Motivational Drivers in Implant Therapy: A Novel Treatment Motivation Scale

Aim This study aims to assess patient motivation during implant therapy using the newly developed implant treatment motivation scale. Materials and methods A questionnaire study was conducted, consisting of 15 questions designed to explore the motivating factors behind patients' decision to undergo implant therapy. A total of 50 patients about to undergo implant treatment at the Departments of Periodontology, Oral and Maxillofacial Surgery, and Prosthodontics participated in the study. Results Analysis revealed a consistently high level of motivation (intrinsic and extrinsic) among all patients undergoing implant therapy. Conclusions The findings highlight the crucial role of motivation in treatment-seeking behavior, emphasizing the importance of dentists in motivating and guiding patients through the process of implant therapy.


Introduction
Dental implants are regarded as a highly significant advancement in contemporary dentistry.Dental implants have emerged as a preferred option for restoring oral function in patients with missing teeth.The field of dentistry has witnessed significant advancements since the introduction of titanium implants for intraoral use in the late 1970s [1].For various reasons, including superior comfort, function, appearance, durability, and the preservation of neighboring tooth structures, osseointegrated dental implants are frequently preferred to conventional dentures.Dental implant treatment offers a potentially more acceptable outcome, especially for individuals who are unable to adjust to traditional dentures.With a claimed 90% 10-year survival rate, this therapy approach is comparatively predictable [2].
Patients consider esthetics to be one of the primary benefits of implants over removable and partial dentures [3].This raises the question of how well-informed the general population is about the advantages of bone-anchored prostheses in terms of functionality [4].
Research has shown that the basic desire for better comfort and ease, reduced physical suffering, and enhanced well-being drives motivation [5].This drive originates in the physiological, behavioral, cognitive, and social domains.In addition, patients' perceptions and motivation significantly influence their treatment-seeking behavior.Numerous theories and models, like the self-determination theory and the push-pull model, have attempted to explain the different extrinsic and intrinsic factors influencing patients' willingness to accept or reject therapy [6].The push-pull model, for example, posits that human motivations and behaviors are fundamentally driven by two primary forces: the pursuit of desirable outcomes (pull factors) and the avoidance of undesirable outcomes (push factors) [7].
Patients' values and preferences, the doctors' heuristics and biases, the ambiguities surrounding diagnosis and treatment, and the financial implications all play a role in implant dentistry decisions.The high cost, the participants' distrust in dentists, the intrusive procedures and related complications, and their poor desire to make sizeable additional payments discourage them from contemplating dental implants.
This scale measures both autonomous and controlled motivations for adopting a healthy attitude toward treatment.Responses are organized on a Likert scale from 1 to 5, ranging from "strongly disagree" to "strongly agree."Each dimension's score is determined by summing the responses for the items within that dimension and calculating the total score.

Statistical tool and analysis
The obtained data was tabulated and analyzed using Stata software version 18 (StataCorp LLC, College Station, Texas).Descriptive statistics and frequency distributions were analyzed.Cronbach's alpha, including item deletion, was used for reliability analysis for internal consistency to determine if removing any item would affect reliability.The content validity ratio (CVR) was determined with the aid of thoroughly screened subject matter experts to assess whether the knowledge of each item was essential or not.Repeatability, or test-retest reliability, was evaluated to determine how closely successive measurements of the same variable agreed with each other.

Results
The study population included 50 patients, 25 males and 25 females, who needed prostheses for missing teeth.The motivation scale's Cronbach's alpha of 0.88 indicated that the scale was a reliable tool.All items showed a good degree of total correlation, around 0.9 (Table 1).CVR measures whether an item is essential.CVR varies between 1 and −1, and a higher score indicates greater agreement among panel members.Options for each item are graded as 1 = essential, 2 = essential, but not useful, and 3 = not useful: CVR = (Ne -N/2)/(N/2), where Ne = number of panelists indicating an item as "essential" and N = total number of panelists.A CVR was generated for each item, and all 15 items had a CVR of 1.00, which indicates a high level of agreement between the members (Table 2).

TABLE 2: Content validation ratio (CVR)
Ne: Number of panelists indicating an item as "essential"; CVR: content validation ratio

Questionnaire data evaluation
The distribution of subjects based on gender and age revealed that 50% were female, with most participants (36%) falling within the 26-35 year age group (mean = 33.26+ 10.67 years) (Table 3).Analysis of the questionnaire responses indicated a high degree of treatment motivation for items 1, 2, 13, 14, and 15, while item 11, "I feel pressure from others to do so," elicited a neutral response.The subjects exhibited high levels of intrinsic, extrinsic, and total motivation (Table 4).A comparison of the mean intrinsic and extrinsic motivation scores showed that there was no statistically significant difference (p-value = 0.08) (Table 5).

Discussion
The current questionnaire is an adaptation of the DTMS [6].The present study aimed to evaluate the motivational factors influencing patients who require implant therapy for missing teeth.Our findings indicate a balanced representation of genders, with an equal number of male and female participants and a predominant age group of 26-35 years.This demographic detail is crucial as it highlights the typical age range of individuals seeking implant-supported prosthetic solutions.
The reliability of the motivation scale, indicated by a Cronbach's alpha of 0.88, confirms that the instrument used for measuring motivation was reliable.This is an essential aspect of the study, ensuring that the responses obtained are consistent and reflective of true motivational levels.Moreover, the questionnaire's content validity was strong, with all 15 items achieving a CVR of 1.00.This unanimity among the panel members underscores the relevance and essentiality of the items included in the motivation scale, thereby affirming its content validity.
Analysis of the questionnaire responses revealed that items 1, 2, 13, 14, and 15 were associated with a high degree of treatment motivation.These items pertain to intrinsic factors, which align with self-determined and autonomous reasons for seeking prosthetic treatment.The results align with a prior study that showed the significant influence of intrinsic motivation on health-related behavior [8].Conversely, item 11, which stated, "I feel pressure from others to do so," elicited a neutral response.This neutrality indicates that external pressure is not a significant motivational factor for the participants.
According to the self-determination theory (SDT) [9,10], individuals with an internal perceived locus of causality (PLOC) perceive themselves as the initiators and sustainers of their own actions.In contrast, those with an external PLOC believe that external forces are responsible for initiating, pressuring, or coercing their actions.The study further demonstrated that participants exhibited high levels of both intrinsic and extrinsic motivation, with no significant difference between the two types (p = 0.08).This finding suggests that, while internal desires and self-driven factors play a crucial role, external factors and incentives are equally influential in motivating patients to pursue implant therapy.This balance between intrinsic and extrinsic motivation could be indicative of a comprehensive approach where personal health awareness and rallying from family, friends, or healthcare professionals collectively contribute to the decision-making process [11,12].
By identifying patients with low motivation early in the treatment process, clinicians can proactively address barriers to adherence and tailor interventions to maximize treatment efficacy and long-term oral health outcomes.

Item Corrected item-total correlation Alpha
1.I feel that I want to take responsibility for my own health 0.7742 0.9462 2. Others would be furious if I did not do it 0.7910 0.9459 3. I have carefully thought about it and believe it is very important for many aspects of my life

TABLE 5 : Comparison of scores between intrinsic and extrinsic motivation
M: Mann-Whitney U test; NS: not significant