Cross-cultural adaptation and validation of the Persian version of the oral health values scale

Abstract

Background

The decisions individuals make regarding oral health reflect their values. Prioritizing oral and dental health is essential for public health. This study aimed to evaluate the validity and reliability of the Persian version of the Oral Health Values Questionnaire.

Methods

A cross-sectional study was conducted involving 500 adults aged 18 years and older at health centers in Shiraz in 2023. The Original Oral Health Values Scale (OHVS) questionnaire was translated into Persian using a forward-backward translation. Participants completed the Persian version of the OHVS, which comprises a 12-item scale with a four-factor structure: professional dental care, appearance and health, flossing, and preservation of natural teeth. The Content Validity Index (CVI), Content Validity Ratio (CVR) and Scale-Level Content Validity Index (S-CVI/Ave) were assessed. Test-retest reliability and Cronbach’s alpha were used to evaluate the internal consistency of the questionnaire. To determine the adequacy of the sample size, the Kaiser-Meyer-Olkin (KMO) index, with a minimum value of 0.7, Bartlett’s test of sphericity, eigenvalues greater than 1, and the Varimax rotation method were utilized, using SPSS Version 24 statistical software.

Results

All questions demonstrated satisfactory Content Validity Ratio (CVR) and Content Validity Index (CVI), scoring above the expected thresholds of 0.8 and 0.9, respectively. The test-retest correlation results confirmed the reliability of the questionnaire, with correlation coefficients exceeding 0.7 for all questions and their sub-areas. Internal consistency was also established usings domains. Factor analysis revealed four primary components with eigenvalues greater than 1, which collectively accounted for 58.963% of the total variance.

Conclusions

The Persian version of the OHVS demonstrated excellent validity and reliability. Consequently, it can be regarded as a reliable and valuable tool for epidemiological and behavioral dental studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-025-05567-5.

Introduction

Oral health refers to the condition of the mouth, teeth, and surrounding oral structures. Maintaining optimal oral health not only allows individuals to perform essential functions such as eating, breathing, and speaking, but it also significantly influences psychosocial aspects. These aspects include self-confidence, overall well-being, social interactions, and participation in activities without experiencing pain, discomfort, or embarrassment [1].

The influence of oral health on overall well-being varies across different stages of life and can empower individuals to engage in social activities and achieve their full potential [2]. The contemporary understanding of oral health encompasses an individual’s overall well-being in terms of physical, mental, psychological, and social aspects. This updated definition emphasizes the holistic nature of health and shifts away from a focus on disease-related factors [3].

The World Health Organization (WHO) considers oral health a vital component of overall well-being and acknowledges that poor oral and dental health can significantly affect quality of life and daily activities. According to the WHO, oral and dental health is defined as “a state of being free from oral and facial pain, oral and throat cancer, oral infections and ulcers, periodontal disease, tooth decay, tooth loss, and other diseases and disorders that restrict a person’s ability to bite, chew, smile, speak, and maintain mental health” [4]. Numerous factors, including psychological, social, and environmental influences, affect behaviors related to oral health, making it an essential aspect of personal well-being [5]. These factors interact with an individual’s socioeconomic status, patterns, beliefs, behaviors, personal and social values, and level of oral health literacy to determine oral health outcomes [6]. Beliefs play a crucial role in empowering individuals to take charge of their oral health, and these values significantly contribute to prioritizing behaviors that promote good oral health [7]. The concept of oral health values is defined by the importance individuals place on their oral health and their commitment to preserving and enhancing the well-being of their mouth, jaw, and face.

In 2021, Edwards et al. [8] introduced the Oral Health Values Scale (OHVS), a comprehensive index designed to evaluate individual values related to oral health and the behaviors associated with it. Prior to the introduction of the OHVS, studies on oral and dental health relied on direct measurement and evaluation of Oral Health Values (OHV). Various questionnaires have been developed to assess different aspects of oral and dental health, including the Oral Health Belief Questionnaire [9] and a questionnaire specifically designed for teenagers to evaluate their beliefs regarding oral and dental hygiene behaviors [10]. These tools have been utilized to assess knowledge, attitudes, and behaviors related to oral health. While the OHVS is the most closely aligned measurement to OHV, it primarily evaluates the impact of oral diseases on overall health, emotional well-being, and functional abilities, without taking into account individual preferences or the significance placed on oral health. Research has established a connection between education and oral health [11]. Beliefs are often instinctive and illogical, whereas values necessitate contemplation and examination [12]. An individual’s understanding and literacy regarding their own oral health significantly influence their awareness of these values.

