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Title: Evaluating the effects of information provision on hypodontia patients' expectations of the process and outcome of combined orthodontic and restorative treatment
Author: Ben Gassem, Afnan Abdulfattah Ahmed
ISNI:       0000 0004 6421 4884
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2017
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Aim: The ultimate goal of the research was to improve information delivered to hypodontia patients regarding their condition and its’ treatment by understanding their expectations of the process and outcome of combined orthodontic/restorative treatment and the effects of patient education in modifying these expectations. Methods: A mixed method research design was adopted with three stages: (a) Study one: semi-structured interviews with 24 hypodontia patients who were either new, in-treatment, or had reached the end of their treatment to determine their information needs and their perceptions of the process and outcome of their combined orthodontic/ restorative treatment. (b) The results of the interviews were used as the basis for the creation of a hypodontia specific interactive computer based education material (ICB-EM) together with a valid and reliable hypodontia treatment expectation questionnaire (HTEQ). Both materials were piloted on a sample of new hypodontia patients (n=10) and a selected panel of experts to assess readability and content validity. The questionnaire was distributed to 32 new hypodontia patients to assess its internal consistency. (c) Study two: a prospective randomised controlled trial was conducted on 96 new hypodontia patients randomly assigned to the intervention group (n=47) who received the ICB-EM or the control group (n=49) who received a standard hypodontia leaflet. The main outcome measure was the change in the participants’ self-reported expectations of the process and outcome of combined orthodontic/restorative treatment as measured by the HTEQ. All participants completed the questionnaire at baseline (T1), post-intervention (T2) and 3-4 weeks follow up (T3). As a secondary outcome, the patients’ acceptability of the method of information provision was measured using the treatment evaluation inventory (TEI) at T2. Results: (a) Themes relating to the participants’ information needs included; ‘what is hypodontia’, ‘treatment of hypodontia’, ‘hypodontia clinic’ and ‘educational material’. Themes relating to perceptions of the treatment process included: ‘hypodontia clinic’, ‘orthodontic treatment’, and ‘restorative treatment’, while themes relating to the treatment outcome included: ‘changes in appearance’, ‘functional changes’, and psychosocial changes’. (b) The ICB-EM and the HTEQ were found to have good face and content validity. The overall Cronbach’s alpha for the questionnaire was 0.80 while for the treatment process and treatment outcome subscales it was 0.71 and 0.88 respectively. (c) The final sample comprised 76 participants; control group (n=38) and the intervention group (n=38). The mean age of the sample was 19 (SD = 7.24) years for the control group and 20.3 (SD = 6.9) years for the intervention group. With regards to the categorical response questions of the questionnaire, Chi square analysis revealed that both groups were similar in their expectations at baseline (T1). At T2, the intervention group conveyed better recall of the number of clinicians in the hypodontia clinic (X2 = 9.72, p = 0.021), the types of clinicians (restorative dentist X2 = 9.01, p = 0.003, dental nurse X2 = 5.23, p = 0.022) and were less likely to answer ‘I don’t know’ (X2 = 4.03, p = 0.045). In addition, a significantly higher proportion of participants in the intervention group expected to receive restorative treatment compared to the control (X2 =8.75, p = 0.013). At T3, the intervention group conveyed better recall of having a check-up and diagnosis in the hypodontia clinic (X2 = 4.52, p = 0.033), the number of clinicians in the clinic (X2 = 19.93, p < 0.001), and the types of clinicians in the clinic (restorative dentist X2= 5.05, p = 0.025, oral surgeon X2 = 6.41, p = 0.011 and dental nurse (X2 = 6.09, p = 0.014). With regards to the visual analogue scale items of the questionnaire a mixed-analysis of variance (ANOVA) revealed that there were statistically significant effects of time for the majority of the items meaning that patients expectations changed over the course of the study (T1 to T3), while there was no statistically significant effect of intervention and no significant interaction between time and intervention was detected. Participants in the intervention group were significantly more satisfied with the ICB-EM than individuals in the control group who received the leaflet (t = -3.53, p = 0.001). Conclusion: A new patient based 25-item HTEQ as well as a patient based hypodontia specific ICB-EM were developed. Both displayed good face and content validity. The questionnaire also displayed satisfactory internal consistency. Provision of information via the ICB-EM was more effective than provision by leaflet in terms of the participants’ recall of the hypodontia clinic. There was no difference between the ICB-EM and the leaflet in terms of patient expectations of the process and outcome of orthodontic and restorative treatment. Patients expressed a preference for the ICB-EM.
Supervisor: Foxton, Richard Mark ; Newton, Jonathan Timothy Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available