Quantifying a qualitative framework of patients perceptions, attitudes and behavior relevant to oral health related quality of life
In a qualitative study, Gregory, Gibson and Robinson proposed a framework of items grouped in seven dimensions reflecting oral health related perceptions, attitudes and behavior to encompass what is relevant when patients assess their own oral health related quality of life (OHRQOL). The aim of this study is to quantify the dimensions of Gregory relevance framework and confirm, or otherwise, the influence on the change in the OHIP-14, an instrument widely used to measure OHRQOL. The study was observational and longitudinal with the OHIP-14 measured before a tooth extraction, and two and four weeks thereafter. Statistical methods of analysis consisted of generalised estimating equations. Responsiveness (or sensitivity to change) of the OHIP-14 was established in our patient population. The dimensions of Gregory relevance framework featured significantly in the models. Patients trust in dental products, perception of own oral health as normal in relation to the average person, preference for natural teeth, character bias in judgement and control by adherence to dentists instructions, were all found to be significant factors in the longitudinal change of the OHIP-14. Borderline significance was found in terms of dental anxiety and symptoms. Perceptions, behaviour and attitudes, rather than socio-demographic characteristics or oral health related knowledge, influence change in OHRQOL. Trusting that the dentist values the patient as a person and the importance the patient gives to having good oral health, are not found significant, yet adhering to dentists advice has a beneficial effect on OHRQOL.