Presenting information on dental risk: PREFER study protocol for a randomised controlled trial involving patients receiving a dental check-up

Abstract

Introduction: A new dental contract being tested in England places patients into traffic light categories according to risk (Red = High risk). This reflects health policy which emphasises patients' shared responsibility for their health, and a growing expectation that clinicians discuss health risk in consultations. Alongside this, there are technological developments such as scans and photographs which have generated new, vivid imagery which may be used to communicate risk information to patients. However, there is little evidence as to whether the form in which risk information is given is important.

Methods: The PREFER study is a pragmatic, multi-centre, three-arm, patient-level randomised controlled trial, based in four NHS dental practices, from which 400 high/medium risk patients will be recruited. The study compares three ways of communicating risk information at dental check-ups: 1) verbal only (usual care); 2) a Traffic Light graphic with verbal explanation; 3) a Quantitative Light-Induced Fluorescence (QLF) photograph showing, for example, patches of red fluorescence where dental plaque has been present for two days or more (with a verbal explanation). The study assesses patient preferences using the economic preference-based valuation methodology Willingness-to-Pay (WTP). Any changes in oral self-care (for example in tooth-brushing), will be measured by self-report, and clinical outcome data collected by clinicians and extracted from QLF photographs. Predictors and moderators of any behaviour change will be explored using demographic characteristics and psychological variables from the Extended Parallel Process Model. A cost-benefit framework will explore the financial implications for NHS dentistry of the three risk presentation methods.

Keywords: Behaviour change; Clinical communication; Health education; Oral health; Risk.

Fig. 1

Extended parallel process model.

Fig. 2

Traffic light algorithm applied to assess patient eligibility (Red/Amber risk patients included). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Card showing oral health advice given – any messages given at the check-up being marked by the dentist.

Fig. 4

Traffic light graphics on cards given to participants allocated to Group 2 (Traffic Light information).

Fig. 5

Example QLF photographic image of plaque coverage: Red fluorescence highlighting plaque present in the mouth for over 48 h. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 6

Study flow diagram.