Publications by authors named "Pedro Henrique Ribeiro Santiago"

12 Publications

  • Page 1 of 1

Drop-the-: Bayesian CFA of the Multidimensional Scale of Perceived Social Support in Australia.

Front Psychol 2021 26;12:542257. Epub 2021 Feb 26.

Australia Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Aim: We aimed to investigate whether the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) constitutes a valid and reliable measure of social support for the general adult Australian population.

Methods: Data were from Australia's National Survey of Adult Oral Health 2004-2006 and included 3899 participants aged 18 years old and over. The psychometric properties were evaluated with Bayesian confirmatory factor analysis. One-, two-, and three-factor (Significant Other, Family and Friends) structures were tested. Model fit was assessed with the posterior predictive -value (PPP), Bayesian root mean square error of approximation (BRMSEA), and Bayesian comparative fit index (BCFI). Dimensionality was tested by comparing competing factorial structures with the Bayes factor (BF). Reliability was evaluated with the Bayesian Ω . Convergent validity was investigated with the Perceived Stress Scale (PSS) and discriminant validity with the Perceived Dental Control scale (PDC-3).

Results: The theoretical three-factor model (Significant Other, Family, and Friends) provided a good fit to the data [PPP < 0.001, BRMSEA = 0.089-95% credible interval (CrI) (0.088, 0.089); BCFI = 0.963-95% CrI (0.963, 0.964)]. The BF provided decisive support for the three-factor structure in relation to the other structures. The SO [BΩ = 0.95 - 95% CrI (0.90, 0.99)], FA (BΩ = 0.92 - 95% CrI (0.87, 0.97), and FR (BΩ = 0.92 - 95% CrI (0.88, 0.97)] subscales displayed excellent reliability. The MSPSS displayed initial evidence of convergent and discriminant validity.

Conclusion: The MSPSS demonstrated good psychometric properties and excellent reliability in a large Australian sample. This instrument can be applied in national surveys and provide evidence of the role of social support in the Australian population.
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http://dx.doi.org/10.3389/fpsyg.2021.542257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953044PMC
February 2021

Psychometric properties of the EQ-5D-5L for aboriginal Australians: a multi-method study.

Health Qual Life Outcomes 2021 Mar 10;19(1):81. Epub 2021 Mar 10.

Adelaide Dental School, The University of Adelaide, Adelaide, Australia.

Introduction: In Australia, health-related quality of life (HRQoL) instruments have been adopted in national population surveys to inform policy decisions that affect the health of Aboriginal and Torres Strait Islanders. However, Western-developed HRQoL instruments should not be assumed to capture Indigenous conceptualization of health and well-being. In our study, following recommendations for cultural adaptation, an Indigenous Reference Group indicated the EQ-5D-5L as a potentially valid instrument to measure aspects of HRQoL and endorsed further psychometric evaluation. Thus, this study aimed to investigate the construct validity and reliability of the EQ-5D-5L in an Aboriginal Australian population.

Methods: The EQ-5D-5L was applied in a sample of 1012 Aboriginal adults. Dimensionality was evaluated using Exploratory Graph Analysis. The Partial Credit Model was employed to evaluate item performance and adequacy of response categories. Area under the receiver operating characteristic curve (AUROC) was used to investigate discriminant validity regarding chronic pain, general health and experiences of discrimination.

Results: The EQ-5D-5L comprised two dimensions, Physiological and Psychological, and reliability was adequate. Performance at an item level was excellent and the EQ-5D-5L individual items displayed good discriminant validity.

Conclusions: The EQ-5D-5L is a suitable instrument to measure five specific aspects (Mobility, Self-Care, Usual activities, Pain/Discomfort, Anxiety/Depression) of Aboriginal and Torres Strait Islander HRQoL. A future research agenda comprises the investigation of other domains of Aboriginal and Torres Strait Islander HRQoL and potential expansions to the instrument.
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http://dx.doi.org/10.1186/s12955-021-01718-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945337PMC
March 2021

Do network centrality measures predict dental outcomes of Indigenous children over time?

Int J Paediatr Dent 2020 Nov 21. Epub 2020 Nov 21.

Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.

