Oral health-related quality of life (OHRQOL) refers to the impact of oral disorders on
aspects of everyday life that are important to patients and persons, with those impacts
being of sufficient magnitude, whether in terms of severity, frequency or duration, to
affect an individual's perception of their life overall. OHRQOL has become an
important focus for assessing the impact of oral conditions on every day life, sometimes
as an outcome of clinical care (e.g. Allen et al 2001; Locker 2004; Marshman and
Robinson 2007).
To date, several studies have explored children's OHRQOL using such child-centred
measures. These studies show that oral health can impact on children's functioning and
well-being. However, none of these studies have incorporated a broad range of clinical
and other non-clinical variables factors that may influence children's OHRQOL or
attempted to explicitly test the relationships between them within a theoretical model.
Such research hopefully would highlight important issues to further our understanding
of the antecedents and consequents of children OHRQOL in order to facilitate effective
intervention strategies.
Thus, this research alms to assess relationships between clinical and non-clinical
variables in relation to children's OHRQOL. The theoretical model chosen to guide the
research is that by Wilson and Cleary (1995), which classifies the variables at five main
levels; clinical status, symptom status, functioning, general health perceptions and
overall quality of life. The model has been used in adults in relation to several health
chronic conditions, including oral health (Baker et al 2007; Baker et al 2008) but is
relatively untested in children's oral health and oral health related quality of life.
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This thesis is structured as follows:
Chapter One captures the overview of the research.
Chapter Two is a narrative reVIew of the literature. It considers health as
conceptualized within different approaches; the biomedical, psychosocial model and
bio-psychosocial models, to develop an understanding on OHRQOL. The review also
introduces two models feasible for use in the study; Locker (1988) and Wilson and
Cleary (1995). The Wilson and Cleary model is then used to structure a brief discussion
on individual factors, sense of coherence, self esteem, oral health beliefs and health
locus of control that may play a role in OHRQOL. Included also are environmental
factors such as parental income, education level and work status.
Chapter Three summarises the rationale, aim and objectives of the study. It argues that
clinical and non clinical variables impact on children's QOL. Individual factors and
environment issues may be important factors that need to be considered in
understanding children's oral health. Furthermore, no study so far has systematically
considered these factors guided by a theoretical framework. The study therefore aimed
to identify the determinants and consequences of oral health related quality of life in
children. The objectives are as follows;
• To test the relationships between clinical variables, symptom status, functioning,
general health perceptions and overall well-being as hypothesised within Wilson
and Cleary's model of patient outcomes.
• To examine whether socio-demographic and individual difference factors
influence children's OHRQOL and the key relationships identified within the
Wilson and Cleary model.
• To explore different configurations of SOC, COHRQOL and the model
Chapter Four describes the translation procedures conducted to achieve high quality
translated measures that are suitable for children.
Chapter Five details the material and methods including a brief description on the data
analysis strategy, missing data management and data analysis management.
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Chapter Six presents the research findings. The sample had good clinical status.
Broadly speaking in lagged analyses the linear relationships of the model were not
strongly supported, whereas individual factors, notably sense of coherence, were
consistently linked to symptoms, functional limitation and overall quality of life.
Chapter Seven brings together the discussion highlighted from the findings.
Chapter Eight highlights the major conclusions and summarises the recommendations
arising from the research.
Chapter Nine lists the references.
Appendices section contains copies of key research documents.