Reliability And Validity Of The Tamil Version Of Modified Dental .
313Journal of Oral Science, Vol. 54, No. 4, 313-320, 2012OriginalReliability and validity of the Tamil version ofModified Dental Anxiety ScaleDevapriya Appukuttan1), Mythireyi Datchnamurthy1), Sherley P. Deborah1),Gladius J. Hirudayaraj2), Anupama Tadepalli1) and Dhayanand J. Victor1)2)Department1)Departmentof Periodontics, SRM Dental College and Hospital, Chennai, Indiaof Community Medicine, Karpaga Vinayaga Institute of Medical Sciences, Kancheepuram, India(Received 27 July and accepted 23 October 2012)Abstract: The aim of this study was to test thereliability and validity of the Tamil version of theModified Dental Anxiety Scale (MDAS). One hundredand forty-six patients attending the OutpatientDepartment of SRM Dental College, Chennai, Indiaconsented to participate in the study. The assessment tools consisted of a history form, Tamil versionof the MDAS questionnaire and a form for VisualAnalogue Scale (VAS). The Tamil version of MDAShad a good internal consistency of 0.839. The meantotal score decreased with age. Females were moreanxious than males (10.16 and 9.43, respectively).Uneducated, unemployed and low income subjectswere more anxious than their counterparts whowere educated, employed and from a higher incomegroup. Persons who perceived their oral health aspoor were more anxious. Independent t-test showeda highly significant difference in the mean total scoreof the respondents who had postponed their dentalvisit due to anxiety (t-test 6.494, P 0.001). VAS andMDAS scores showed a highly significant correlation(r 0.827, P 0.001).This supported the convergentvalidity of MDAS. The Tamil version of MDASshowed acceptable psychometric properties. (J OralSci 54, 313-320, 2012)Keywords: psychometric properties; construct validity;convergent validity; factor analysis; reliability.Correspondence to Dr. Devapriya Appukuttan, Plot no 902, 38thStreet, TNHB Colony Korattur, Chennai 600 080, Tamil Nadu,IndiaTel: 91-9840197121E-mail: devapriyamds@gmail.comIntroductionThe era of modern science has witnessed tremendousadvancements in the field of pain control and patientmanagement. Despite these advances, anxiety related todental treatment and the fear of pain associated with itremain widespread among the general population. Dentalanxiety is defined as patient’s response to stress that isspecific to the dental situation (1). Anxious individualsgenerally avoid dental visits, they are uncooperativeduring dental treatment procedures, cancel more dentalappointments, and have a lower pain threshold. A modelfor vicious cycle of dental fear has been hypothesisedwhereby dental fear, delayed dental visiting pattern,increased dental problem and symptom driven treatmentform a linked chain feeding back into the fear experience(2-5).A wide range of self assessment questionnaires suchas Corah’s Dental Anxiety Scale (CDAS) (6), ModifiedDental Anxiety Scale (MDAS) (7), State Trait AnxietyScale (STAI) (8), General Geer Fear Scale (9), GetzDental Belief Survey (10), Dental Fear Survey (DFS)(11) are available to measure dental anxiety and fear. Themost commonly used measures are CDAS, MDAS andKleinknecht’s DFS. The former two questionnaires aremore useful for screening and diagnosing patients withdental anxiety in a clinical setting, while the latter is morecommonly used as a research tool for assessing dentalfear among adults. The original CDAS is a 4-item questionnaire that measures anxiety during different dentalsituations. Each question is scored from 1 to 5 so thepossible total scores range from 4 to 20. Total scores of 15or more indicate profound anxiety (6). MDAS was devel-
