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It is important to assess the extent to which patients are actively involved in such decision-making. Therefore, this study developed an instrument that evaluates patient participation in treatment decision-making among adults with malocclusion and tested its reliability and validity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional instrument-development methodological approach was adopted. Guided by the concept of participation and shared decision-making theory, an initial scale was developed through literature analysis, qualitative interviews, expert evaluation, and a pre-survey. From September to December 2023, 257 patients from three tertiary general hospitals in Shanghai were selected for a questionnaire survey, item analysis, and exploratory factor analysis. From January to May 2024, 269 patients from these hospitals were selected to conduct a questionnaire survey for confirmatory factor analysis and criterion-related validity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final scale included 21 items across three dimensions. The Cronbach\u2019s \u03b1 coefficient was 0.953; split-half reliability, test-retest reliability, and the scale level content validity index were 0.957, 0.885, and 0.926 respectively. The correlation coefficients between each dimension and the total score of the scale and SDM-9 scores were 0.590\u20130.650 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Exploratory factor analysis extracted three common factors; the Kaiser-Meyer-Olkin value was 0.974 and the Bartlett\u2019s sphericity test \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      value was 5652.33 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001); the cumulative variance explained was 60.920%. The fit indices of the scale model tested in the confirmatory factor analysis were as follows: \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \/df\u2009=\u20091.059, RMR\u2009=\u20090.033, GFI\u2009=\u20090.936, CFI\u2009=\u20090.968, TLI\u2009=\u20090.964, NFI\u2009=\u20090.641, RMSEA\u2009=\u20090.015. Confirmatory factor analysis revealed that the scale\u2019s factor structure was stable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This instrument is a reliable and valid measurement tool for assessing adult patients\u2019 level of participation in decision-making regarding treatment for malocclusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-025-06825-2","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T16:11:11Z","timestamp":1760199071000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of the participation in treatment decision-making scale for adults with malocclusion (PTDMS-AM)"],"prefix":"10.1186","volume":"25","author":[{"given":"Xiangying","family":"Hu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bixia","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Pan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weijun","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"6825_CR1","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.jormas.2020.08.008","volume":"122","author":"S Barone","year":"2021","unstructured":"Barone S, Morice A, Picard A, Giudice A. 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