{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:54:02Z","timestamp":1791395642934,"version":"4.3.3"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000190","name":"University of Alberta","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000190","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Alpha Omega Foundation of Canada"},{"DOI":"10.13039\/100005648","name":"American Association of Orthodontists Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005648","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Resident Research Award"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Poor adherence in orthodontic care is a complex issue involving both children and their parents. The study aimed to expand the theory of planned behavior (TPB) by integrating sense of coherence (SOC) to predict appointment attendance in adolescent orthodontic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This prospective cohort study recruited adolescents from the University of Alberta Graduate Orthodontic Clinic. Baseline questionnaires captured sociodemographic data, TPB constructs, and SOC. Appointment attendance and oral hygiene were monitored over 1 year. Structural equation modeling (SEM) was used to examine relationships between TPB constructs and appointment adherence, with model fit assessed using \u03c72, chi-square\/degrees of freedom ratio (CMIN\/DF), root mean square error of approximation (RMSEA), and comparative fit index (CFI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 168 adolescent\u2013parent pairs participated, and 57% of participants missed at least one appointment during the first year of treatment. SEM demonstrated moderate model fit (CMIN\/DF = 1.74; RMSEA = 0.06; CFI = 0.84). Within the TPB constructs, only perceived behavioral control (PBC) significantly predicted intention (P &amp;lt; 0.05), whereas attitude and subjective norm were not significant predictors. SOC did not significantly predict intention, TPB constructs, or appointment adherence in either the adolescent or parent models. Intention also failed to significantly predict actual attendance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within the expanded TPB\u2013SOC framework, PBC was the sole psychosocial predictor of orthodontic appointment-adherence intention. However, neither intention nor SOC translates into actual clinical attendance. The moderate model fit indicates that psychosocial constructs alone are insufficient to fully explain orthodontic appointment adherence. To build more effective adherence models, future research and clinical strategies must look beyond psychology and account for structural, logistical, and environmental barriers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejo\/cjag065","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:11:08Z","timestamp":1788520268000},"source":"Crossref","is-referenced-by-count":0,"title":["Predicting orthodontic appointment adherence in adolescents and parents using an extended behavioral model"],"prefix":"10.1093","volume":"48","author":[{"given":"Maryam","family":"Elyasi","sequence":"first","affiliation":[{"name":"Mike Petryk School of Dentistry, University of Alberta , 5-513 Dianne and Irving Kipnes Health Research Academy, Edmonton, Alberta, T6G 1C9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babak","family":"Bohlouli","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, University of Alberta , 5-513 Dianne and Irving Kipnes Health Research Academy, Edmonton, Alberta, T6G 1C9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-6725","authenticated-orcid":false,"given":"Akriti","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, University of Alberta , 5-513 Dianne and Irving Kipnes Health Research Academy, Edmonton, Alberta, T6G 1C9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2249-5465","authenticated-orcid":false,"given":"Maryam","family":"Amin","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, University of Alberta , 5-513 Dianne and Irving Kipnes Health Research Academy, Edmonton, Alberta, T6G 1C9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026100713114708000_cjag065-B1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1093\/pch\/13.1.19","article-title":"Adherence to treatment in adolescents","volume":"13","author":"Taddeo","year":"2008","journal-title":"Paediatr Child Health"},{"key":"2026100713114708000_cjag065-B2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1002\/psb.1371","article-title":"Medication adherence in children remains a challenge","volume":"26","author":"Chappell","year":"2015","journal-title":"Prescriber"},{"key":"2026100713114708000_cjag065-B3","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1043\/0003-3219(2003)073&lt;0051:DFALTD&gt;2.0.CO;2","article-title":"Do failed appointments lead to discontinuation of orthodontic treatment?","volume":"73","author":"Trenouth","year":"2003","journal-title":"Angle Orthod"},{"key":"2026100713114708000_cjag065-B4","doi-asserted-by":"publisher","first-page":"28","DOI":"10.15386\/mpr-2415","article-title":"Parental influence in orthodontic treatment: a systematic review","volume":"96","author":"Nobre","year":"2023","journal-title":"Med Pharm Rep"},{"key":"2026100713114708000_cjag065-B5","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.ajodo.2011.08.024","article-title":"Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists","volume":"141","author":"Maxfield","year":"2012","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"2026100713114708000_cjag065-B6","doi-asserted-by":"publisher","first-page":"1807","DOI":"10.2147\/PPA.S141943","article-title":"How is adult patient adherence recorded in orthodontists\u2019 clinical notes? 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