314Table 1 T he mean, median, standard deviation of age, five items of the MDAS, total MDAS score, and VAS for the 179Total score9.6893.758VAS‡24.182021.619Standard Deviation, ‡ Visual Analogue Scaleoped to improve the psychometrics and content validityof the original CDAS. It is a 5-item questionnaire, anddiffers from CDAS as there is an additional item aboutreceiving local anaesthetic injections. Each item hasfive responses and the responses range in an ascendingorder from “not anxious” to “extremely anxious”. Theresponses are scored from 1 to 5 in ascending orderwith increasing intensity of dental anxiety. Adding theresponse score for each of the five items, the total scorefor the scale ranges from 5 to 25. The cut off score of 19 indicates patients with high dental anxiety or possiblydental phobia (7). It is simple and easy to completeand requires minimal time for completion. Completionof the questionnaire does not increase patient fear, andhas been shown to reduce state-trait anxiety in clinicalsettings (12). It has been found to be reliable and valid(7,13) cross culturally, and was translated into differentlanguages like Spanish (14), Greek (15), Chinese (16),Romanian (17), and Turkish (18).The aim of this study was to test the reliability andvalidity of the Tamil version of MDAS, so that it canbe utilised as an effective tool to assess dental anxietyamong the Tamil-speaking South Indian population.Materials and MethodsThe study was approved by the Ethical review boardof SRM Dental College and Hospital, Ramavaram,Chennai, India. The study was conducted from December2011 to February 2012.QuestionnaireThe MDAS questionnaire was translated according to“forward and backward blind translation” process. TheMDAS was forward translated from English to Tamil bytwo bilingual professionals, fluent in English and havingTamil as their native language. The two Tamil-translatedversions were back translated into English by two otherprofessional translators, who were blinded to the originalquestionnaire in English. This blinding process wasdone to reduce bias in translation. The back-translatedversions were reviewed by the first and second authors.The translated version was corrected with the help of thetranslators to eliminate any difference in the meaningbetween the original version and the back-translatedversion. The final back-translated version was pretestedon the target Tamil-speaking population. A conveniencesample of thirty patients attending the dental outpatientclinic was selected to fill out the questionnaire; theselected patients were from different socioeconomicbackground and education level. The patients were interviewed while they were completing the questionnaire inorder to check whether they understood the questions,and the answer formats. They were asked to report if anyquestion was confusing or difficult to comprehend. Finalcorrections were made to the translated Tamil versionand used for testing the psychometric properties.SubjectsTest-retestThirty patients attending the dental outpatient clinicwere recruited for test-retest. The patients were informedabout the study and those who consented were included.Patients who refused to give consent and those whowere undergoing psychiatric therapy or were sufferingfrom generalised anxiety disorders were excluded fromthe study. Since the study was carried out in a dentalteaching institution, all patients may not report back forrecall and review so only those patients who were willingto report back after a week were selected. The patientsselected were aged 18-70 years, and were from differentsocioeconomic status and educational background. Thepatients completed the questionnaire on their first visitand they were given an appointment after a week. All the30 patients reported after one week and completed thesame questionnaire.For Psychometric testingOne hundred and forty-six patients attending theoutpatient department of SRM Dental College wererecruited for the study. The patients were aged between18-70 years. Only patients who were willing to participatewere included in the study. Patients who refused to giveinformed consent and those who were undergoing psychiatric therapy or were suffering from generalised anxietydisorders were excluded from the study. The assessment
