A knowledge translation perspective on improving adherence to removable appliances in adolescents

Abstract

Malocclusion, a misalignment of teeth, affects over 50% of adolescents globally. It significantly impedes functional well-being and contributes to psychological distress. While removable orthodontic appliances (ROAs) are clinically effective in addressing malocclusion, adherence to recommended treatment regimens remains challenging, with poor adherence rates ranging from 43% to 50% among adolescents. Theoretically-informed interventions have proven effective in addressing adherence to treatment recommendations. This paper discusses the Theoretical Domains Framework (TDF) and the Integrative Model of Behavioral Prediction (IMBP) as conceptual frameworks that can guide efforts to bridge the gap between research findings on treatment adherence and their implementation. Traditional knowledge translation (KT) approaches need to be complemented by behavioral change approaches to address the poor adherence to wearing ROAs. The paper recommends theory-informed, evidence-based behavioral interventions, such as motivational interviewing, peer support programs, and audit and feedback. These interventions are specifically designed to address proximal determinants of behaviors, including motivation, social norms, affective responses, and perceived behavioral control, which can lead to better orthodontic outcomes, shorter treatment times, and more efficient healthcare. This perspective paper aims to guide future initiatives focused on developing and evaluating strategies to improve adolescents' adherence to removable orthodontic appliances.