Understanding factors influencing compliance with removable functional appliances: A qualitative study

Lack of compliance during functional appliance therapy may lead to extended treatment or even induce treatment failure. The aims of this study were to explore factors influencing compliance in adolescents treated with a Twin-block appliance. A qualitative study using one-to-one semistructured interviews involving a sample of adolescents undergoing Twin-block therapy with objectively recorded wear durations was undertaken. A topic guide was used to standardize data collection. Participants’ views were tape recorded and field notes taken. Data were transcribed verbatim and analyzed with the use of framework methodology. A total of 22 participants were interviewed. Factors influencing compliance with removable functional appliance included: self-motivation, peer and authority influence, quality of life impairment and adaptability, perceived treatment progress, and pragmatic and recall issues. These factors were found to exert important roles as enablers, barriers, or both. Patient recommendations to improve compliance included effective communication, tailoring of prescribed wear duration, physical alteration of the appliance, and use of reminding tools. The study highlights the multifaceted perceptions of removable functional appliance wear, with compliance fluctuating over time and a range of factors influencing this. The potential for professional and parental influence as well as customized reminders to enhance compliance were also reported. •Compliance with prescribed Twin-block wear time depended largely on social influences, including the orthodontist, parents, and peers.•Physical and psychologic impairment related to functional appliance treatment may lead to temporary deterioration in compliance levels, with positive attitudes toward treatment and perceived treatment progress linked to enhanced compliance.•Physical alteration to the appliance, good communication, and customized reminders were variously recommended to improve compliance.