Preliminary validation of the Persian version of the patients’ attitudes to prevention in oral health (PAPOH) questionnaire: a cross-cultural methodological study

Patients’ attitudes toward prevention influence oral-health behaviours and engagement with dental services, yet culturally adapted instruments for assessing these attitudes remain limited. This study translated, culturally adapted, and evaluated the measurement properties of the Patients’ Attitudes to Prevention in Oral Health (PAPOH) questionnaire which was developed for ADVOCATE (Added Value for Oral Care) project for use among Iranian adults. A cross-sectional methodological study was conducted in two phases. The PAPOH questionnaire was translated into Persian through forward–backward translation, expert review, and cognitive debriefing. Content validity was assessed by eight experts using the Content Validity Ratio and Content Validity Index. Construct validity was examined using confirmatory factor analysis (CFA) in 310 adults aged 18–60 years in Isfahan, Iran. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega, and test–retest reliability using intraclass correlation coefficients. Descriptive analyses, known-groups comparisons, and behavioural discrimination analyses were also performed. Content validity was strong (S-CVI/Ave = 0.958). CFA showed acceptable absolute fit (χ²/df = 2.11; RMSEA = 0.060; SRMR = 0.064), but the CFI (0.83) and TLI (0.80) were below recommended thresholds, indicating only partial support for the hypothesised factor structure. Overall internal consistency was acceptable (Cronbach’s alpha = 0.777), and test–retest reliability was good (ICC = 0.843), although domain-level reliability was weaker for message delivery and responsibility. Motivation and responsibility scores were comparatively high, whereas knowledge gaps and variability in preventive advice received were observed. In known-groups analyses, women and married participants had higher overall attitude scores, while education and income were associated with selected domains. The total attitude score showed limited behavioural discrimination, except for a modest distinction between acceptable and unacceptable toothbrushing frequency ( p < 0.001; AUC = 0.62). The PAPOH-P is a promising preliminary measure of preventive oral-health attitudes in Persian-speaking adults, with satisfactory content validity and reliability but incomplete structural equivalence to the original instrument. Its current form is better suited to exploratory assessment than definitive group comparison or behavioural prediction, and further item refinement and validation in more diverse samples are required.