Questionnaire data

S o c io d e m o g r a p h ic in fo rm a tio n

The sociodemographic information included age, sex, marital status, education level, present and past occupation, family income and self-assessment social class. Age was at last birthday. Education level, occupation, family income and self-assessment social class were assessed and used for measure o f social class, because there is no definitive classification o f social class for people in China. Educational level, occupation, income and self-assessment social class can provide some information related to social class.

Socio-economic background in terms o f education, occupation and income was reported in many studies (Borrell et al., 2004; Du et al., 2000; Hu et al., 2005; Sanders and Spencer, 2004; Yu et al., 2002). Education referred to years o f formal school education.

Educational level was divided into six categories: no education (illiterate), 1-6 years (primary school), 7-9 years (middle school), 10-12 years (high school), 13-19 years (college and university), 19 and over years (postgraduate). The past occupation included eight categories:

Professionals - including doctors, lawyers, teachers, and managers

Administrators - officers who work for the government.

Clerks - people who work in the office or a company with skilled manual occupations

Business - people working in shop but not managers, e.g. shop assistant, seller

Services: including hairdressers, bus drivers, cooks, waiters, and tailors.

Peasant or fishermen

Workers: including skilled and unskilled workers, e.g. factory worker, builder.

Other occupation

Both categories o f educational level and occupation were adapted from those used in the second national oral health survey in China (Wang et al., 2002).

Income level was according to the self-reported average monthly income per capita o f the participants’ family.

Self-assessed social class was measured by using the MacArthur Scale o f Subjective Social Status (Adler et al., 2000) for older people in the UK. They were shown a drawing o f a ladder with 10 rungs which was described as follows: 'T h in k o f this ladder as representing where people stand in our society. At the top o f the ladder are the people who are the best off - those who have the most money, most education and best jobs. At the bottom are the people who are the worst off - who have the least money, least education, and the worst jobs or no jobs. The higher up you are on this ladder, the closer you are to the people at the very top and the lower you are, the closer you are to the people at the very bottom.” They were then asked put an X on the rung which best represented where they thought that they stood on the ladder (ELSA, 2002 http://www.data-archive.ac.uk/). The scale, whose test-retest reliability has been demonstrated (Operario D et al., 2004), has been used in many research studies o f health (Goodman et al., 2001; Goodman et al., 2003; Kopp et al., 2004; Singh-Manoux

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et al., 2003).

Example:

G e n era l h ea lth sta tu s

General health status information included general health perceptions, physical disability, and medicine history. General health perceptions were measured by asking each subject whether his/her general health was excellent, very good, good, fair or poor.

Physical disability was ascertained by asking whether they had or had not a long-standing illness, disability or infirmity. Medical history reported the medicines that the subject was taking within the last 14 days by using an interviewer-administered questionnaire.

P erc ep tio n s o f o ra l health s ta tu s

There were four kinds of information in this section: oral health perceptions, self-perceived dry mouth, denture perceptions, and perceived treatment need. Oral health perception was assessed by self-rated oral health, subjects indicated their oral

health as excellent, very good, good, fair or poor. Dry mouth was ascertained by self-report assessment o f each subject on dry mouth (yes/no). Subjects were also asked some related questions on dry mouth, such as “when you feel dry mouth (during eating/at night)?”, “does your dry mouth cause difficulty in chewing/ swallowing/taking medicine?”, “do you chew gum/suck hard sweet or mints/sip water or other liquids/take some medicine to 'reliev e your dry mouth”. Denture perception and self-perceived treatment needs were measured by self-reported assessment on their perception about the denture perception and the dental treatment needs.

O r a l im p a c ts

1. Eating difficulty:

Five measures were used to assess eating difficulty and eating impacts in this study.

The first measure is General Eating Difficulty (GED)1. GED was measured using a single-item question involving self-rating o f general eating difficulty. The following scale was used: 1 = “no difficulty”, 2 = “a little difficulty”, 3 = “a fair amount of difficulty”, 4 = “a great amount o f difficulty” .

The second measure was Dissatisfaction with Chewing Ability (DCA) which measured people’s levels o f dissatisfaction with chewing ability. Subjects were asked a single question to rate overall dissatisfaction with chewing ability using the following

1 Throughout this thesis the term General Eating Difficulty (GED) refers to the answer to Q1 in Part 4 (Eating) o f questionnaires (see Appendix 4)

2 Throughout this thesis the term Dissatisfaction with Chewing Ability (DCA) refers to the answer to Q2 in Part 4 (Eating) o f questionnaires (see Appendix 4)

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scale:

1 = “very satisfied”, 2 = “satisfied”, 3 = “dissatisfied”, 4 = “very dissatisfied”.