Background: Centrality measures identify items that are central to a network, which may inform potential targets for oral interventions.

Aim: We tested whether centrality measures in a cross-sectional network of mothers' baseline factors are able to predict the association with children's dental outcomes at age 5 years.

Design: A network approach was applied to longitudinal data from a randomised controlled trial of dental caries prevention delivered to 448 women pregnant with an Indigenous child in South Australia. Central items were identified at baseline using three centrality measures (strength, betweenness, and closeness). Centrality values of mothers' outcomes were regressed with their predictive values to dental caries experience and dental service utilisation at child age 5 years.

Results: Items of oral health self-efficacy and oral health literacy were central to mothers' baseline network. Strength at baseline explained 51% and 45% of items' predictive values to dental caries experience and dental service utilisation at child age 5 years, respectively. Adjusted and unadjusted values of node strength for the children's oral health network were highly correlated.

Conclusion: Strength at baseline successfully identified mothers' items with greater importance to dental caries experience and dental service utilisation at child age 5 years.
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http://dx.doi.org/10.1111/ipd.12749DOI Listing
November 2020

Sense of personal control: Can it be assessed culturally unbiased across Aboriginal and non-Aboriginal Australians?

PLoS One 2020 1;15(10):e0239384. Epub 2020 Oct 1.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

In recent decades, several studies have emphasized sense of personal control as a prominent aspect of Aboriginal health. However, one limitation is that instruments available to measure personal control were originally developed in western countries and validation for Aboriginal Australians has not been conducted. The aims of the current study were to evaluate whether the Sense of Personal Control Scale (SPCS) can be used to obtain culturally unbiased measurement of personal control across Aboriginal and non-Aboriginal Australians and to assess the psychometric properties of the SPCS for Aboriginal and non-Aboriginal Australian.

Methods: The current study utilized two Australian subsamples retrieved from the Teeth Talk Study (n = 317) and the National Survey of Adult Oral Health 2004-2006 (n = 3,857) in which the SPCS was included. Graphical Loglinear Rasch Models (GLLRM) were used to fulfill the aims of the study.

Results: The Perceived Constraints subscale fitted a GLLRM for Aboriginal Australians after the exclusion of three items, while fit to any Rasch model (RM) or GLLRM model could not be found in the non-Aboriginal sample. The Mastery subscale fitted a GLLRM in the non-Aboriginal sample after the exclusion of one item. In the Aboriginal sample, two items of the Mastery subscale fitted the RM, however, two items cannot be considered as a scale.

Conclusion: In the present study, we showed that the development of new items is crucial before the revised SPCS might constitute a valid and reliable measure of sense of personal control in both Aboriginal and non-Aboriginal Australian populations, and it is possible to assess whether the SPCS can be measured without bias across these two populations.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239384PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529283PMC
November 2020

Validation of a 4-item child perception questionnaire in Australian children.

PLoS One 2020 22;15(9):e0239449. Epub 2020 Sep 22.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objective: To develop and validate a 4-item child oral health-related quality of life (OHRQoL) instrument that might be more amenable for uptake in large scale, multifaceted surveys of children's health and wellbeing than current, longer-form child OHRQoL instruments.

Methods: Data were obtained from a study of the South Australian School Dental Service population designed to investigate OHRQoL among school children aged 8-13 years in 2002-2003. The Child Perception Questionnaire (CPQ8-10 and CPQ11-14) was utilised, which comprises 25 & 37 items representing four conceptual domains: oral symptoms, functional limitations, emotional wellbeing and social wellbeing. Initially, the psychometric properties of the short form 8-item CPQ were tested in both age groups using Confirmatory Factor Analysis. The rationale was that, if the 8-item CPQ8-10 and CPQ11-14 did not display good psychometric properties, there was no reason to proceed with further shortening into 4-item versions. Following a good fit of the 8-item CPQ, items with higher factor loadings in each domain were maintained and tested in the development of a 4-item CPQ. Exploratory Factor Analysis was conducted to determine dimensionality, followed by tests for reliability and validity. Model fits were assessed using Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Standardized Root Mean Square Residual (SRMR).