The OHVS is a comprehensive tool designed to assess individual awareness of oral health and commitment to supplementary oral care [8]. The test consists of 12 items, with responses based on a 5-point Likert scale. The tool evaluates four subscales: professional dental care and associated costs, the appearance and health of teeth, flossing as a continuous self-care behavior, and the value of maintaining natural teeth, which impacts a person’s performance and overall health. Edwards et al. demonstrated a correlation between OHVS outcomes and other assessments of oral and dental health, including oral health literacy, oral self-care practices, quality of life related to oral health, fear of tooth loss, and mistrust of dentists [8]. The questionnaire has been translated and analyzed in various countries. However, cultural norms, levels of oral health literacy, investments in oral and dental health across different social classes, and societal perceptions may lead to diverse attitudes toward this concept.

The comprehension and identification of oral health values can illuminate disparities in treatment utilization patterns and highlight the objectives of various interventions, including those aimed at improving dental treatment-seeking behavior. Currently, educational programs for both the general population and specific target groups within the Iranian oral health system are designed solely based on clinical indicators of dental health. These training initiatives are articulated in broad terms, without taking into account the beliefs, values, and attitudes of different groups. A contributing factor to this approach is the limited availability of practical Persian instruments for assessing oral health values and attitudes. To date, no efforts have been made to develop an Iranian version of such an instrument. Furthermore, none of the Iranian studies have utilized the Oral Health Value Survey (OHVS). Self-report measures should be cross-culturally adapted and tested for psychometric properties before being used in a different context or cultural group. This process ensures their appropriateness for the new culture and their equivalence to the original measure. The objective of this study was to develop a Persian version of the OHVS to provide a suitable tool for assessing oral health in the Iranian community.

Materials and methods

Design and participants

In a cross-sectional study conducted from August to December 2023, 500 participants were enrolled using cluster sampling. Participants were selected from clients of health centers in Shiraz, the capital of Fars Province in southern Iran. Assuming a sample-to-material ratio of 1:10 to 1:20 [13, 14], and considering the selection of 20 to 30 samples from each cluster (averaging 25 samples) across the 20 studied clusters [15], the approximate number of samples was estimated to be 500. The target population included adults aged 18 years and older who provided informed consent and visited the health centers in Shiraz. Data were collected using a self-administered questionnaire that comprised four sections: demographic characteristics, the Persian version of the OHVS, the Persian version of the Oral Health Impact Profile (OHIP-14) and The Health Literacy in Dentistry Questionnaire (HeLD-14).

Instruments

The sociodemographic characteristics recorded included age, sex, educational level (illiterate, elementary to middle school, high school to diploma, university graduate), occupational status (student, employed, unemployed, or retired), and place of residence (urban or suburban).

Oral health values scale questionnaire

The original Oral Health Values Scale (OHVS) questionnaire quantitatively evaluates the significance that an individual attributes to oral health. This instrument consists of 12 items and is systematically organized into four distinct subscales that examine pertinent domains of Oral Health Values: professional dental care (items 4, 8, and 11); esthetic appearance and health (items 3, 7, and 12); flossing practices (items 2, 5, and 10); and the maintenance of natural dentition (items 1, 6, and 9). Each item was assessed using a 5-point Likert scale, which was defined as follows: 1 = “Strongly disagree,” 2 = “Disagree,” 3 = “Neutral,” 4 = “Agree,” and 5 = “Strongly agree”. The aggregate score was derived by summing the responses for the Oral Health Value Scale (OHVS) items, implementing reverse scoring for items 2, 4, 6, 8, 9, and 11 in accordance with established guidelines for the construction of psychometric scales [8]. In the Persian version of the Oral Health Values Questionnaire, all questions were answered with a positive theme. To improve the evaluation of the requested items and the respondents’ understanding of the questions, the Likert scale scoring method was modified as follows: 1 = “Strongly disagree,” 2 = “Disagree,” 3 = “have no opinion,” 4 = “Agree,” and 5 = “Strongly agree”. In addition, the questions related to each factor were organized and categorized in order (Appendix).

