Investigation of the feasibility and utility of electronic patient-reported outcome measures in Paediatric Dentistry clinical practice

Background: There is a shift within healthcare services towards incorporating Patient-Reported Outcome Measures (PROMs) rather than relying solely on clinical outcomes. There is a lack of evidence exploring the routine clinical use of PROMs in children’s oral health.

Aim: To explore the feasibility and utility of web-based electronic PROMs in routine clinical practice in paediatric dentistry.

Design: The first stage involved the development of the electronic Personal Assessment Questionnaire-Paediatric (ePAQ-PD) using paediatric oral health PROMs, Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) and Children’s Experiences of Dental Anxiety Measure-short form (CEDAM-8) and additional free-text questions. Next, technical and usability testing was conducted to ensure readiness of the ePAQ-PD for routine use. This was followed by implementation of the ePAQ-PD in routine practice with a purposive sample of children, parents/carers and clinical staff interviewed to explore their views on the feasibility and utility of the ePAQ-PD. Finally, the psychometric properties of the eCARIES-QC were evaluated using classical test theory and Rasch model analysis.

Results: The ePAQ-PD showed acceptable technical and usability performance. Children (n=237) and their parents/carers with varying socio-demographic characteristics completed the ePAQ-PD with a response rate of 69.5%. A range of views were captured in terms of children’s preferences, acceptability of the electronic format, role in clinical effectiveness and potential impact on treatment planning. The ‘Question to Dentist’ item was found to be effective in capturing information and concerns from children and parents/carers. Areas for improvement were suggested including the content of the invitation text, intuitiveness and child-friendliness of the design. Clinical staff requested improvements in accessibility and readability to facilitate faster interpretation. The eCARIES-QC showed strong construct validity (p < 0.001) and a high Cronbach's alpha of 0.91 with a good fit to the Rasch model. The free-text question captured additional impacts mainly related to pain, sensitivity, aesthetics and anxiety.

Conclusion: The ePAQ-PD had acceptable feasibility and utility for routine use in paediatric dental practice. The ePAQ-PD has been shown to improve children’s involvement in their oral care, their clinical experience and communication with clinical staff. eCARIES-QC had acceptable psychometric properties for a wider age range than initially designed and appeared to capture the impacts of non-caries-related oral conditions with high reliability. The free-text questions captured further valuable impacts that should be used to complement the eCARIES-QC in routine clinical practice.