The third measure was Index o f Eating Difficulty (IED)3. The IED is a five-item index, described here. It is derived from the questions: are you able to eat

-E a tq l: whole apple or com on the cob, or something very similar to that.

Eatq2: cooked sliced pork or cooked green vegetable, or something very similar to that.

Eatq3: boiled chicken or duck, or something very similar to that.

Eatq4: salted roasting chicken or roast pork ribs or roast duck or chicken, or something very similar to that.

Eatq5: cooked cucumber or lotus root or cooked carrots, or something very similar to that.

The subjects were asked to select from three answers (l-yes; 0-no; 2-have not tried).

The food categories for which a subject was unable to eat was coded to give an index code as shown in Table 4.3.

The coding was as follows:

IED = 0: people can eat one or more foods in each o f 6 categories (Table 4.3).

IED = 1: people can eat one or more foods listed in categories 2 to 5 but cannot eat

3 Throughout this thesis the term Index o f Eating Difficulty refers to the answer to Q3 (1-5) in Part 4 (Eating) o f questionnaires (see Appendix 4)

foods in category 6 (Table 4.3).

IED = 2: people can eat one or more foods in categories 2 to 4 but not 5 and 6 (Table 4.3).

IED = 3: people can eat one or more foods in categories 2 and 3 but not 4 to 6 (Table 4.3).

IED - 4: people can only eat one or more foods in category 2 (Table 4.3).

IED = 5: people cannot eat any o f the foods listed in any o f the categories in Table 4.3.

Table 4.3 Index of Eating Difficulty (IED).

Category Difficulty eating foods IED

1 None of foods listed 5

2 Cooked sliced pork, cooked green vegetable 4

3 Cooked cucumber or lotus root, cooked carrots 3

4 Boiled chicken or duck 2

5 Whole apple, com on the cob 1

6 Salted roasting chicken, roast pork ribs, roast duck or chicken 0

Note: If person could eat one food and not all of the foods in one category then they are given that category code.

Based on the frequency distribution o f IED categories in this sample, subjects were classified into two groups: IED = 1-5 and IED = 0. People in a higher IED category had a higher level o f eating difficulty (Appendix 1).

The fourth measure is Ease o f Eating certain Foods (EEF)4 using the list of 16 foods obtained from the first pilot study. That included same foods used in the IED question

4 Throughout this thesis the term Ease o f Eating certain Foods (EEF) refers to the answer to Q4 in Part 4 (Eating) o f questionnaires (see Appendix 4)

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plus cooked sliced beef, steamed bread, soft rice, rice porridge, boiled fish and tofu in water which were not used in the IED questions. Subjects were asked to rate the amount o f difficulty they had eating certain food listed. The answers were coded: 1 = “could eat easily”, 2 = “could eat with some difficulty”, 3 = “could not eat at all” .

The final measure is OIDP eating impact which refers to the OIDP item on difficulty eating. It is a measure o f the impact o f oral condition on eating difficulty.

For detail o f questions on eating difficulty methods in this section see Appendix 4.

2. Oral Impacts on Daily Performances

The Oral Impacts on Daily Performances (OIDP) developed by Adulyanon and Sheiham (1997) and modified by Tsakos et al (Tsakos et al., 2001b) is a social-dental indicator to measure the ultimate oral impacts on the person’s ability to perform certain daily activities. Nine performances included eating, speaking, cleaning teeth, light physical activities, going out, relaxing/sleeping, smiling, emotional stability and social contact were used in this study. The participants were asked to give the frequency and severity o f impacts, ranging from 0 to 5 for each measure, as an indication o f how much the impact affected their daily living. The score represents the total impact and was calculated by multiplying the frequency with the severity scores. The total score was the sum o f all the performance scores for an individual. For the questions used and scoring methods, see Appendix 4 and Appendix 5.

In order to make the questionnaire o f OIDP easier to understand by the elderly people, the modifications related to the clarification o f the content, with some examples given for each daily activity performed conducted are given below:

Eating and enjoying food: the examples were biting an apple, drinking cold or hot drinks or eating hot foods.

Speaking and pronouncing clear: say some word beginning with an “S”

Cleaning teeth: brushing you teeth or rinsing your teeth with cold or hot water

Light physical activities: the examples were cooking or cleaning your room.

Going out: the examples were going to the park for walk, shopping, visiting friend or relatives.

Relaxing (including sleeping): the examples were watching TV for relaxing.

Smiling, laughing and showing your teeth without embarrassment: did not need to change.

Maintain usual emotional state without being irritable: the examples were becoming more easily upset than usual, crying easily, being sad, and being more irritable.

Enjoying the contact o f other people, such as relatives, friends or neighbours: did not need to change.

The subjects who reported oral impacts were also asked whether the impact on any of the performance above was due to their dental condition, such as tooth loss, dental pain, decay, sensitive teeth etc.