Oral Health Impact Profile (OHIP-14)

The Oral Health Impact Profile (OHIP) questionnaire is a tool designed to assess individuals’ perceptions of the social impact of oral and dental disorders on their quality of life, with a particular focus on the impact on oral health-related quality of life. The questionnaire comprises 14 items that are answered on a 5-point Likert scale, ranging from 0 (never) to 4 (very often). The questionnaire was divided into seven dimensions: pain, psychological distress, physical disability, psychological disability, social disability, and disability. Each dimension includes two items that address functional and physical limitations. The internal consistency of the total score is highlighted in different cultural models. The Persian version has adequate psychometric properties [16].

Health Literacy in Dentistry Questionnaire (HeLD-14)

The Health Literacy in Dentistry Questionnaire (HeLD-14) is an instrument designed to assess an individual’s health literacy specifically in the field of dental care. This study consists of 14 items that assess various aspects of health literacy, such as understanding, accessing, and using dental health information, and the questions are in the form of a 5-point Likert scale. Scores were calculated by assigning 0 to the “no problem” response and 4 to “I cannot do this”. The scores ranged from 0 to 56, with higher values indicating lower oral health literacy. The validity and reliability of the Persian version of the questionnaire were well documented [17].

Assessing the suitability of an implementation tool

In the preliminary phase, the applicability of the OHVS questionnaire in assessing oral health values within the context of Iranian culture must be evaluated. Accordingly, a panel was convened, consisting of two dental specialists with expertise in medical education and two community dental specialists, to review and approve the suitability of the questionnaire. The panel deliberated on two questions concerning the appropriateness of the OHVS items for use in the Iranian population:

Do the values assessed in the OVHS questionnaire align with the oral health culture of the Iranian society?

Second, it is important to determine whether behaviors associated with oral health values should be included in the OHVS questionnaire [18].

Semantic equivalence

The next step involved creating a pre-final version of the Persian OHVS that was both conceptually and semantically equivalent to the original English OHVS. The semantic equivalence between the versions was assessed to evaluate the similarity in meaning and usage of terms, following the four steps proposed by Guillemin, Bombardier and Beaton (1993) [19]:

First, the OVHS questionnaire was translated into Persian using a rigorous back-translation process. For this purpose, two bilingual native Persian speakers translated the OVHS into Persian independently.

The resulting Persian translations were subsequently reviewed by a team of four subject-matter experts to consolidate them into a cohesive Persian version. A back-to-back translation of this Persian version into English was then conducted by two additional bilingual translators who produced two independent translations. The translations were discussed with the researchers to create the final English version. The expert committee reviewed the translations and ultimately approved the pre-final Persian OHVS, noting that no major or significant changes were recommended.

Operational equivalence

Face validity

To evaluate qualitative face validity, the Persian version of the OVHS was distributed to 12 dental specialists from the Faculty of Dentistry at the Shiraz University of Medical Sciences. They were asked to assess the items based on three criteria: difficulty (the challenge of understanding words and sentences), relevance (the relationship of items to the dimensions of the questionnaire), and ambiguity (the likelihood of misinterpretation of sentences or unclear meanings of words). After qualitative face validity was evaluated, the defective items were revised. Dental specialists were also asked to employ the item impact method to assess quantitative face validity and determine the significance of the items. For this purpose, participants rated each item on a 5-point Likert scale: (5 = very important; 4 = important; 3 = fairly important; 2 = not very important; and 1 = not at all important). Finally, all questionnaires were collected and analyzed, with impact scores above 1.5 deemed acceptable [20].

