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

BACKGROUND: 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. AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.