Adherence rate and predictors of clear aligner wear in Canadian university and private practice settings: a survey development protocol

Abstract: Clear aligners (CAs) are a popular orthodontic treatment due to their aesthetic appeal and perceived convenience; however, patient adherence remains a challenge. This study protocol aims to assess distal and proximal determinants of intended and actual CAs wear among adolescents currently undergoing treatment or who completed treatment within the past 3 months at the University of Alberta’s Graduate Orthodontics Program and private clinics in Edmonton, Alberta.

Methods and analysis: This study follows AMEE Guide No. 87 for survey development and is grounded in the Integrative Model of Behavioral Prediction (IMBP). The study includes six steps. Step 1 involves a scoping review to summarise the literature on adherence to removable appliances, including CAs, identify research gaps and inform survey development on behavioural determinants such as barriers, facilitators and perceived costs and benefits. Step 2 includes semistructured interviews with current and former adolescent patients to explore attitudes, subjective norms and perceived barriers, analysed using inductive manifest content analysis. Step 3 synthesises findings from the scoping review and interviews to guide survey development. Step 4 focuses on survey item development, incorporating direct and indirect questions to assess IMBP constructs. Step 5 establishes survey validity and reliability through expert review, adolescent cognitive interviews and internal consistency assessment using Cronbach’s alpha. Step 6 includes survey administration and analysis. The validated survey will be administered via a web-based platform to adolescents in university and private practice settings. Descriptive statistics will summarise determinants, while multiple regression and path modelling will examine associations with intended and actual CAs wear.