Content validity

The content validity of the instrument was evaluated using both qualitative and quantitative methods. In the qualitative assessment, twelve dental professionals were invited to rate items based on their necessity, importance, relevance, and overall evaluation. Additionally, in the quantitative assessment, metrics such as the Content Validity Ratio (CVR), Content Validity Index (CVI), and the Scale-level Content Validity Index (S-CVI/Ave) were calculated. The CVR was determined by the same group of dental professionals using a 3-point Likert scale, where items were classified as essential, useful but not essential, or unnecessary. Items with a CVR of 0.49 or higher were deemed suitable for retention. [21–22]. Furthermore, the relevance, clarity, and simplicity of each item were evaluated by dental professionals using a 4-point Likert scale to derive the CVI. The S-CVI/Ave was subsequently calculated based on the average CVI score across all items, with an S-CVI/Ave score of 0.90 or higher considered acceptable [23].

Reliability test

To assess the reliability of the questionnaire, two methods were employed. Cronbach’s alpha was used to measure internal consistency [24], while stability was evaluated using test-retest correlation methods with a two-week interval in a sample of 50 participants (10% of the total sample size) [25–26]. Additionally, the Intraclass Correlation Coefficient (ICC) test was utilized [27].

Exploratory factor analysis and internal consistency

To assess the structural validity, we employed factor analysis to examine the internal consistency of the questionnaire statements and identify variables Kaiser-Meyer-Olkin (KMO) sampling adequacy test was used to evaluate the suitability of the sample, along with Bartlett’s test of sphericity (BTS) to determine whether factor analysis based on the studied matrix is justified and appropriate. Additionally, we used principal component analysis, a scree plot, and varimax rotation. A minimum factor loading of 0.40 was deemed necessary to retain each item in the extracted factors from the factor analysis [28].

Result

Participant’s description

The mean age of the participants was 38.53 ± 10.92 years (range: 14 to 74 years). The majority of participants (65.7%) were male. In terms of education, most participants were university graduates (69%), followed by those with a high school diploma (22%) and those who completed elementary to middle school (7%). A significant portion of participants (87%) resided in urban areas. Regarding employment status, 76.9% of individuals were employed, 7.9% were students, and the remaining participants were unemployed.

Content validity

The assessment of the Content Validity Index (CVI) for the initial questions revealed that three questions (2, 4, and 7) had an index of 0.77. After revising and correcting the wording of these questions, the CVI was re-evaluated and found to range between 0.90 and 1.00. The average Content Validity Ratio (CVR) index determined by a panel of experts ranged from 0.83 to 1.00. The questionnaire was deemed valid after confirmation of both content validity and face validity.

Reliability of OHVS

The pilot questionnaire was administered to a group of 50 participants to assess its internal consistency. The Cronbach’s alpha coefficient was calculated for four factors: professional dental care, appearance and health, flossing, and the retention of natural teeth. The findings indicate that the subscales exhibited coefficients above 0.70, while all 12 items demonstrated a coefficient of 0.82. The results of the intra-cluster correlation index (ICC) test revealed significant agreement between the scores of the test and retest (P < 0.001), confirming the repeatability of the subscales (ranging from 0.97 to 0.98) and the entire questionnaire (0.98), thereby demonstrating high stability in the OHVS questionnaire.

Factorial structure

Construct validity was assessed through exploratory factor analysis, which included the Kaiser-Meyer-Olkin (KMO) index, Bartlett’s test of sphericity, and varimax rotation. After identifying the factors, the contribution of each factor to the total variance explained was determined. The Varimax (orthogonal) method was employed for factor rotation, resulting in the formation of a matrix of rotated factors. Based on the correlation of each question with the factors (factor loadings) in this matrix, the questions were categorized into components. Exploratory factor analysis was conducted on a set of 12 statements using the principal component method. The obtained KMO value was 0.817, indicating that the data are suitable for factor analysis, as it exceeds the recommended threshold of 0.7. Furthermore, Bartlett’s test of sphericity yielded a significant result of 938.5884 at the 0.001 level, justifying the use of factor analysis based on the correlation matrix derived from the sample under study. The KMO index evaluation produced a value of 0.75, demonstrating that the data are appropriate for factor analysis. Therefore, this evaluation should be conducted prior to performing factor analysis. Additionally, Bartlett’s test of sphericity showed a significant result (Χ²(66) = 1121.276, p < 0.001), indicating an acceptable correlation between the variables, which is a prerequisite for factor analysis. Table 1 presents the communality results for each variable concerning the main and extracted components.