Results: There were 308 children aged 8-10 years who completed CPQ8-10 and 461 children aged 11-13 years who completed CPQ11-14. For the short-form 8-item instrument, satisfactory goodness of fit was demonstrated for the two age groups, with acceptable thresholds for RMSEA, CFI, and SRMR. The four items with the highest factor loading in each domain were the same for the 8-item CPQ8-10 and CPQ11-14. and these items were selected to comprise the 4-item CPQ8-10 and CPQ11-14. The 4-item short form displayed good criterion validity, with expected score patterns found in the majority of the known groups evaluated.

Conclusions: We developed short-form 4-item CPQ8-10 and CPQ11-14 instruments that were tested in a large convenience sample of South Australian school children. The instruments demonstrated acceptable reliability and validity. Implications for practice are discussed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239449PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508370PMC
November 2020

The utility of network analysis in the context of Indigenous Australian oral health literacy.

PLoS One 2020 3;15(6):e0233972. Epub 2020 Jun 3.

Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.

Background: The study of oral health literacy (OHL) is likely to gain new and interesting insights with the use of network analysis, a powerful analytical tool that allows the investigation of complex systems of relationships. Our aim was to investigate the relationships between oral health literacy and oral health-related factors in a sample of Indigenous Australian adults using a network analysis approach.

Methods: Data from 400 Indigenous Australian adults was used to estimate four regularised partial correlation networks. Initially, a network with the 14 items of the Health Literacy in Dentistry scale (HeLD-14) was estimated. In a second step, psychosocial, sociodemographic and oral health-related factors were included in the network. Finally, two networks were estimated for participants with high and low oral health literacy. Participants were categorised into 'high' or 'low' OHL networks based on a median split. Centrality measures, clustering coefficients, network stability, and edge accuracy were evaluated. A permutation-based test was used to test differences between networks.

Results: Solid connections among HeLD-14 items followed the structure of theoretical domains across all networks. Oral health-related self-efficacy, sporting activities, and self-rated oral health status were the strongest positively associated nodes with items of the HeLD-14 scale. HeLD-14 items were the four most central nodes in both HeLD-14 + covariates network and high OHL network, but not in the low OHL network. Differences between high and low OHL models were observed in terms of overall network structure, edge weight, and clustering coefficient.

Conclusion: Network models captured the dynamic relationships between oral health literacy and psychosocial, sociodemographic and oral health-related factors. Discussion on the implications of these findings for informing the development of targeted interventions to improve oral health literacy is presented.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233972PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269264PMC
August 2020

Development and initial psychometric assessment of the race-related attitudes and multiculturalism scale in Australia.

PLoS One 2020 1;15(4):e0230724. Epub 2020 Apr 1.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide, Australia.

Aim: The present study aims to develop the Race-related Attitudes and Multiculturalism Scale (RRAMS), as well as to perform an initial psychometric assessment of this instrument in a national sample of Australian adults.

Methods: The sample comprised 2,714 Australian adults who took part in the 2013 National Dental Telephone Interview Survey (NDTIS), which includes a telephone-based interview and a follow-up postal questionnaire. We used Exploratory Factor Analysis (EFA) to evaluate the RRAMS' factorial structure (n = 271) and then proceeded with Confirmatory Factor Analysis (CFA) to confirm the proposed structure in an independent sample (n = 2,443). Measurement invariance was evaluated according to sex, age and educational attainment. Construct validity was assessed through known-groups comparisons. Internal consistency was assessed with McDonald's ΩH and ordinal α. Multiple imputation by chained equations was adopted to handle missing data.

Results: EFA indicated that, after excluding 4 out of the 12 items, a two-factor structure provided a good fit to the data. This configural structure was then confirmed in an independent sample by means of CFA (χ2(19) = 341.070, p<0.001, CFI = 0.974, RMSEA = 0.083; 90% CI [0.076, 0.091]). Measurement invariance analyses suggested that the RRAMS items can be used to compare men/women, respondents with/without tertiary education and young/older participants. The "Anglo-centric/Assimilationist attitudes" (ΩH = 0.83, αORDINAL = 0.85) and "Inclusive/Pluralistic attitudes" subscales (ΩH = 0.77, αORDINAL = 0.79) showed adequate reliability. Men and participants with low education had higher Anglo-centric/assimilationist attitudes and lower inclusive/pluralistic attitudes, suggesting construct validity.

