Motivations of patients with dentofacial deformities seeking orthognathic treatment: an application of Q methodology

Objectives This study aims to systematically investigate the motivations behind orthognathic surgery in dentofacial deformity patients using Q methodology, thereby providing valuable insights for clinical decision-making in dentofacial deformity treatment. Additionally, the research seeks to evaluate the efficacy of Q methodology in subjective opinion surveys within this specific medical context. Methods This exploratory, cross-sectional Q-methodology study (without pre-specified hypotheses) was conducted at the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China, from December 2020 to December 30, 2021. Q methodology was employed to interview patients with dentofacial deformities to explore their motivations for surgery. The Q methodology comprises five main steps: 1. Q Statement Collection: Initially, the subject was defined, followed by the collection of motivation-related statements through literature reviews and interviews with patients with dentofacial deformities and orthognathic surgeons. 2. Q sample construction: Two professors of orthognathic surgery discussed and identified a Q sample, then tested it by a pre-experiment. 3. P sample selection: The quantity of the P sample depends on the Q sample and follows the principles of Q methodology. 4. Q-Sort: The P sample ranked the statements on an 11-point distribution grid ranging from “most agree” to “most disagree”. 5. Statistical analysis: Data processing and analysis were performed using the PQMethod2.35 program, and principal component analysis and factor analysis were carried out. Results Through factor analysis, three distinct motivational viewpoints were identified, accounting for 67.5% of the total variance: Type 1, appearance-driven (27.5%); Type 2, occlusal function-dominant (17.5%); and Type 3, combined facial shape and occlusal function-driven (22.5%). Patients' explanations of their motivations for orthognathic surgery revealed that orthodontists' advice significantly influenced their decision to proceed with surgery. Conclusion In this study, three distinct motivational profiles were identified among patients seeking orthognathic surgery: appearance-oriented, occlusal function-dominant, and a combined type. Awareness of these profiles may facilitate patient-centered communication and help align clinical discussions with patient expectations. Orthodontists' recommendations played an important role in patients' decision-making. These findings suggest that Q methodology represents a promising approach for investigating patient motivations in clinical settings.