315Table 2 The variables with the percentage, mean total score and statistical testVariableNumber of samplespercentageAge group 308031-5048 5118GenderMale96Female50EducationSchool education71Degree/diploma60Post graduation12Not Retired personnel5Income 10,0008211,000-15,0002316,000 -20,00015 20,00026Oral HealthExcellent33Good42Average63Poor8Visit to dentistYes99No47Previous dental visit experienceGood94Bad5Total ment of dental visit due to dental anxietyYes17No129Time since last dental visitWithin 6 months326-12 months131-2 years20 2 years34tools consisted of a history form, Tamil version of MDASquestionnaire and a form for Visual Analogue Scale(VAS) to measure dental anxiety. The history form wasused to obtain information on age, gender, educationalqualification, occupation, income, history regarding553312Mean total 12.1267.832.29.729.694.95.19.719.8Statistical testP valueANOVAF value 0.501 0.05t-test1.19 0.05ANOVAF value 2.867 0.05ANOVAF value 2.273 0.05ANOVAF value 0.985 0.05ANOVAF value 1.392 0.05t-test0.182 0.05t-test-0.045 49.099.1511.29.65t-test6.494 0.001**ANOVAF value 1.168 0.05previous visit to dentist, duration since the last visit todentist, previous dental experience, self perceived oralhealth status and avoidance of dental treatment due todental anxiety. Convergent validity was assessed usingVAS. Standard scales used for assessing dental fear and
316Table 3 Inter-item correlation matrixTest retest146 10.9090.4550.5690.4230.4890.4990.534Table 4 The item deleted mean and Cronbach’s alpha if item deletedQuestionNumberq1q2q3q4q5Scale mean ifitem deleted7.968.037.348.067.32Scale varianceif item deleted9.47410.119.1659.7558.509Corrected ed h’s alpha ifitem deleted0.7860.8090.8150.8010.824Table 5 Exploratory factor analysis with rotation shows the total variation of the factorsComponent1ItemsQ1Q2Q3Q4Q5Initial eigen valueTotal% of variance2.74454.879Matrix of the factorial structure0.8090.7220.7260.7180.725anxiety like DFS have not been translated and validatedin Tamil; hence, we considered using VAS for this study.It has been used in studies for assessing dental anxiety,and shown to be effective and valid (19-21). VAS is ameasurement instrument that measures a characteristicor attitude that is believed to range across a continuumof values and cannot easily be directly measured. It isusually a horizontal line, 100 mm in length, marked 0at left extreme to 100 on the right extreme. Zero refersto “not at all anxious” and 100 refers to “extreme dentalanxiety or dental phobic”. The patients were asked tomark a point on the line that they feel represents theirlevel of dental anxiety towards dental treatment. Thescore is determined by measuring in mm from the lefthand end of the line to the point that the patient marks.Statistical analysisData was analysed using SPSS 16. Reliability was% 210.5280.5150.526calculated using Cronbach’s alpha, inter-item correlation matrix and intra-class correlation. Kaiser MeyerOlkin (KMO) and Bartlett’s test of sphericity were donefor sampling adequacy and factor analysis. Exploratory factor analysis with direct oblimin rotation wasperformed. Spearman rho correlation was used tocorrelate the variables in the study. The independentt-test and one-way Analysis of variance (ANOVA) wereused to study the difference in the groups based on theirmean total score. Tukey’s HSD was done for pair wisecomparison in ANOVA.ResultsTable 1 shows the mean, median, standard deviationof age, five items of the MDAS, total MDAS score, andVAS for the 146 samples. Mean age of the samples was32.42 years and mean total score was 9.68. Table 2 showsthe descriptives of the variables assessed in the study.
317Fig. 1 Eigenvalues resulting from the exploratoryfactor analysis.Reliability measuresSpearman’s rho correlation between the five items infirst and second visit was 0.9, 0.83, 0.89, 0.89, and 0.92for q1, q2, q3, q4, and q5, respectively with P value 0.001. Table 3 shows the inter-item correlation matrixbetween the five items in the two visits; there was apositive correlation between the items. Cronbach’s alphafor the test retest samples was 0.863. The intra-classcorrelation between the items was 0.348 (95% CI, 0.224,0.516, F test 7.32, P 0.001). Cronbach’s alpha for the146 samples was 0.839. Table 3 shows the inter-itemcorrelation matrix between the five items for the 146samples, positive correlation is seen between the fiveitems. Intra-class correlation between the five items was0.83 (95% CI, 0.79, 0.877, F test 6.214, P 0.001). Itemdeleted mean score and Cronbach’s alpha if item deletedshowed that all the five items significantly contributedfor acceptable internal consistency of the study (Table 