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.