‘Always’.

The mean GOHAI score was 32.01 (4.10; range

17 – 36; Table 2). The mean GOHAI score was

almost identical in males and females. Education

and occupation did not seem to have any effect

on the total GOHAI scores (Table 1).

Reliability

The Cronbach’s a for GOHAI-Hi was 0.79, which

is very good. The item-scale correlation ranged

Validation of GOHAI in Hindi 91




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from 0.062 to 0.754 where the lowest score of

0.062 was for the question ‘sensitivity to sweet/

hot/cold food’ and 0.754 was for the question

‘Have to limit food intake/choice of food’. The

test – retest correlation ranged from 0.728 to 0.951

showing excellent intra-observer reliability

(Table 3).

Validity

The patient’s perceptive need for prosthesis was

also positively correlated with his/her GOHAI

scores (r = 0.442). The number of posterior

occluding pair of teeth was positively correlated

with the total GOHAI scores, that is, more the

number of posterior occluding pair of teeth, better

the GOHAI score. In addition, the prosthetic need

was negatively correlated with the total GOHAI

Table 1 Demographic details of the elderly population.

n %

Mean

GOHAI

score SD p-value

Gender

Male 322 64.4 29.36 3.24 0.975

Female 178 35.6 29.35 3.29

Age group

Group 1 (up to

69 years)

359 71.8 29.60 3.25 0.022

Group 2 (70 –

79 years)

117 23.4 28.65 3.21

Group 3 (more

than 80 years)

24 4.8 29.12 3.11

Educationa

Illiterate 129 25.8 29.33 3.20 1.000

Primary school

level

45 9.0 29.33 3.37

Middle schoollevel

81 16.2 29.36 3.18

High school

level

108 21.6 29.37 3.19

Intermediate

level

24 4.8 29.38 3.80

Graduate level 102 20.4 29.42 3.40

Postgraduate

level

11 2.2 29.09 2.80

Income groupab

0 or unwilling

to divulge

29 5.8 29.28 3.25 0.838

1412 30 6.0 29.73 2.76

1413 – 4232 104 20.8 29.58 3.42

4232 –

7052 75 15.0 29.52 2.98

7053 – 10554 65 13.0 29.26 3.62

10555 – 14106 57 11.4 29.12 3.54

14107 – 28214 107 21.4 29.39 3.13

28215 + 33 6.6 28.55 3.00

Marital status

Married 461 92.2 29.33 3.31 0.753

Widowed/

Divorced

37 7.4 29.65 2.58

Unmarried 2 0.4 30.5 2.12

Smoking

Smoker 58 11.6 29.05 3.78 0.389

Past smoker 99 19.8 29.07 3.20

Non-smoker 343 68.6 29.49 3.17Tobacco

Tobacco user 96 19.2 29.47 3.21 0.848

Past user 81 16.2 29.19 3.26

Non-user 323 64.6 29.36 3.27

Alcohol

Alcohol user 28 5.6 28.57 3.47 0.391

Past 59 11.8 29.25 3.22

Non-alcoholic 413 82.6 29.42 3.24

Socio-economic classa

Lower 46 9.2 29.67 3.60 0.949

(Continued)

Table 1 (Continued)

n %

Mean

GOHAI

score SD p-value

Upper lower 214 42.8 29.37 3.16

Lower middle 136 27.2 2 9.28 3.50Upper middle 103 20.6 2 9.29 2.99

Upper 1 .2 28 0

Mini Nutritional Assessment Index

Well nourished 271 54.2 29.32 3.28 0.752

At risk of

malnourishment

178 35.6 29.33 3.20

Malnourished 51 10.2 29.69 3.37

Body Mass Index

Underweight 77 15.4 29.31 3.49 0.018

Normal 184 36.8 29.04 3.34

Overweight 188 37.6 29.90 2.87

Obese 51 10.2 28.56 3.66

Systemic diseasesc

Hypertension 134 – – – –

Diabetes

mellitus

83 – – –

Gast rointestinal 141 – – –

Respiratory 222 – – –

Joint Pain 134 – – –

Others 336 – – –

Calf circumference

31 cm 261 52.2 29.67 3.10

Wears removable denture

Yes 61 12.2 30.11 2.91 .037

No 439 87.8 29.25 3.29

GOHAI, Geriatric Oral Health Assessment Index.aAccording to Kuppuswamy index (2011 update). bIn Indian rupees.cMost patients had multiple ailments (percentages and

mean GOHAI score cannot be calculated precisely).