4).Validity measuresThe correlation matrix showed a strong positive correlation between all the five items in the questionnaire, theBartlett’s test of sphericity was statistically significant(χ2 193.17, P 0.001). For Factor analysis, samplingadequacy was verified using the KMO test. The test gavean acceptable score of 0.795, thus the samples fulfilledthe criteria to use Factor analysis. Exploratory factoranalysis was performed to check the factorial structureof MDAS. Factor analysis demonstrated that the eigenvalue for the first factor (2.744) accounted for 55% ofthe data variation (Table 5). The screen plot shows theeigenvalues derived from the analysis (Fig. 1).Fig. 2 Scatter plot showing correlation of VASwith MDAS Total Score.Construct validityAgeSpearman rho correlation showed no significant correlation between age and mean total score (r -0.144, P 0.05). Participants who were less than 30 years of age hada mean total score of 9.94, those between 31 to 50 yearsof age had a mean total score of 9.48, and respondentsmore than 51 years old had a mean total score of 9.06.One-way ANOVA also showed no significant differencebetween the age groups in relation to their mean totalscore (F value 0.501, P 0.05) Table 2.GenderThe mean total score of male participants was 9.43while that of females was 10.16. Independent t-testshowed no significant differences between both thegenders with respect to their mean total scores (t-test1.19, P 0.05) Table 2. Spearman rho correlation showedno significant correlation between mean total score andgender (r 0.083, P 0.05)Education, employment and incomeThe mean total score based on level of education isgiven in Table 2. Uneducated respondents scored highon the anxiety scale when compared with educatedrespondents. One-way ANOVA showed a significantdifference in anxiety level with the educational qualification of the participants (F value 2.867, P 0.05).Tukey’s HSD showed a significant difference betweenthe anxiety scores of uneducated participants and thosewho had school education or higher education (statisticsnot given).The mean total score of the employed participantswas 9.45 and that for those who were unemployedwas 10.19. Students had a mean total score of 10.85and retired participants had very low mean total scoreof 6.2. One-way ANOVA showed no significant differ-
318ence between the participants based on employmentand dental anxiety (F value 2.273, P 0.05) (Table 2).Tukey’s HSD showed no significant difference betweenthe participants in relation to their anxiety score based ontheir employment status (statistics not given).Participants with monthly income less than ten thousand Indian rupees had a higher mean anxiety score of10.15 than those with income more than 20,000 rupees(Table 2). ANOVA showed no significant differencebetween the respondents with regard to their anxietyscores based on their income (F value 0.985, P 0.05).Tukey’s HSD showed no significant difference in theanxiety score between the participants with respect totheir income (statistics not given).Dental attendance patternThe mean total score of the participants who hadvisited the dentist previously was 9.72 while those whohad never visited the dentist scored 9.6. Independent t-testshowed no significant difference in the mean total scorewith respect to the previous dental visit (t-test 0.182, P 0.05). Among the 99 participants who had visited dentistpreviously, the duration since the last dental visit wasrecorded as dental visit within 6 months, 6-12 months,1-2 years since the last visit and more than 2 years. Themean anxiety score increased with longer duration sincethe last dental visit (Table 2). One-way ANOVA showedno significant difference in the mean total score withrelation to duration of time since the last dental visit (Ftest 1.168, P 0.05). Ninety-four participants had gooddental experience and five had bad experience, the meantotal score was 9.71 and 9.8, respectively. Independentt-test showed no significant difference in the anxietyscore based on the previous dental experience (t-test-0.045, P 0.05).Oral healthThe mean total score of the participants in relation totheir self perceived oral health status is given in Table 2.Participants who