{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:59:45Z","timestamp":1781697585404,"version":"3.54.5"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malocclusion represents a prevalent oral health concern with notable psychosocial implications. Despite high treatment need among young adults in China, the transition from awareness to actual uptake of orthodontic care remains inadequately understood, particularly in student populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to assess the willingness to undergo orthodontic treatment and identify its predictors among university students in Liaoning Province, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional survey was conducted using multistage stratified cluster random sampling across 14 cities in Liaoning Province. A total of 1,299 students aware of orthodontic treatment completed a structured questionnaire. Data were analyzed using\n                      <jats:italic>t<\/jats:italic>\n                      -tests, ANOVA, and structural equation modeling (SEM) to examine the relationships between service quality dimensions (reliability, responsiveness, assurance, empathy), social norms, satisfaction, and treatment acceptance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant demographic differences were found in relation to acceptance willingness or its predictors (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt; 0.05). SEM indicated that reliability (\u03b2 = 0.172), responsiveness (\u03b2 = 0.135), assurance (\u03b2 = 0.230), and empathy (\u03b2 = 0.135) positively influenced satisfaction. Satisfaction (\u03b2 = 0.179), along with reliability (\u03b2 = 0.185), responsiveness (\u03b2 = 0.199), assurance (\u03b2 = 0.212), empathy (\u03b2 = 0.147), and social norms (\u03b2 = 0.106), directly enhanced willingness to accept treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Perceived service quality, social norms, and satisfaction are pivotal in shaping orthodontic acceptance among Chinese university students. Enhancing reliability, responsiveness, assurance, and empathy in clinical practice may improve treatment uptake in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1806852","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T16:10:26Z","timestamp":1774368626000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of orthodontic treatment acceptance among university students in Northern China: a structural equation modeling approach"],"prefix":"10.3389","volume":"14","author":[{"given":"Peng","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Stomatology, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiliang","family":"Chu","sequence":"additional","affiliation":[{"name":"School of Health Management, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Li","sequence":"additional","affiliation":[{"name":"School of Stomatology, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Chai","sequence":"additional","affiliation":[{"name":"School of Stomatology, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renbin","family":"Han","sequence":"additional","affiliation":[{"name":"School of Stomatology, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Dong","sequence":"additional","affiliation":[{"name":"Innovation and Entrepreneurship Center, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: a global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet."},{"key":"B2","first-page":"195","article-title":"Periodontal status of Chinese adolescents: findings from the 4th national oral health survey","volume":"21","author":"Chen","year":"2018","journal-title":"Chin J Dent Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.2147\/PPA.S524287","article-title":"Aesthetic and orthodontic treatment desires and their psychosocial impact in dental students: a questionnaire study","volume":"19","author":"Nazir","year":"2025","journal-title":"Patient Prefer Adherence."},{"key":"B4","doi-asserted-by":"publisher","first-page":"154","DOI":"10.15386\/mpr-2457","article-title":"Socioeconomic burden of orthodontic treatment: a systematic review","volume":"96","author":"Ghonmode","year":"2023","journal-title":"Med Pharm Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1093\/ejo\/cju046","article-title":"The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies","volume":"37","author":"Dimberg","year":"2015","journal-title":"Eur J Orthod."},{"key":"B6","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1038\/s41415-022-3878-6","article-title":"Factors affecting willingness to pay for NHS-based orthodontic treatment","volume":"233","author":"Fleming","year":"2022","journal-title":"Br Dent J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1080\/08870446.2019.1613546","article-title":"Autonomy-supportive dental treatment, oral health-related eudaimonic well-being and oral health: a randomized clinical trial","volume":"34","author":"Halvari","year":"2019","journal-title":"Psychol Health."},{"key":"B8","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1177\/03015742211023420","article-title":"Assessment of contributing factors for discontinuation of orthodontic treatment: a questionnaire survey","volume":"55","author":"Bhatt","year":"2021","journal-title":"J Indian Orthod Soc."},{"key":"B9","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":"B10","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.ajodo.2015.09.020","article-title":"How long does treatment with fixed orthodontic appliances last? 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