Objectives. To review and appraise the validity of psychometric instruments used in dentistry, to report on the use of a written vignette and focus groups among older adults, and to evaluate and if necessary refine a model of oral health in old age under the scopes of framework analysis. Methods. A systematic search was performed to find and compare the psychometric instruments for structure, content and method of validation. In six focus groups, 42 participants (30 women, 12 men), discussed their own experiences of oral health, and how they relate to a vignette and a current model of oral health. Participants focused on the completeness, relevance and interdependency of the model's components. Results. 16 instruments were identified, and most of them were based conceptually on a negative and functionalist perspective of disability. The validation approach to test these instruments has been focused on how well they reflect their theoretical framework, how clear and relevant is the content of their questions, and how accurately they predict a given criteria. The participants of the focus groups reiterated that not everyone gets limited and impaired when oral health is disturbed. The participants confirmed the relevance of the essential components of the model, and added diet, expectations, economic priorities, and health values and beliefs as new components in a different graphic arrangement. Conclusions. The validation approach used to validate the psychometric instruments needs a broader scope of attention to evaluate continuously the content of the questions, the predictive potential of the scores, and their theoretical framework. The graphic changes of the model represent an overlapping and non-hierarchical elliptical rather than a concentric-circular portrayal of oral health as originally presented to remain relevant to older adults.Dentistry, Faculty ofGraduat