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scores. This meant that participants in the present

sample who did not need prosthetic rehabilitation

had higher GOHAI scores. Similarly, positive cor-

relation was seen with prosthetic status and

higher GOHAI scores showing that people withprosthesis had higher scores compared with the

edentulous or partially edentulous (Table 1). The

results were found as was expected. The CPI

scores (Table 4) for each sextant were also signifi-

cantly correlated with the GOHAI scores. There

was a significant correlation between the number

of natural teeth present and the total GOHAI

scores. Interestingly, even though the mid-arm

circumference showed no significance on GOHAI

scores, participants with higher calf circumference

had a higher GOHAI score. The results show that

the Hindi version of GOHAI shows good reliability

and validity, and the test – retest correlation and

item-scale correlation are satisfactory.

Discussion

Hindi (modern standard Hindi) is a standardisedand Sanskritised register of the Indian subconti-

nent and is the official language of the Republic

of India. This study was conducted to translate

the English version of GOHAI to Hindi and while

doing so, to adapt the English version according

to the Indian cultural interpretation, the partici-

pants understanding and their ability to respond

to the questions. The GOHAI that was originally

developed and tested on well-educated, elderly

Americans has also been demonstrated suitable in

poorly educated populations8. The first concern of

the reviewing committee set-up for the purposeof translation of the GOHAI was the type of popu-

lation it was to be applied on. To help in the

understanding of the questionnaire and its ease of

answering, the 3-point likert scale of ‘Always’,

‘Sometimes’ and ‘Never’ was used. Agreeing with

the study conducted by Atchison and Dolan, this

study found more participants reporting problems

with physical functioning and fewer problems

with psychosocial functioning. Unlike the Chinese

translation of GOHAI where the positive and neg-

ative intonations of the questions were mixed up,

no such changes were deemed necessary for this

study.The GOHAI that was originally developed and

tested on well-educated, elderly Americans has

also been demonstrated suitable in poorly edu-

cated populations8. When the initial 6-scale

Hindi-translated GOHAI questionnaire was first

assessed for acceptance among the Indian popula-

tion on 23 participants, the major cause for con-

fusion to the participants was from the

contiguousness of options provided for each ques-

tion. Most participants were unable to clearly dis-

tinguish between ‘Always’ and ‘Very often’,

‘Seldom’ and ‘Never’. It was believed that thiscould pose a problem when the study was carried

out on a higher number of participants; hence, to

keep it simple for the participants, a simple 3-

point likert scale was used as cited by Atchison16

where the English equivalent of Always, Very

Often and Often was clubbed together as Always;

Seldom and Never were clubbed into Never

thereby giving Always, Sometimes and Never

as the three options). Questions were asked in

both negative and positive ways to discourage

respondent acquiescence. One drawback of using

Table 2 Percentage distribution of subjects according to

their response to individual Geriatric Oral Health

Assessment Index (GOHAI) questions (n = 500).

Individual

question Always = 1 Sometimes = 2 Never = 3

Physical functioning

Trouble biting/

chewing

22.2 20.8 57.0

Have to limit

food intake/

choice of food

15.6 18.4 66.0

Unable to

speak clearly

9.4 5.8 84.8

Pain and discomfort

Discomfort

during eating

13.8 23.4 62.8

Sensitive to

hot/cold/

sweet food

8.6 14.6 76.8

Use medication

to relieve

pain

2.4 17.4 80.2

Able to

swallow

comfortably

92.0 2.6 5.4

Psychosocial functioning

Worried about

teeth

problems

5.8 21.0 73.2

Limit contact

with people

1.0 2.0 97.0

Uncomfortable

eating in

front of others

3.4 4.0 92.6

Self-conscious

of teeth

problems

8.2 23.0 68.8

Pleased with

look of teeth

69.2 7.8 23.0





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a 3-point likert scale was that it was difficult to

directly compare this study to the other studies17.

Although considering the Indian cultural diver-

sity, the authors believed that the 3-point system

was the best way to collect data from the Indian

population at the ground level.

