Validity and reliability of the Turkish version of the malocclusion impact questionnaire (MIQ)

Background: The Malocclusion Impact Questionnaire (MIQ) assesses oral health-related quality of life (OHRQoL) in patients aged 10–16 years with malocclusion. This cross-sectional study aims to create a Turkish version of the MIQ (MIQ-T) and evaluate its suitability for Turkish adolescents in determining malocclusion’s impact on OHRQoL. Methods: The MIQ-T was developed following recommended guidelines. A total of 350 adolescents, aged 10–16 years, were recruited to the study to evaluate the psychometric properties of the questionnaire. For assessing the psychometric properties of the questionnaire, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), content validity, convergent validity, internal consistency and test-retest reliability methods were employed. Results: EFA identified three subgroups with a total variance of 65.911%. The CFA showed all fit indices met acceptable standards: Root Mean Square Error of Approximation (RMSEA) = 0.07, The Chi-square Degree of Freedom (CMIN/df ) = 3.016, Tucker-Lewis Index (TLI) = 0.94, Goodness-of-Fit Index (GFI) = 0.90, and Comparative Fit Index (CFI) = 0.95. Convergent validity coefficients for the two global questions and specific items were 0.690 and 0.680, respectively. Test-retest reliability was 0.890, and the MIQ-T demonstrated strong internal consistency with Cronbach’s alpha of 0.915. Split-half reliability analysis showed Cronbach’s alpha values of 0.918 and 0.745 for the first and last nine items, respectively. Conclusions: These findings suggest that the MIQ-T is a useful tool for assessing the impact of malocclusion on OHRQoL in Turkish adolescents.

Validity and reliability; Test-retest reliability; Malocclusion

[1] Alvarez-Azaustre MP, Greco R, Llena C. Oral health-related quality of life in adolescents as measured with the Child-OIDP questionnaire: a systematic review. International Journal of Environmental Research and Public Health. 2021; 18: 12995.

[2] Akpasa IO, Yemitan TA, Ogunbanjo BO, Oyapero A. Impact of severity of malocclusion and self-perceived smile and dental aesthetics on self-esteem among adolescents. Journal of the World Federation of Orthodontists. 2022; 11: 120–124.

[3] Juvonen J, Graham S. Bullying in schools: the power of bullies and the plight of victims. Annual Review of Psychology. 2014; 65: 159–185.

[4] Yoon D, Shipe SL, Park J, Yoon M. Bullying patterns and their associations with child maltreatment and adolescent psychosocial problems. Children and Youth Services Review. 2021; 129: 106178.

[5] Farre A, Rapley T. The new old (and old new) medical model: four decades navigating the biomedical and psychosocial understandings of health and illness. Healthcare. 2017; 5: 88.

[6] Havelka M, Lucanin JD, Lucanin D. Biopsychosocial model—the integrated approach to health and disease. Collegium Antropologicum. 2009; 33: 303–310.

[7] Thomson WM, Broder HL. Oral-health-related quality of life in children and adolescents. Pediatric Clinics of North America. 2018; 65: 1073–1084.

[8] Locker D, Allen F. What do measures of “oral health-related quality of life” measure? Community Dentistry and Oral Epidemiology. 2007; 35: 401–411.

[9] Kotha SB, Chaudhary M, Terkawi S, Ahmed M, Ghabban SN, Fernandez RAA. Correlation of perceived self-rated oral health status with various dental health and awareness factors. Journal of International Society of Preventive and Community Dentistry. 2017; 7: S119–S124.

[10] Volpato GH, de Almeida-Pedrin RR, Oltramari PVP, Freire Fernandes TM, de Almeida MR, de Castro Ferreira Conti AC. Self-perception of facial esthetics by patients with different profiles compared with assessments of orthodontists and lay people. American Journal of Orthodontics and Dentofacial Orthopedics. 2020; 158: 840–848.

[11] McKeta N, Rinchuse DJ, Close JM. Practitioner and patient perceptions of orthodontic treatment: is the patient always right? Journal of Esthetic and Restorative Dentistry. 2012; 24: 40–50.

[12] Chai HH, Gao SS, Chen KJ, Lo ECM, Duangthip D, Chu CH. Tools evaluating child oral health-related quality of life. International Dental Journal. 2024; 74: 15–24.

[13] Baiju RM, Peter E, Varghese NO, Sivaram R. Oral health and quality of life: current concepts. Journal of Clinical and Diagnostic Research. 2017; 11: ZE21–ZE26.

[14] John MT, Omara M, Su N, List T, Sekulic S, Häggman-Henrikson B, et al. Recommendations for use and scoring of oral health impact profile versions. Journal of Evidence-Based Dental Practice. 2022; 22: 101619.