believed that their oral health was poorhad a higher mean total score of 12.12. One-way ANOVAshowed no significant difference in the mean total scorebased on their oral health status (F value 1.392, P 0.05).Avoidance of dental visitSeventeen participants had avoided dental visits due todental anxiety. The mean total score of these respondentswas 14.59. Postponement of dental visit due to anxietyshowed a highly significant difference among the groupsin independent t-test (t-test 6.494, P 0.001) Table 2.VAS and MDASVAS and MDAS score showed a highly significantcorrelation (r 0.827, P 0.001). This supported theconvergent validity of MDAS. Spearman rho correlationbetween VAS and individual items q1, q2, q3, q4 and q5was 0.640, 0.545, 0.715, 0.594, and 0.650, respectively.The scatter plot shows the correlation between VAS andMDAS with mean and 95% confidence interval (Fig. 2).DiscussionThe results showed that the Tamil-translated versionof MDAS had good internal consistency and test retestreliability. Reliability is expressed in terms of stability,equivalence and consistency. Consistency was checkedusing Cronbach’s alpha. It can vary among differentcountries depending on the content, language and contentlanguage interaction. The study had a good acceptableCronbach’s alpha value of 0.83. Test-retest for stabilityalso showed good internal consistency of 0.863. Cronbach’s alpha value for the Indian version of MDAS was0.78 (22), Turkish version 0.91 (18), Spanish version0.88 (14), Romanian 0.90 (17), Greek 0.90 (15), UnitedKingdom 0.957 (23), the Chinese MDAS consisted oftwo factors: Anticipatory Dental Anxiety (ADA) andTreatment Dental Anxiety (TDA), the internal consistency coefficients were 0.74 and 0.86, respectively (16).At the cut off value of 19 for MDAS score, 2.7% ofthe patients had extremely high level of dental anxiety,which was similar to the findings of Acharya (2.2%) inthe Indian population (22). The percentage of people withdental anxiety was less when compared with Westerncountries like UK 11% (23), Northern Ireland 19.5%(13), Turkey 23.5% (18) and Finland 3% (13). Anxietyduring drilling and injection showed the highest meanscore in this South Indian population, which was similarto the findings from other countries (13,24,25).The study results showed that the mean anxiety scorereduced with increasing age. This is in agreement withthe studies by Acharya (22), Settineri et al. (26), SiyangYuan (16). Lidell and Locker reported that older individuals had less anxiety levels and painful experiencesthan younger persons (27). These results are contraryto the reports of Tunc (18) and Thomson (28), whoshowed positive correlation of anxiety level with age.Studies have shown that fears and phobias decline withage, which could be attributed to age dependent cerebraldeterioration, factors like extinction or habituation, andadaptive resignation towards the inevitable (29-31).Locker and Liddell suggested that the age dependentdecline in dental anxiety might be due to the generaldecline in anxiety with aging and greater exposure toother diseases and their treatment (27). Females in thisstudy were more dentally anxious than males, similar tothe findings of Acharya (22), Ekta A Malvania (32), and
319Vela D Desai (33) in the Indian population. Females aremore likely to acknowledge their anxiety and are moreprone to anxiety disorders (19).The study showed that uneducated participants weredentally more anxious than educated participants, thiswas in agreement with the studies by Acharya (22), Tunc(18), Moore (24), Ragnarsson (34), Peretz (25). Thiscould be due to the fact that higher education enablesa person to cope better with stress by rationalisationof the situation. Unemployed participants in this studyexperienced more dental anxiety than employed persons,similar to the reports of Acharya (22), Armfield (35),and Moore (24). Among the employed participants,those with higher income were less anxious. This was inagreement to the findings by Armfield (35), who reportedthat people from lower socio-economic background hadpoorer physical health, more psychological problems andreduced access to resources and hence, could have morefear towards dental treatment.Participants