Determinants of orthodontic treatment acceptance among university students in Northern China: a structural equation modeling approach

Background Malocclusion represents a prevalent oral health concern with notable psychosocial implications. Despite high treatment need among young adults in China, the transition from awareness to actual uptake of orthodontic care remains inadequately understood, particularly in student populations. Objective This study aimed to assess the willingness to undergo orthodontic treatment and identify its predictors among university students in Liaoning Province, China. Methods A cross-sectional survey was conducted using multistage stratified cluster random sampling across 14 cities in Liaoning Province. A total of 1,299 students aware of orthodontic treatment completed a structured questionnaire. Data were analyzed using t -tests, ANOVA, and structural equation modeling (SEM) to examine the relationships between service quality dimensions (reliability, responsiveness, assurance, empathy), social norms, satisfaction, and treatment acceptance. Results No significant demographic differences were found in relation to acceptance willingness or its predictors (all p > 0.05). SEM indicated that reliability (β = 0.172), responsiveness (β = 0.135), assurance (β = 0.230), and empathy (β = 0.135) positively influenced satisfaction. Satisfaction (β = 0.179), along with reliability (β = 0.185), responsiveness (β = 0.199), assurance (β = 0.212), empathy (β = 0.147), and social norms (β = 0.106), directly enhanced willingness to accept treatment. Conclusion Perceived service quality, social norms, and satisfaction are pivotal in shaping orthodontic acceptance among Chinese university students. Enhancing reliability, responsiveness, assurance, and empathy in clinical practice may improve treatment uptake in this population.