Development and psychometric validation of social cognitive theory scales in an oral health context

Objective: This study aimed to develop and evaluate scales reflecting potentially modifiable social cognitive theory-based risk indicators associated with homeless populations' oral health. The scales are referred to as the social cognitive theory risk scales in an oral health context (SCTOH) and are referred to as SCTOH(SE), SCTOH(K) and SCTOH(F), respectively. Methods: The three SCTOH scales assess the key constructs of social cognitive theory: self-efficacy, knowledge and fatalism. The reliability and validity of the three scales were evaluated in a convenience sample of 248 homeless participants (age range 17-78 years, 79% male) located in a metropolitan setting in Australia. Results: The scales were supported by exploratory factor analysis and established three distinct and internally consistent domains of social cognition: oral health-related self-efficacy, oral health-related knowledge and oral health-related fatalism, with Cronbach's alphas of 0.95, 0.85 and Spearman's-Brown ρ of 0.69. Concurrent ability was confirmed by each SCTOH scale's association with oral health status in the expected directions. Conclusions and implications: The three SCTOH scales appear to be internally valid and reliable. If confirmed by further research, these scales could potentially be used for tailored educational and cognitive-behavioural interventions to reduce oral health inequalities among homeless and other vulnerable populations.