who had reported poor oral health weremore anxious than those who perceived their oral healthas excellent or good. This was similar to the findings byLocker (30). The present study showed that participantswho avoided dental visits were more dentally anxious,which was similar to the findings of previous studies(19,36). Study results showed no significant differencein dental anxiety score between the participants basedon their previous dental visit, previous dental experienceor duration since the last dental visit, contradicting theresults of Acharya (22). VAS correlated significantlywith individual items in MDAS questionnaire and totalanxiety score. Thus, the convergent validity of MDASscale was established.Our study had few limitations. Convenience samplingwas done, criterion validity could not be established usingstandard scales due to non availability of translated andvalidated dental fear questionnaires in Tamil, dentallyphobic patients could not be selected to test validity dueto absence of special dental fear clinics and as the studywas done in a teaching dental institution where studentstreated the patients, the dentist rating of patient anxietyduring treatment could not be done for validation.It is evident from this study that the Tamil version ofMDAS is reliable and valid. Convergent validity wasestablished. Construct validity was evident, but needsfurther evaluation since factors influencing dental anxietyhave not been established in this population and the studyresults from other Western, European countries cannotbe compared with our study population. Since veryfew studies are available at present in the South IndianTamil-speaking population, large scale epidemiologicalstudies are needed to evaluate dental anxiety on a broaderperspective. The scale can be used in dental clinics andfor research purpose among the Tamil-speaking population.References1. Corah NL, Gale EN, Illig SJ (1978) Assessmentof a dental anxiety scale. J Am Dent Assoc 97,816-819.2. Bouma J, Uitenbroek D, Westert G, Schaub RM,van de Poel F (1987) Pathways to full mouthextraction. Community Dent Oral Epidemiol 15,301-305.3. Hakeberg M (1992) Dental anxiety and health.A prevalence study and assessment of treatmentoutcomes. Thesis, University of Gothenburg,Sweden, 1-54.4. Thomson WM, Stewart JF, Carter KD, Spencer AJ(1996) Dental anxiety among Australians. Int DentJ 46, 320-324.5. Armfield JM, Stewart JF, Spencer AJ (2007) Thevicious cycle of dental fear: exploring the interplaybetween oral health, service utilization and dentalfear. BMC Oral Health 7, 1.6. Corah NL (1969) Development of a dental anxietyscale. J Dent Res 48, 596.7. Humphris GM, Morrison T, Lindsay SJE (1995)The Modified Dental Anxiety Scale: validation andUnited Kingdom norms. Community Dent Health12, 143-150.8. Spielberger CD, Gorsuch RL, Lushene RE (1970)Manual for the State-Trait Anxiety Inventory, Selfevaluation questionnaire. Consulting PsychologistsPress, Palo Alto.9. Geer JH (1965) The development of a scale tomeasure fear. Behav Res Ther 3, 45-53.10. Kvale G, Berg E, Nilsen CM, Raadal M, NielsenGH, Johnsen TB, Wormnes B (1997) Validation ofthe dental fear scale and the dental belief surveyin a Norwegian sample. Community Dent OralEpidemiol 25, 160-164.11. Kleinknecht RA, Thorndike RM, McGlynn FD,Harkavy J (1984) Factor analysis of the dental fearsurvey with cross-validation. J Am Dent Assoc108, 59-61.12. Humphris GM, Hull P (2007) Do dental anxietyquestionnaires raise anxiety in dentally anxiousadult patients? A two wave panel study. Prim DentCare 14, 7-11.13. Humphris GM, Freeman R, Campbell J, Tuutti H,D’Souza V (2000) Further evidence for the reli-