Table 1.

Communality sharing results for the main and extractive components

Communalities
items	Main componentsa	Extractive componentsb
My smile is an important part of my appearance.	1.000	0.492
I think it is important that my teeth and gums are a source of pride.	1.000	0.540
The condition of my teeth and gums is an important part of my overall health.	1.000	0.603
Going to a dentist is not worth the cost	1.000	0.554
If I have a toothache, I prefer to wait and see if it will go away on its own before seeing a dentist	1.000	0.645
Going to the dentist is only important if my teeth or gums are bothering me.	1.000	0.697
Flossing my teeth every day is a high priority for me.	1.000	0.572
It is okay for me to miss a day or two of flossing when I am busy	1.000	0.433
I make sure I have dental floss available with me so I have it when I need it	1.000	0.597
It is important to me to keep my natural teeth	1.000	0.527
would rather get dentures than spend money to treat cavities or gum disease	1.000	0.796
I would not mind if I had to have a false tooth or dentures	1.000	0.620

^a: the variances associated with each variable are adequately explained

^b: No variables are removed from the analysis

The main component analysis indicates that all variables have a communality value of 1, signifying that the variances associated with each variable have been thoroughly explained. Furthermore, the extracted components demonstrate that none of the variables exhibit a low extracted share, ensuring that all variables were included in the analysis. The presence of main components with a communality of 1 indicates a strong model fit, suggesting that these components effectively explain the variables. The extracted components represent common factors identified in the data that account for the correlations among the observed variables. Table 2 presents the variance explained by each component, summarizing the contribution of each to the overall variance. As shown, 12 components were extracted, collectively accounting for 100% of the variance. According to the results presented in Table 2, only four factors have an eigenvalue of one or greater. The total variance explained by the first four principal components is approximately 59%.

Table 2.

Total variance explained

Total Variance Explained
Component	Initial Eigenvalues			Extraction Sums of Squared Loadings			Rotation Sums of Squared Loadings
	Total	% Variance	Cumulative %	Total	% Variance	Cumulative %	Total	% Variance	Cumulative %
1*	3.207	26.724	26.724	3.207	26.724	26.724	1.990	16.587	16.587
2*	1.602	13.348	40.072	1.602	13.348	40.072	1.860	15.540	32.128
3*	1.202	10.019	50.090	1.202	10.019	50.090	1.733	14.441	46.569
4*	1.065	8.873	58.936	1.065	8.873	58.963	1.487	12.394	58.963
5	0.802	6.687	65.649
6	0.771	6.424	72.074
7	0.704	5.863	77.937
8	0.671	5.592	83.529
9	0.590	4.916	88.445
10	0.582	4.849	93.924
11	0.440	3.665	96.959
12	0.365	3.041	100.000

*: Eigenvalues>1: Only four factors were considered 

This result indicates that only four components have eigenvalues greater than 1, collectively accounting for 58.963% of the total variance. Figure 1 illustrates the scree plot of the eigenvalues obtained from the principal component analysis.

Fig. 1.

Eigenvalues of the extracted components

The graph further confirms that the four components of the solution offer a more accurate representation of the primary components. By combining the information from Table 2; Fig. 1, we identified four components with eigenvalues greater than one. These components collectively account for approximately 59% of the total variance in oral health values. The first component explains about 16% of the variance, while the fourth component contributes the least, at approximately 12%. Table 3 presents the factor loadings for each item following Varimax rotation.

Table 3.