[15] O’Brien K, Kay L, Fox D, Mandall N. Assessing oral health outcomes for orthodontics--measuring health status and quality of life. Community Dental Health Journal. 1998; 15: 22–26.

[16] Cunningham SJ, O’Brien C. Quality of life and orthodontics. Seminars in Orthodontics. 2007; 13: 96–103.

[17] Patel N, Hodges SJ, Hall M, Benson PE, Marshman Z, Cunningham SJ. Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life of young people with malocclusion: part 1—qualitative inquiry. Journal of Orthodontics. 2016; 43: 7–13.

[18] Benson PE, Cunningham SJ, Shah N, Gilchrist F, Baker SR, Hodges SJ, et al. Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life of young people with malocclusion: part 2—cross-sectional validation. Journal of Orthodontics. 2016; 43: 14–23.

[19] Li MY, He SL, Wang JH. Validation of the Chinese version of the Malocclusion Impact Questionnaire (MIQ). Clinical Oral Investigations. 2021; 25: 2419–2427.

[20] Hope B, Zaror C, Sandoval P, Garay M, Streiner DL. Cross-cultural adaptation and validation in Spanish of the malocclusion impact questionnaire (MIQ). Health Qual Life Outcomes. 2020; 18: 146.

[21] Agou S, Al-Sakkaf G, Barboud L, Elhussein M. Cross-cultural adaptation and validation of the malocclusion impact questionnaire for patients seeking orthodontic treatment. Journal of Orthodontic Science. 2022; 11: 37.

[22] Cuschieri S. The STROBE guidelines. Saudi Journal of Anaesthesia. 2019; 13: S31–S34.

[23] Nunnally JC, Bernstein IH. Psychometric theory. 3rd edn. MacGraw-Hill: New York. 1994.

[24] Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000; 25: 3186–3191.

[25] Shrestha N. Factor analysis as a tool for survey analysis. American Journal of Applied Mathematics and Statistics. 2021; 9: 4–11.

[26] Sakaluk JK, Short SD. A methodological review of exploratory factor analysis in sexuality research: used practices, best practices, and data analysis resources. The Journal of Sex Research. 2017; 54: 1–9.

[27] Peterson RA. A meta-analysis of variance accounted for and factor loadings in exploratory factor analysis. Marketing Letters. 2000; 11: 261–275.

[28] Alidost F, Zareiyan A, Bőthe B, Farnam F. Psychometric properties of the persian short version of the problematic pornography consumption scale (PPCS-6). Sexual Health & Compulsivity. 2022; 29: 96–107.

[29] Margolis DJ, Apter AJ, Mitra N, Gupta J, Hoffstad O, Papadopoulos M, et al. Reliability and validity of genotyping filaggrin null mutations. Journal of Dermatological Science. 2013; 70: 67–68.

[30] Sharma B. A focus on reliability in developmental research through Cronbach’s Alpha among medical, dental and paramedical professionals. Asian Pacific Journal of Health Sciences. 2016; 3: 271–278.

[31] Ruscio J, Roche B. Determining the number of factors to retain in an exploratory factor analysis using comparison data of known factorial structure. Psychological Assessment. 2012; 24: 282–292.

[32] Epstein J, Santo RM, Guillemin F. A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. Journal of Clinical Epidemiology. 2015; 68: 435–441.

[33] Malter S, Hirsch C, Reissmann DR, Schierz O, Bekes K. Effects of method of administration on oral health-related quality of life assessment using the Child Perceptions Questionnaire (CPQ-G11-14). Clinical Oral Investigations. 2015; 19: 1939–1945.

[34] Chin WW. Commentary: Issues and opinion on structural equation modeling. MIS Quarterly. 1998; 22: vii–xvi.

[35] Sun X, Lv K, Wang F, Ge P, Niu Y, Yu W, et al. Validity and reliability of the Chinese version of the Health Literacy Scale Short-Form in the Chinese population. BMC Public Health. 2023; 23: 385.

[36] Madadizadeh F, Bahariniya S. Tutorial on how to calculating content validity of scales in medical research. Perioperative Care and Operating Room Management. 2023; 31: 100315.

[37] Benson PE, Gilchrist F, Farella M. The Malocclusion Impact Questionnaire (MIQ): cross-sectional validation in a group of young people seeking orthodontic treatment in New Zealand. Dentistry Journal. 2019; 7: 24.

[38] Churruca K, Pomare C, Ellis LA, Long JC, Henderson SB, Murphy LED, et al. Patient-reported outcome measures (PROMs): a review of generic and condition-specific measures and a discussion of trends and issues. Health Expectations. 2021; 24: 1015–1024.