Strategies for improving compliance with removable retention appliances: A qualitative study

Objective: To explore experiences affecting patients’ compliance with removable retention appliances, and to investigate strategies for improving adherence to wear recommendations from the profession. Design: A qualitative study designed alongside a randomised controlled trial regarding post-treatment stability and patients’ perceptions. Setting: Orthodontic Clinic, Public Dental Health Service, Region Gävleborg, Gävle, Sweden. Participants: A total of 15 purposively selected participants (age range = 25–32 years) with a recommendation of long-term retainer wear. Methods: In-depth interviews were performed, using a pre-tested topic guide, and analysed according to the qualitative method of Grounded Theory. Results: Compliance failures were preceded by one or more triggers that emerged after a couple of weeks or after several years of retention. A core category was identified and labelled ‘Pragmatic actions for improved adherence’, which summarises the decisions to either discontinue or continue to follow current retention protocol as being based on pragmatic patient-centred considerations. Data analysis revealed three interacting categories for improving compliance from both the patient and the clinician perspectives: Individual factors, Support, Self-motivation and Routines. Conclusions: To be successful, strategies to enhance compliance with removable retainers must originate from the individual patient and their life situation. Long-term support from both family and professionals as well as good routines are considered crucial for this process.