Factor loadings of Persian-OHVS based on EFA with Varimax rotation

Items		Factors
		1	2	3	4
Q6	Going to the dentist is only important if my teeth or gums are bothering me	0.821	-0.027	-0.067	-0.131
Q5	If I have a toothache, I prefer to wait and see if it will go away on its own before seeing a dentist	0.794	-0.074	-0.039	-0.089
Q4	Going to a dentist is not worth the cost to me	0.706	0.144	-0.181	-0.048
Q11	I would rather get dentures than spend money to treat cavities or gum disease	0.147	0.880	-0.011	-0.016
Q12	It is important to me to keep my natural teeth	0.091	0.744	-0.212	-0.166
Q10	It is important to me to keep my natural teeth	-0.033	-0.594	0.408	0.078
Q3	The condition of my teeth and gums is an important part of my overall health	-0.113	0.025	0.762	0.093
Q2	I think it is important that my teeth and gums are a source of pride.	-0.028	-0.244	0.673	0.161
Q1	My smile is an important part of my appearance	-0.118	-0.219	0.652	-0.070
Q9	I make sure I have dental floss available with me so I have it when I need it	-0.109	-0.144	0.048	0.750
Q7	Flossing my teeth every day is a high priority for me	-0.026	0.074	0.139	0.739
Q8	It is okay for me to miss a day or two of flossing when I am busy	0.341	0.151	0.037	-0.540

OHVS, oral health values scale; EFA, exploratory factor analysis

Note: factor 1 = professional dental care; factor; factor 2 = natural teeth retention; factor 3 = appearance and health; factor 4 = flossing factor

The table illustrates those questions 4, 5, and 6 exhibit the highest correlation with the first factor (professional and dental care), while questions 10, 11, and 12 show the strongest correlation with the second factor (retaining natural teeth). Questions 1, 2, and 3 demonstrate the highest correlation with the third factor (appearance and health), whereas questions 7, 8, and 9 correlate most strongly with the fourth factor (flossing). Question 10 displays a shared correlation between factors 2 and 3 and is categorized under the subgroup of factor 2 due to its stronger correlation with factor 2 compared to factor 3.

The results of the Pearson correlation coefficient analysis between OHVS scores and two distinct health indices, OHIP-14 and HeLD-14, revealed a statistically significant positive correlation between OHVS and HeLD-14 (r = 0.478, P ≤ 0.001). Conversely, a statistically significant negative correlation was observed between OHVS and OHIP-14 (r = -0.336, P ≤ 0.001).

Discussion

This study investigated the validity and reliability of the Persian version of the Oral Health Value Scale (OHVS). The translation and adaptation of this instrument can help assess the importance and value that individuals in the Persian-speaking community place on oral health. The results suggest that the Persian-OHVS is a valuable tool for evaluating oral health in patients. This validation study demonstrated that the Persian-OHVS, similar to other translated versions based on the English version developed by Edward et al. [8], provides patients with a meaningful assessment of their oral health. Exploratory factor analysis of the Persian-OHVS revealed four main components. Despite the limited number of items in each subscale, the Persian-OHVS exhibited sufficient internal consistency and reliability.

The internal consistency of the measures examined in our study indicated that, across all domains and in total, Cronbach’s alpha was ≥ 0.7. This finding suggests that the Persian version of the Oral Health Values Questionnaire possesses adequate internal consistency [29]. These results align with those reported by Edwards et al. [8] and Machado et al. [30]. Consequently, the OHVS may enhance the comprehensive understanding of the psychological and social/environmental factors influencing oral health beliefs, thereby facilitating the development of future oral health behavioral intervention strategies [31].

The total score and the scores of the four subscales of the Persian-OHVS demonstrate the necessary reliability and validity for measuring occupational health values (OHV). Other translations of the OHVS, including the Portuguese [30], Romanian [32], and Arabic versions [33], also revealed four factors consistent with the original Edwards questionnaire [8]. In contrast, the Hindi translation identified only two factors instead of four [34]. This discrepancy may be attributed to the absence of a hierarchical model in India, unlike the other versions [34].

In general, oral health values refer to the importance an individual places on maintaining and caring for their teeth through proper hygiene practices. Studies have shown that individuals who prioritize their oral health tend to have a favorable perception of dentists and oral health care systems. These values encourage individuals to seek professional dental services and uphold good oral hygiene [35]. Models such as the Health Belief Model demonstrate how personal values shape health-related attitudes and concerns. Individuals with positive attitudes toward health risks are more likely to engage in behaviors that promote their well-being [36]. Furthermore, oral health values in behavioral dentistry can significantly influence essential behaviors, such as dental care, which serve as social determinants of oral health [37].

