Objectives: To investigate the reliability and validity of computerized anxiety assessment with New Zealand children, and to explore children's preferences for the method of anxiety assessment.
Design: A validation study including test-retest reliability, and mean anxiety scores for items on the computerised Smiley Faces Program-Revised scale (SFP-R), together with qualitative data on children's preferences following two computer assessments and a pen-and-paper assessment using the Modified Children's Dental Anxiety Scale.
Participants: 206 children ranging in age from five to 13 years and from from three primary schools (one each of high, medium and low decile ranking). Approximately one-third (33%) were European, one-quarter M&ori or Polynesian, and 38% were Asian.
Results: Estimates of internal consistency, (calculated using Cronbach's alpha), demonstrated an acceptable level of reliability for the SFP-R (alpha = 0.75). Test-retest data from the sub-sample of children across a two-week period showed a strong correlation (r = 0.75, p < 0.001). The SFP-R was found to significantly correlate with the MCDAS demonstrating concurrent validity (r = 0.67, p < 0.01). The mean anxiety score for all children was 19.9 (SD = 6.1). A two-way analysis of variance was employed to test for the effect of gender and age on total dental anxiety scores. There was no main effect for gender (F(1, 195) = 0.017, p > 0.05) or age group (F(3, 195) = 1.527, p > 0.05) and no interaction between the two factors. Children rated themselves most anxious when faced with the drill (mean = 4.5, SD = 1.7). 'Happy' faces were chosen some of the time for all of the items, even for the invasive procedures.
Conclusions: The SFP-R demonstrated good reliability and validity with New Zealand children and data indicated that it is a stable measure over time. It demonstrated concurrent validity, as evidenced by the moderately strong correlation with the MCDAS. Mean scores and frequency data suggest that, as there is still a significant proportion of children with very high overall anxiety scores, dental anxiety should be formally assessed and managed in NZ children. Children's preferences were for the computerised assessment of dental anxiety, supporting the continued development of Dental Jungle, the New Zealand dental anxiety intervention program.