Conclusions: The RRAMS appears to be a valid and reliable measure to evaluate multiculturalist attitudes in the Australian context. The instrument may be useful in the assessment and monitoring of interventions aiming to promote multiculturalist inclusive attitudes and to increase social cohesion in Australia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230724PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112161PMC
July 2020

Degrees of xerostomia? A Rasch analysis of the Xerostomia Inventory.

Community Dent Oral Epidemiol 2020 02 12;48(1):63-71. Epub 2019 Nov 12.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Objective(s): The global demographic changes resulting in an ageing population require attention on xerostomia, as its prevalence appears to increase with age. The Xerostomia Inventory (XI) is a 11-item instrument developed to evaluate the symptoms and behavioural components of xerostomia, while a shortened 5-item version named Summated Xerostomia Inventory (SXI) was later proposed. The aim of the present study was to evaluate the construct validity of the XI and whether the SXI can provide a shortened version. Since previous studies focused only on dimensionality and reliability, we employed modern psychometric methodology to investigate properties such as differential item functioning (DIF) and targeting.

Study Design: The XI was applied to 164 middle-aged to older adults who participated in a randomized controlled trial to investigate the effects of alcohol-containing mouth rinse in Singapore. The psychometric properties of the XI were investigated with the Rasch model (Partial Credit Model). Overall model fit was evaluated with a summary chi-square statistic. Item fit was evaluated with the Fit Residual, and values between -2.5 and 2.5 are considered acceptable. DIF by sex was evaluated through a two-way ANOVA of the residuals.

Results: After collapsing the categories of "Hardly ever" and "Fairly often", the test of global fit (χ (30) = 34.32, P = .27) indicated overall fit to the Rasch model. Since Fit Residuals were between -2 and 2, the fit of individual items was also adequate. No DIF was found between men and women, and targeting was adequate (μ = -0.56).

Conclusion: The current study expanded the evidence on the XI and SXI validity and provides new implications for practice: a 3-point categorization ("Never," "Occasionally" and "Very often") should be preferred rather than the original 5-point categorization; the XI and SXI scores can be compared between men and women and will reflect true differences in xerostomia rather than measurement bias.
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http://dx.doi.org/10.1111/cdoe.12504DOI Listing
February 2020

Prevalence and associated factors with integrative and complementary practices use in Brazil.

Complement Ther Clin Pract 2019 Nov 27;37:1-5. Epub 2019 Jul 27.

Postgraduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Electronic address:

The aim of the current study was to investigate the prevalence of the use the integrative and complementary practices (ICP) and its associated factors in Brazil. Data was obtained from the cross-sectional National Health Survey 2013 (NHS), which had 145,580 adults aged 18 or over were interviewed. The outcome was the use of any ICP over the last 12 months and independent variables were macro-region, sex, age, educational attainment, skin color/race, and chronic disease. The results show that the prevalence of ICPs use in Brazil was 4.1%, while the most used types were medicinal plants and phytotherapy (2.5%), acupuncture (0.9%) and homeopathy (0.6%). The prevalence of ICPs use was higher in the North Region, among older people, women, participants with higher educational attainment, and with a higher number of chronic diseases. The findings from the current study provide valuable evidence that can inform future evidence-based public policies in Brazil.
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http://dx.doi.org/10.1016/j.ctcp.2019.07.009DOI Listing
November 2019

Stress beyond coping? A Rasch analysis of the Perceived Stress Scale (PSS-14) in an Aboriginal population.