Understanding the importance of oral health is essential for effective policymaking in this area. These values are significantly shaped by the cultural beliefs and attitudes prevalent in society [38]. By understanding these values, policymakers can design programs and policies that align with the cultural needs and expectations of the community. Additionally, recognizing the values associated with oral health can help identify existing barriers to accessing dental services. If individuals have a negative perception of visiting a dentist or do not consider it necessary, it is crucial to adjust policies to change these perceptions. A comprehensive understanding of these values can serve as a foundation for developing effective educational campaigns aimed at increasing public awareness of the importance of oral health. Such campaigns can be tailored to resonate with existing views and beliefs, thereby enhancing their impact. Information gathered from research on oral health values can facilitate improved, multifaceted decision-making by health officials. Overall, an accurate understanding of the values related to oral health will not only lead to more effective policymaking but also contribute to enhancing the quality of life for individuals, as a healthy society requires serious attention to various aspects of health, including oral health [39].

Despite this progress, the oral healthcare system in Iran continues to face significant challenges. To date, the Iranian health system has primarily adopted a clinical approach to oral health assessment, relying on general oral health indicators. Based on these indicators, the report outlines policies in both the prevention and treatment sectors [40]. However, the lack of comprehensive tools for evaluating the factors influencing oral health within the Iranian health system has resulted in a situation where, despite notable advancements, decision-makers are unable to accurately identify the true needs of society due to the absence of valid and reliable data across all health-related sectors. Insufficient attention has been given to oral health as a social determinant that impacts critical behaviors, such as dental care. This oversight may lead to the development of inefficient and ineffective policies that fail to address existing issues, ultimately increasing the prevalence of oral diseases. Additionally, the absence of appropriate tools to assess factors affecting oral health status hinders the creation of effective educational programs aimed at raising public awareness regarding the importance of oral and dental care.

Limitations

This study has several limitations that warrant discussion. During data collection, we aimed to include individuals from diverse socioeconomic backgrounds with a substantial sample size. However, it is important to note that individuals with higher socioeconomic status may be less inclined to seek care at health centers, which could limit the generalizability of our results. Additionally, most of the study participants were middle-aged university graduates, indicating that the findings do not fully represent the perspectives of all segments of society. Therefore, future research should strive for samples that are more evenly distributed in terms of age and education level to ensure a more accurate validation of the Persian version of the OHVS. Despite these limitations, this study establishes the construct validity of the OHVS and serves as a foundation for further investigation. To enhance our understanding of the quality of items and information provided by the OHVS, future research should employ item response theory (IRT).

Conclusion

The Persian version of the OHVS has been successfully adapted for the Persian language. The psychometric evaluation of the Persian OHVS revealed an acceptable level of internal consistency and strong test-retest reliability. These attributes make it a valuable tool for assessing oral health values in Iranian society and can be employed in future research aimed at evaluating dental behaviors.

Electronic supplementary material

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Abbreviations

OHVS

Oral Health Values Scale questionnaire

WHO

World Health Organization

OHV

Oral Health Values

EFA

Exploratory Factor Analysis

KMO

Keyser-Meyer-Elkin sampling index test

BT

Bartlett’s test of sphericity

CVI

Content Validity Index

CVR

Content Validity Ratio

S-CVI

Content Validity Index for Scale

ICC

Intra-cluster Correlation index

IRT

Item Response Theory

Author contributions

KM contributed to the study design, manuscript writing, and data analysis. MKH contributed to the data gathering. All the authors read and approved the final manuscript.

Funding

This article is based on a thesis (Grant# 25692) prepared by Marjan Khalaji to fulfill the requirements for a dental doctoral degree. This project was funded by the Vice-Chancellor for Research at the Shiraz University of Medical Science.

Data availability

The datasets utilized and/or examined during the present study can be obtained from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The protocol approved by the Ethics Committee of Shiraz University of Medical Sciences (ethical code IR.SUMS.DENTAL.REC.1401.043). At the start of the study, the participants were given explanations about the objectives, and informed written consent was obtained from all participants. The complete anonymity and confidentiality of the data was assured. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no conflicts of interest.

Competing interests

The authors declare no competing interests.