320ability and validity of the Modified Dental AnxietyScale. Int Dent J 50, 367-370.14. Coolidge T, Hillstead MB, Farjo N, Weinstein P,Coldwell SE (2010) Additional psychometric datafor the Spanish Modified Dental Anxiety Scale,and psychometric data for a Spanish version of theRevised Dental Beliefs Survey. BMC Oral Health10, 12.15. Coolidge T, Arapostathis KN, Emmanouil D,Dabarakis N, Patrikiou A, Economides N, KotsanosN (2008) Psychometric properties of Greekversions of the Modified Corah Dental AnxietyScale (MDAS) and the Dental Fear Survey (DFS).BMC Oral Health 8, 29.16. Yuan S, Freeman R, Lahti S, Lloyd-Williams F,Humphris G (2008) Some psychometric properties of the Chinese version of the Modified DentalAnxiety Scale with cross validation. Health QualLife Outcomes 6, 22.17. Mărginean I, Filimon L (2012) Modified DentalAnxiety Scale: a validation study on communitiesfrom the west part of Romania. Int J Edu PsycholCommunity 2, 102-114.18. Tunc EP, Firat D, Onur OD, Sar V (2005) Reliability and validity of the Modified Dental AnxietyScale (MDAS) in a Turkish population. Community Dent Oral Epidemiol 33, 357-362.19. Luyk NH, Beck FM, Weaver JM (1988) A visualanalogue scale in the assessment of dental anxiety.Anesth Prog 35, 121-123.20. Heaton LJ, Carlson CR, Smith TA, Baer RA, deLeeuw R (2007) Predicting anxiety during dentaltreatment using patients’self-reports: less is more.J Am Dent Assoc 138, 188-195.21. Facco E, Zanette G, Favero L, Bacci C, Sivolella S,Cavallin F, Manani G (2011) Toward the validationof visual analogue scale for anxiety. Anesth Prog58, 8-13.22. Acharya S (2008) Factors affecting dental anxietyand beliefs in an Indian Population. J Oral Rehabil35, 259-267.23. Humphris GM, Dyer TA, Robinson PG (2009) Themodified dental anxiety scale: UK general publicpopulation norms in 2008 with further psychometrics and effects of age. BMC Oral Health 9, 20.24. Moore R, Birn H, Kirkegaard E, Brødsgaard I,Scheutz F (1993) Prevalence and characteristics ofdental anxiety in Danish adults. Community DentOral Epidemiol 21, 292-296.25. Peretz B, Efrat J (2000) Dental anxiety amongyoung adolescent patients in Israel. Int J PaediatrDent 10, 126-132.26. Settineri S, Tati F, Fanara G (2005) Genderdifferences in dental anxiety: is the chair positionimportant? J Contemp Dent Pract 6, 115-122.27. Liddell A, Locker D (1997) Gender and age differences in attitudes to dental pain and dental control.Community Dent Oral Epidemiol 25, 313-318.28. Thomson WM, Locker D, Poulton R (2000) Incidence of dental anxiety in young adults in relationto dental treatment experience. Community DentOral Epidemiol 28, 289-294.29. Agras S, Sylvester D, Oliveau D (1969) Theepidemiology of common fears and phobia. ComprPsychiatry 10, 151-156.30. Locker D, Liddell AM (1991) Correlates ofdental anxiety among older adults. J Dent Res 70,198-203.31. Arnarson EO, Gudmundsdóttir A, Boyle GJ (1998)Six-month prevalence of phobic symptoms inIceland: an epidemiological postal survey. J ClinPsychol 54, 257-265.32. Malvania EA, Ajithkrishnan CG (2011) Prevalenceand socio demographic correlates of dental anxietyamong group of adult patients attending a dentalinstitution in Vadodara city, Gujarat, India. IndianJ Dent Res 22, 179-180.33. Desai VD, Gaurav I, Bailoor DN (2011) Dentalanxiety – an area of concern for the oral physician– a study. J Indian Dent Assoc 5, 177-179.34. Ragnarsson E (1998) Dental fear and anxiety inan adult Icelandic population. Acta Odontol Scand56, 100-104.35. Armfield JM, Spencer AJ, Stewart JF (2006) Dentalfear in Australia: who’s afraid of the dentist? AustDent J 51, 78-85.36. Woolgrove J, Cumberbatch G (1986) Dentalanxiety and regularity of dental attendance. J Dent14, 209-213.
validity of MDAS. The Tamil version of MDAS showed acceptable psychometric properties. (J Oral Sci 54, 313-320, 2012) Keywords: psychometric properties; construct validity; convergent validity; factor analysis; reliability . Introduction The era of modern science has witnessed tremendous advancements in the field of pain control and patient .
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4,8,12,16,39 20,24,28,32,40 10 Total 20 20 40 2.3. Construct Validity and Construct Reliability To test the construct validity and construct reliability, this study uses the outer model testing through the SmartPLS 3.2.8 program. The construct validity test consists of tests of convergent validity and discriminant
conceptual issues relating to the underlying structure of the data (Hair et al., 2006). Further, Construct validity involves the validity of the convergent validity and discriminant validity. Convergent Validity were evaluated based on the coefficient of each item loaded significantly (p 0.05) and composite reliability of a latent