PLoS One 2019 3;14(5):e0216333. Epub 2019 May 3.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

The history of colonization contributed to Aboriginal and Torres Strait Islanders becoming one of the most disadvantaged groups in Australia. The multiple social inequalities, and therefore the constant insecurities for many about low income, poor living conditions, unemployment, and discrimination, generate chronic stress in this population. In the Baby Teeth Talk Study, an oral-health randomized controlled trial, the Perceived Stress Scale (PSS-14) was administered to 367 pregnant Aboriginal women at baseline. The aim of the present study was to evaluate the validity and reliability of the PSS-14 in an Aboriginal population. The study analysed: (a) model fit; (b) dimensionality; (c) local dependence; (d) differential item functioning; (e) threshold ordering and item fit; (f) targeting; (g) reliability; and (h) criterion validity. The dimensionality analysis indicated a two-factor structure, with negatively and positively worded items clustering together and 21.7% (95% Agresti-Coull C.I. [17.8%, 26.2%]) statistically significant t-tests between the persons' estimates. After the creation of composite items, the revised Perceived Distress (χ2 (21) = 11.74, p = 0.946) and Perceived Coping (χ2 (28) = 17.63, p = 0.935) subscales fitted the Rasch model. Reliability was modest (PersonSeparationIndexdistress = 0.72; PersonSeparationIndexcoping = 0.76). The latent correlation between the Perceived Distress and Perceived Coping subscales was r = 0.14. It is hypothesized that the social inequalities experienced by the Aboriginal population are so pronounced that even Aboriginal pregnant women that perceived themselves as coping well with life challenges ended up endorsing items regarding high levels of stress. The present research showed that a revised PSS-14 is a culturally valid and modestly reliable psychological instrument to measure stress in a population of pregnant Aboriginal women in Australia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216333PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499425PMC
January 2020

Feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system.

Complement Ther Clin Pract 2019 May 11;35:8-17. Epub 2019 Jan 11.

Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina (UFSC), Endereço: Campus Reitor João David Ferreira Lima, Rua Delfino Conti, s/n, Bloco H, Brasil. Electronic address:

Background And Purpose: In the last decades, an increasing body of scientific studies has shown mindfulness-based interventions as efficacious for reducing stress, including among primary care professionals. Despite the strength of the evidence, mindfulness-based interventions still are not widely adopted as a clinical practice in national health systems. The aim of the present study was to conduct a feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system.

Materials And Methods: A pilot mindfulness program was conducted through the course of four weekly encounters in the municipality of Biguaçu with the participation of 26 primary care professionals. Data was collected through direct observations and four self-report questionnaires. The information was used to complete an evaluation matrix and reach a value judgment about the feasibility level of the components of the mindfulness-based program.

Results: The subdimensions Integration, Demand, and Acceptability were judged as "Highly Feasible", the subdimension Practicality was judged as "Feasible" and the subdimension Adaptation was judged as "Lowly Feasible". The results indicated that there is a high demand for stress-reduction interventions within the context of primary care and the acceptability by the stakeholders (participants and management) was excellent. However, the two main barriers found were the need for a brief version of the program to accommodate the restrictive timetable of the primary care professionals and the low retention rates.

Conclusion: The implementation of a mindfulness-based program for primary care professionals in Brazilian national health system was judged as "Feasible". Further studies need to conduct the feasibility evaluation in other municipalities and with larger sample sizes to ensure the generalizability of these results.
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http://dx.doi.org/10.1016/j.ctcp.2019.01.005DOI Listing
May 2019

Feasibility evaluation of a mindfulness-based intervention for primary care professionals: Proposal of an evaluative model.

Complement Ther Clin Pract 2018 May 1;31:57-63. Epub 2018 Feb 1.

Department of Public Health, Campus Reitor João David Ferreira Lima, Delfino Conti Street, s/n, Bloco H, Universidade Federal de Santa Catarina, Florianópolis, Brazil. Electronic address:

A critical issue in the contemporary field of public health is the organizational stress experienced by healthcare professionals. An integrative and complementary therapy that research has shown as efficacious in helping healthcare professionals to cope with stress is mindfulness meditation. An intervention, however, can't merely be efficacious, it also needs to be feasible to be implemented in a specific political and organizational context. This paper proposes a theoretical logical model and evaluation matrix of the feasibility of a mindfulness-based stress reduction program for primary care professionals. The literature review about the topic was the source for the construction of the theoretical logical model and evaluation matrix, and the validation of those was given by consensus methods, gathering data from experts in the field.
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http://dx.doi.org/10.1016/j.ctcp.2018.01.013DOI Listing
May 2018