Participation in Treatment Decision-Making Scale for Adults with Malocclusion

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Abstract

The Participation in Treatment Decision-Making Scale for Adults with Malocclusion (PTDMS-AM) is a specialized psychometric instrument engineered to quantify how actively adult patients engage in formulating their dental care plans. Correcting misaligned jaws and teeth often involves high-stakes, expensive, and lengthy procedures, such as orthognathic surgery combined with Orthodontics. Because these medical choices carry significant aesthetic and functional consequences with varying degrees of clinical certainty, patient involvement is paramount. This scale provides a standardized method to evaluate whether patients are truly collaborating with their healthcare providers or merely passively receiving care.

Developed specifically for the Chinese healthcare context, the PTDMS-AM addresses the limitations of broader, generalized Shared Decision-Making tools that may suffer from ceiling effects or fail to capture the unique cultural nuances of dental consultations. By breaking down patient involvement into cognitive, behavioral, and emotional components, the instrument offers a holistic view of patient empowerment. It allows researchers and clinicians to pinpoint exactly where a patient might be disengaging—whether they lack understanding of the options, are hesitant to ask questions, or feel emotionally disconnected from the collaborative process.

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Keywords
Shared Decision-Making
Malocclusion
Patient Participation
Orthodontics
psychometrics
scale development
health psychology

📊 Psychometric Scorecard

Items Count
21
Structure
Multidimensional
Cronbach's α
0.95
Fit Index (CFI)
0.968
Validation Country
📍 China

Authors

👤 Xiangying Hu
🏛 Department of Nursing, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

👤 Bixia Wang
🏛 Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

👤 Ting Pan
🏛 Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

👤 Weijun Yuan
✉ [email protected]
🏛 Department of Nursing, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

👤 Lili Hou
✉ [email protected]
🏛 Department of Nursing, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Purpose

In the realm of health psychology and behavioral medicine, measuring Shared Decision-Making is critical for improving patient adherence and satisfaction. For Adults facing severe Malocclusion, the treatment journey is arduous and highly preference-sensitive. If a patient chooses a surgical route without fully grasping the long-term implications, the risk of post-treatment regret and non-compliance skyrockets. The PTDMS-AM was created to fill a distinct gap in the literature: the need for a condition-specific, culturally adapted tool that measures the depth of a patient's involvement in these high-stakes dental decisions.

For graduate students and researchers focusing on patient-provider communication, this scale serves as a prime example of how to operationalize a complex, interactive construct. Clinically, dental professionals can utilize the PTDMS-AM to screen for passive patients who might need additional educational resources or more encouraging communication strategies before finalizing a surgical or orthodontic plan. Ultimately, the tool champions the shift from paternalistic medical models to collaborative, patient-centered care.

Construct

The theoretical foundation of the PTDMS-AM is anchored in the Shared Decision-Making (SDM) framework, which posits that optimal medical choices occur when both the provider and the patient actively exchange information and preferences. The scale conceptualizes participation not as a single action, but as a multidimensional psychological construct comprising three distinct facets: cognitive, behavioral, and emotional engagement.

The cognitive dimension assesses the patient's internal processing, such as their ability to comprehend medical jargon, weigh the pros and cons of various interventions, and integrate new information with their prior knowledge. The behavioral dimension captures observable actions, including researching options independently, preparing questions for the doctor, and explicitly stating aesthetic goals. Finally, the emotional dimension evaluates the affective experience of the consultation, measuring feelings of fulfillment, excitement, and the sense of accomplishment that arises from building a cooperative alliance with the dental surgeon. Together, these subscales provide a comprehensive profile of patient activation.

Validity

To establish the scale's validity, the developers employed a rigorous, multi-phase methodological approach. Content validity was initially secured through expert panel reviews, yielding an excellent Scale-Level Content Validity Index (S-CVI) of 0.926, which comfortably exceeds the standard threshold of 0.80. This indicates strong agreement among experts that the items accurately reflect the target construct.

Furthermore, the researchers evaluated criterion-related validity by comparing the PTDMS-AM against the established 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The analysis revealed moderate to strong positive correlations, ranging from 0.590 to 0.650. From a psychometric standpoint, this is an ideal outcome: the correlations are high enough to prove that the new scale is indeed measuring Shared Decision-Making, but not so high as to suggest redundancy. The PTDMS-AM captures unique, context-specific variance that the generic SDM-Q-9 misses.

