Using photo-elicitation to explore young people’s short-term experience of orthodontic retainers

Background: Adherence to retainer wear following orthodontic treatment is known to prevent relapse, if worn as advised. However, non-adherence is a persistent and widespread problem for young people. Aim: To investigate young people’s lived experience of retainer wear and the factors affecting adherence in the immediate term following completion of their orthodontic treatment. Design: Qualitative study using photo-elicitation, underpinned by a relativist ontology, constructivist epistemology and an interpretivist methodology. Methods: 12 participants aged 13-18 were recruited from two teaching hospitals, Leeds Dental Institute and Bradford Hospitals NHS Teaching Trust, using a purposive sampling approach. Data collection occurred through one-to-one, virtual, photo-elicitation interviews. Recruitment continued until it was deemed that data saturation had been reached. Analysis: Interpretative phenomenological analysis (IPA). Results: Three overarching themes were developed to describe young people’s experience, including their immediate experience and expectation of retainers, the process of adaptation and motivating factors. Challenges to adherence were mostly ascribed to day-time wear, despite normalisation of retainers in young people’s lives. Interventions to help individuals overcome the initial adaptation phase and self-manage their foreseen problems of forgetfulness include routines, reminders and compensatory changes in behaviours. Internal motivation, external motivation and self-determination significantly contribute to retainer adherence immediately following treatment completion. Conclusions: Factors associated with young people’s immediate experience of orthodontic retention are complex and multifaceted, comprising a web of influential factors that overlap. Thoughtful consideration of young people’s capability, opportunity and motivation toward retainer wear may enable orthodontists to understand the nuances of their behaviour whilst optimising and co-constructing strategies for adherence on an individual basis.