Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

Abstract

BackgroundThis study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient’s mouth).MethodsA multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models.ResultsA total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p < 0.0001). Practice attended was predictive of verbal as first preference, and being older. Practice attended, preferring TL the most and having fewer than 20 teeth were associated with increased WTP; and living in a relatively deprived area or having low literacy decreased WTP. There were no significant differences in behaviour change on follow-up.ConclusionsAlthough a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy.Trial registrationISRCTN, ISRCTN71242343. Retrospectively registered on 27 March 2018.

Visualising health risks with medical imaging for changing recipients’ health behaviours and risk factors: Systematic review with meta-analysis

“…Most (14/21) studies were undertaken in inpatient or outpatient healthcare or clinical research settings [ 39 – 52 ], with the remainder conducted in nonclinical research or community settings [ 53 – 59 ]. In terms of imaging technologies used and the health conditions being investigated, nine studies imaged cardiovascular risk, specifically arterial, venous or cardiac health, using either ultrasound [ 39 , 40 , 46 , 50 , 52 ] or CT [ 44 , 45 , 48 , 51 ]; six studies used UV photography to image UV exposure–related skin damage [ 53 – 58 ]; three studies used oral photography (intraoral or quantitative light fluorescence photography) to image gingivitis, dental plaque, or tooth decay within dental consultations [ 41 – 43 ]; one used whole body photography to aid in monitoring new and changing skin moles [ 47 ]; one used photography to image skin health related to fruit and vegetable consumption [ 59 ]; and one used fundus photography to image retinal health linked to diabetes [ 49 ]. A total of 11 studies were conducted in the USA [ 40 , 44 , 47 , 48 , 51 , 53 – 58 ], three in the UK [ 43 , 52 , 59 ], two in Portugal [ 41 , 42 ], and one each in Australia [ 49 ], Sweden [ 46 ], Denmark [ 45 ], Switzerland [ 50 ], and the Seychelles [ 39 ].…”

“…Eight studies [ 39 , 43 , 45 , 46 , 48 , 50 – 52 ] assessed current smoking status, or cessation in known smokers, up to 48 months postintervention, the modal follow-up being 12 months. Seven studies used either ultrasound or CT to visualise cardiovascular health [ 39 , 45 , 46 , 48 , 50 – 52 ], while one study used quantitative light fluorescence photography to visualise oral health [ 43 ].…”

“…Eight studies [ 39 , 43 , 45 , 46 , 48 , 50 – 52 ] assessed current smoking status, or cessation in known smokers, up to 48 months postintervention, the modal follow-up being 12 months. Seven studies used either ultrasound or CT to visualise cardiovascular health [ 39 , 45 , 46 , 48 , 50 – 52 ], while one study used quantitative light fluorescence photography to visualise oral health [ 43 ]. Pooled analysis ( n = 4,308) showed that imaging feedback led to an increase in the proportion of participants not smoking (risk ratio 1.11, 95% CI 1.01 to 1.23, p = 0.04, I 2 = 44% (I 2 CI 0% to 74%); Fig 2 ).…”

Presenting patients with information on their oral health risk: the PREFER three-arm RCT and ethnography

“…Thi s chapter draws on the article by Harris et al 102 Flow of trial participants and the CONSORT flow diagram Figure 10 describes the flow of participants through the trial. Of the 423 patients approached to take part in the study, 11 declined, most of whom cited that they were too busy to take part.…”

“…Tobit regression model to show predictors of WTP for most preferred intervention [n = 254, LR of χ 2 = 32.52 (p = 0.0129), pseudo-R 2 = 0.017] (continued ) Reproduced with permission from Harris et al102 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.…”