Convergent & Discriminant Validation Correlations

Reference Instrument Correlation Coefficient (r)
9-item Shared Decision-Making Questionnaire (SDM-Q-9) r=0.590-0.650

Reliability

The internal consistency of the PTDMS-AM is exceptionally robust. The overall instrument demonstrated a Cronbach's alpha of 0.953, indicating that the 21 items are highly correlated and reliably measure the same underlying concept. The individual subscales also performed admirably, with alpha values ranging from 0.860 to 0.909. These figures are well above the conventional 0.70 cutoff, making the scale highly suitable for both group-level research and individual clinical assessment.

Beyond internal consistency, the researchers also established the tool's temporal stability. A test-retest reliability coefficient of 0.885 was observed, meaning that patients' scores remained stable over time when their clinical situation had not changed. Additionally, a split-half reliability of 0.957 further corroborated the structural dependability of the questionnaire. For researchers planning longitudinal studies to track patient empowerment over the course of a multi-year orthodontic treatment, this high level of reliability is a crucial asset.

Factor Analysis

The structural integrity of the scale was tested using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) on two separate patient samples. The EFA successfully extracted three latent factors—aligning perfectly with the proposed cognitive, behavioral, and emotional dimensions—which together explained approximately 61% of the total variance. The data's suitability for this analysis was confirmed by a stellar Kaiser-Meyer-Olkin (KMO) measure of 0.974.

Subsequently, the CFA was deployed to verify this tripartite model. The fit indices largely supported the structure, showcasing an excellent Root Mean Square Error of Approximation (RMSEA) of 0.015, alongside strong Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) values of 0.968 and 0.964, respectively. While the Normed Fit Index (NFI) of 0.641 fell below traditional acceptability thresholds, the overall constellation of fit metrics suggests a stable and robust model. The authors also noted that factor loadings were generally lower in the CFA compared to the EFA, a common psychometric phenomenon that occurs when cross-loadings are constrained to zero in confirmatory models.

Subscales

Subscale Items Description
Cognitive participation 1, 4, 5, 6, 7 Measures the patient's intellectual engagement, including understanding medical information, remembering details, and recognizing the pros and cons of different treatment options.
Behavioral participation 8, 10, 11, 13, 14, 15, 19, 20, 21, 23 Assesses observable actions taken by the patient, such as researching treatments, preparing questions, expressing desired aesthetic results, and actively discussing plans with the doctor.
Emotional participation 24, 25, 26, 29, 30, 31 Evaluates the affective components of the consultation, including feelings of excitement, fulfillment, and a sense of accomplishment when collaborating with the healthcare provider.

Instrument

Test Type Self-report questionnaire
Format 21 items, 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree)
Scoring Sum of all items. Item 31 is reverse-scored. Total scores range from 21 to 105, with higher scores indicating greater Patient Participation in decision-making.
Language Chinese
Population Adults, Clinical patients, Medical patients
Age Group 18-43 years
Administration Self-administered

Scoring & Interpretation Guidelines

Scoring Instructions Reverse score item 31

Participation in Treatment Decision-Making Scale for Adults with Malocclusion Items

📋 Items are currently not available

The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.

Sample

Two independent samples of adult patients with Malocclusion were recruited from three tertiary general hospitals in Shanghai, China. The EFA sample consisted of 257 patients (mean age 25.19 years; 70.42% female). The CFA sample consisted of 269 patients (mean age 26.13 years; 65.79% female). The majority of participants in both samples were unmarried and held a bachelor's degree or higher.

Permissions & Test Year

Open access under Creative Commons Attribution 4.0 International License (CC BY 4.0).

Test Year: 2025

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Cite This Paper

Xiangying Hu, Bixia Wang, Ting Pan, Weijun Yuan, Lili Hou (2025). Participation in Treatment Decision-Making Scale for Adults with Malocclusion. BMC oral health. https://doi.org/10.1186/s12903-025-06825-2

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References
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Cite this article

Mohammed looti (2026). Participation in Treatment Decision-Making Scale for Adults with Malocclusion. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/participation-in-treatment-decision-making-scale-for-adults-with-malocclusion/

Mohammed looti. "Participation in Treatment Decision-Making Scale for Adults with Malocclusion." PSYCHOLOGICAL SCALES, 14 Aug. 2026, https://scales.arabpsychology.com/s/participation-in-treatment-decision-making-scale-for-adults-with-malocclusion/.

Mohammed looti. "Participation in Treatment Decision-Making Scale for Adults with Malocclusion." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/participation-in-treatment-decision-making-scale-for-adults-with-malocclusion/.

Mohammed looti (2026) 'Participation in Treatment Decision-Making Scale for Adults with Malocclusion', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/participation-in-treatment-decision-making-scale-for-adults-with-malocclusion/.

[1] Mohammed looti, "Participation in Treatment Decision-Making Scale for Adults with Malocclusion," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.

Mohammed looti. Participation in Treatment Decision-Making Scale for Adults with Malocclusion. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.

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