Atchison, for the purpose of comparing GOHAI

findings among a number of range of response

categories, rescored the original 6-point likert

scoring system into a 3-point likert system17. The

resulting mean GOHAI of their study according to

the new scoring system was 34.3 (SD = 2.5),

which is higher than that of the current study

(mean = 29.36; SD = 3.25). The only other

published study carried out with a 3-point likert

scale was by Kressin et al. (n = 957; Table 5).

Both of these studies were carried out in a devel-

oped nation, which may account for a higher

mean GOHAI score as compared to the current

study.India being a country with both extremes of

economic status often coexisting, adjustments

needs to be made according to the literacy levels

and demography. Nevertheless, studies need to be

carried out with a 5- or 6-point likert scales to

evaluate the possible merits on this type of scor-

ing system on Indian population too. For this, an

interview system can be adapted which will help

the interviewee to better communicate the ques-

tion items to the participant. Moreover, additional

aids to responses such as graphical representation

may be used for a more exact response from the

participants.

Table 5 Comparison of Geriatric Oral Health Assessment Index (GOHAI) findings among other studies with 3-point

likert scale.

Study Sample size Mean age No. (range) of response categories Mean GOHAI range SD

Atchison and Dolan (Original) 1755 74 6 (0 – 5) 52.5 5 – 60 7.8

Rescored 1911 Not given 3 (1 – 3) 34.3 16 – 36 2.5

This study 500 66.8 3 (1 – 3) 32.02 17 – 36 4.1

Kressin et al.17 957 63 3 (1 – 3) 31.2 17 – 36 4.4

Table 3 Item-scale and test – retest correlation for Geriatric Oral Health Assessment Index (GOHAI) items.

Individual question Item-scale correlation If item deleted Test – retest correlationa

Physical functioning

Trouble biting/chewing 0.668 0.746 0.874

Have to limit food intake/choice of food 0.754 0.736 0.946

Unable to speak clearly 0.349 0.783 0.927

Pain and discomfort

Discomfort during eating 0.747 0.738 0.728

Sensitive to hot/cold/sweet food 0.062 0.810 0.968

Use medication to relieve pain 0.232 0.791 0.894

Able to swallow comfortably 0.139 0.798 0.930

Psychosocial functioning

Worried about teeth problems 0.580 0.762 0.931

Limit contact with people 0.207 0.792 0.782

Uncomfortable eating in front of others 0.318 0.786 0.876

Self-conscious of teeth problems 0.554 0.763 0.857

Pleased with look of teeth 0.466 0.774 0.951

Cronbach’s a –

0.79, Mean –

32.02 (

4.106).aPearson’s correlation coefficient.

Table 4 Community periodontal index (CPI) scores of

each tooth in the study sample.

CPI score – Tooth

17/

16 11

26/

27

36/

37 31

47/

46

Bleeding 194 132 206 202 210 188

Calculus 41 163 50 74 76 72

Pocket 4 – 5 mm 108 118 107 85 103 96

Pocket 6 mm

or more

53 32 54 47 49 51

Not recorded 104 55 83 92 62 93





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Geriatric Oral Health Assessment Index was

lower in the age group of 70 – 79 years. Various

factors could be involved such as poor general

health, familial neglect, morbidity. The advanced

age group of 80 years and above although had a

better score in comparison, but the reason for this

could be that only a small group of such patients(n = 24; 4.8%) presented for the study and may

not be adequate representation for their age

group.

When the present study was compared with

other translational validations, the Cronbach’s a

(0.79) was similar to that of the Malay study but

lower than French, German, Arabic and Chinese

studies (Table 6). The test – retest correlation

showed intra-observer reliability was lowest for

two questions – ‘Discomfort during eating’ and

‘Limit contact with people’ (Table 3). The lowest

a

values were for the items ‘Sensitive to hot/cold/sweet food’ and ‘Able to swallow comfortably’.

Although it shows that these questions may not

be useful in the questionnaire among the present

sample population, it has to be borne in mind

that the present sample contained a high number

of edentulous participants (explaining the former)

and many of them were non-denture wearers

(explaining the latter). Moreover, when these

items are not included, Cronbach’s a increased.

