Effects of perceived vs actual frequency of rewards on orthodontic patient attitudes and compliance.

Objectives: To examine the longitudinal association of different reward schedules on patient compliance (as measured by oral hygiene assessments). The cross-sectional associations of actual vs perceived rewards frequency on patient attitudes were also examined.

Materials and methods: 138 patients undergoing treatment at a university orthodontic clinic were surveyed to collect information on perceived frequency of rewards, likelihood of making patient referrals, and attitudes toward reward programs and orthodontic treatment. Oral hygiene assessment from the most recent appointment and actual frequency of rewards were obtained from patient charts.

Results: Among participants, 44.9% were male, age ranged from 11 to 18 (mean = 14.9 ± 1.7) years; treatment time ranged from 9 to 56 (mean = 23.2 ± 9.8) months. Mean perceived frequency of rewards was 48% while actual frequency of rewards was 19.6%. There were no significant differences in attitudes by actual reward frequency (P > .10). However, those who perceived always receiving rewards were significantly more likely to have more positive opinions of reward programs (P = .004 and P = .024). Age- and treatment-time adjusted analyses showed that always receiving actual rewards was associated with odds of good oral hygiene 3.8 times (95% CI = 1.13, 13.09) higher than those never/rarely receiving actual rewards, but there was no association between perceived rewards and odds of good oral hygiene. Actual and perceived reward frequencies were significantly and positively correlated (r = 0.40, P < .001).

Conclusions: It is beneficial to give rewards to patients as often as possible to maximize compliance (as shown by hygiene ratings) and foster positive attitudes.