Abstract
Objective: To assess participants’ expectations during a course of fixed orthodontic appliance treatment, and to determine participants’ expectations in association with their satisfaction and quality of life (QoL).Design: A prospective longitudinal study which used validated questionnaires to quantitatively measure participants’ expectations throughout a course of treatment in a hospital orthodontic department. Additionally, to measure quality of life before and after treatment, and participants’ satisfaction on completion of treatment. In-depth participant interviews provided longitudinal qualitative data to provide information on participant expectations about their treatment.
Materials and methods: Mixed methods study which combined a questionnaire survey with a qualitative study. The questionnaire study included 100 adolescent participants who were aged 12-15 years old, and assessed expectations and quality of life before treatment and expectations at 6, 12, 18 months intervals until the end of treatment. On completion of treatment and at the retainer review, participants also completed a satisfaction and quality of life questionnaire. Qualitative interviews were conducted before treatment, 12 months into treatment and on completion of treatment with a cohort of 13 participants from the original group of 100 participants.
Results of qualitative study: In-depth interviews before treatment revealed 2 major themes and subthemes. The first major theme and subthemes were related to participants’ expectations about the process and outcome of orthodontic treatment; while the second major theme and subthemes were related to participants’ expectations of themselves during and after treatment.
The qualitative interviews before orthodontic treatment also identified 3 multiple-linkage typologies of participants’ expectations of the orthodontic treatment process. The first group of participants had ‘minimal’ expectations of the treatment process, discomfort or pain and felt that treatment would cause little disruption to their daily life. The second type of participant, had expectations that treatment involved arch wire changes, dental extractions, and resulted in some discomfort and pain which would cause minimal disruption to their daily life (moderate expectations). The third type of participant, expected the treatment process to involve arch wire changes, dental extractions, and anticipated discomfort and pain which would affect their daily life (marked expectations). After 12 months of treatment there was a shift in typology category involving participants who had ‘minimal’ or ‘marked’ expectations before the start of treatment to ‘moderate’ however, participants who had ‘moderate’ expectations before the start of treatment described little or no change and remained in this category. On completion of treatment all participants had ‘moderate’ expectations with no further changes in participants’ typology category.
Results of quantitative study: Descriptive data from the questionnaire survey revealed changes in participants’ expectations regarding the process and outcome of orthodontic treatment over time. This was shown in a lowering of expectations related to the treatment process related to: dental pain, treatment problems, eating issues, dietary and drinking restrictions during treatment, and increased expectations for treatment outcome (items 10a to 10g inclusive) before treatment (T0) to completion of treatment (T4). Expectations about treatment outcome were then classified into low, medium and high and there was a significant increase in the proportion of participants with high expectations and a reduction in participants with low expectations during treatment (p< 0.01). A similar trend was seen when individual responses for items 10a to 10g were classified into low, medium and high expectations too. The percentage of participants who provided the maximum score of ‘10’ for all seven items (10a to 10g) were consistent during treatment but increased from 2 to 8% on completion of treatment (T4).
A weak to moderate, but positive significant correlation was found between expectations before orthodontic treatment (T0) for a good smile (p<0.01), improved eating (p<0.05), speaking (p<0.05), good career (p<0.05), improved social confidence (p< 0.01) and increased satisfaction on completion of treatment (T4). The relationship between expectations and QoL could not be confirmed with generally weak correlations.
Conclusions: The qualitative and quantitative data revealed that participants’ expectations changed over time, and this seemed to be driven by participants’ personal experiences of orthodontic treatment which can be explained by the confirmation-expectancy theory (Oliver, 1980). The significant, positive relationship between expectations for treatment outcome before treatment (T0) and increased satisfaction on completion of treatment (T4) suggests that increased or ‘high’ expectations may have a positive association rather than a negative association as previously reported. The results of this study did not confirm the relationship between expectations and QoL. However, internationally this is currently the largest longitudinal study which has investigated patients’ expectations during a course of orthodontic treatment, and explored the relationship between expectations with QoL and satisfaction.
| Date of Award | 1 Jan 2023 |
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| Original language | English |
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| Supervisor | Tim Newton (Supervisor) & Susan J Cunningham (Supervisor) |