This could be because these questions may not be

valid for edentulous participants, non-denture

wearers etc. who comprised a higher number of

the sample size. Also, as this study was conductedin a set-up where majority of patients presented

with health ailments, the participants may not

have been concerned with their oral health at the

moment. Nevertheless, number of participants

who did not want a prosthesis due to priority

towards other ailments was relatively low

(n = 28: 10%). In this regard, it demonstrates that

GOHAI is a general scale for a diverse population

covering all aspects of oral health-related quality

of life.

The frequency distributions of items demon-

strate that the group of elderly studied had a ten-

dency towards giving negative response. This was

especially so for the questions ‘limiting contact

with people’, ‘uncomfortable eating in front of

others’ suggesting that the participants did not

regard oral conditions as a barrier to social inter-actions. Cronbach’s a was highest for the items

‘Have to limit food intake/choice of food’ and

‘Discomfort during eating’ showing increased con-

cern of the participants to the physical function-

ing. This group of participants showed a lower

concern about their teeth problems possibly due

to factors such as socio-economic status and liter-

acy levels.

The elderly participants of this study show that

the major problem for them lay with the physical

functioning and pain and discomfort. Therefore,

the items ‘Discomfort during eating’, ‘Have tolimit food intake/choice of food’ and ‘Trouble bit-

ing/chewing’ were mostly answered affirmatively

(22.2, 15.6 and 13.8%, respectively). Least prob-

lems found with ‘Limit contact with people’

(probably due to indifference to aesthetics), ‘Able

to swallow properly’ (mixed sample with non-

denture wearers) and ‘Uncomfortable eating in

front of others’. This pattern of most concern

towards the physical and psychosocial functioning

may be due to the high number of participants

requiring multiple unit prosthesis.

The frequency for need of multi-unit prosthesis

or full prosthesis in the participants was found to be high, but the prosthesis wear was low. The

low proportion of denture wearers may be due to

the fact that older people do not use dental

healthcare services adequately due to lack of

awareness, financial constraints and reduced

mobility. Participants having removable dentures

had a better GOHAI score than those without

dentures. Majority of the participants were of the

upper-lower socio-economic class (n = 214;

42.8%), which may explain the negative impact

of oral conditions on functioning and well-being.

Unlike the French study11

, low level of education,low income or the occupation had no effect on

GOHAI scores.

There are various factors to determine the

need of dental treatment in an individual and

indices has been formulated. The current study

does not delve into the clinical/individual mea-

sures of oral health instead it focuses on the

population level. The results of the study show

that this version of GOHAI can be used as an

effective tool to judge the oral health status and

rehabilitation needs of the elderly population.

Table 6 Cronbach’s a for various studies.

Candidate Cronbach’s a Sample size Mean age(years)

Hindi 0.79 500 66.8

French 0.86 260 Not given

Malay 0.79 189 67.1

German 0.92 218 73

Arabic 0.88 288 33.4

Romanian 0.63 45 Not given

Chinese 0.81 1023 72.3





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Seemingly, the Hindi version of GOHAI can also

be used as indicator for oral health on an indi-

vidual basis, but further study needs to be car-

ried out in this regard.

In conclusion, Hindi version of GOHAI showed

satisfactory intraexaminer and test – retest reliabil-

ity with Cronbach’s alpha score of 0.79, similar toother translation studies. It also showed accept-

able concurrent and discriminant validity and is a

good indicator to nutritional status, dentition

status and perceptive need for dental prosthesis.

The Hindi version of GOHAI proves to be an

important measure for the assessment of oral

health-related quality of life among the Indian

elderly population. However, further studies need

to be performed to evaluate the effect of a 5 or 6

category response with the aid of the interviewer.

Furthermore, the study needs to be performed in

a population-based study. Use of GOHAI as a

means to evaluate treatment outcomes in Indianpopulation should be explored too.

Acknowledgements

This study was funded by Indian Council of Medi-

cal Research (ICMR), New Delhi.

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Correspondence to:

Veena Jain, Department of

Prosthodontics, Centre for

Dental Education & Research,

Room 212,

All India Institute of Medical

Sciences, New Delhi 110029,

India.

Tel.: +09868187441

Fax: +911126588663

E-mail: [email protected]




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