# Amharic oral health tools for refugees: a hybrid review of OHIP-14 and WHO adaptations

## TL;DR

This paper reviews the adaptation of oral health tools into different languages and highlights the lack of Amharic versions for Ethiopian refugees.

## Contribution

The paper identifies the absence of validated Amharic-language oral health tools and emphasizes the need for culturally appropriate adaptations.

## Key findings

- OHIP-14 and WHO tools show strong psychometric properties across cultures but lack Amharic adaptations.
- Many studies omit essential cross-cultural adaptation steps, risking validity.
- Refugee-specific beliefs, like spiritual interpretations of pain, are rarely included in current tools.

## Abstract

Despite the growing need for culturally valid oral health tools in refugee populations, no validated Amharic-language versions of key instruments currently exist. This review synthesises how the OHIP-14 and WHO Oral Health Assessment tools have been adapted across linguistic and cultural contexts, with implications for Amharic-speaking Ethiopian refugees.

To assess how OHIP-14 and WHO-OHAFT have been cross-culturally adapted and validated globally, and to identify gaps and equity implications for developing Amharic-language tools in refugee contexts.

We conducted a hybrid systematic–narrative review of 21 studies, using structured database and grey-literature searches followed by descriptive mapping and thematic synthesis. Studies were charted by language, adaptation procedures, and psychometric properties (e.g., Cronbach’s α, intraclass correlation coefficients). Cross-cultural adaptation frameworks, such as those of Beaton et al. and WHO translation guidelines, guided the assessment of methodological and linguistic rigour across studies.

Three main themes emerged: [1] consistent psychometric strength across diverse cultural adaptations; [2] methodological variation and reporting gaps in cross-cultural validation; and [3] a complete absence of validated Amharic-language tools. While Cronbach’s α values ranged from 0.72 to 0.99 (mean = 0.88), many studies omitted essential adaptation steps. Refugee-specific oral health beliefs, such as spiritual interpretations of pain, are rarely integrated.

This review highlights both strong potential and critical limitations in current cross-cultural oral health assessments. It emphasises the ethical and clinical needs for developing validated, culturally appropriate Amharic tools. Cross-cultural adaptation should be seen as a step towards linguistic justice and oral health equity for Amharic-speaking refugee and displaced populations.