Dr Andrew Flett BOSF Grant 2015

Patient Perceptions of Online Information about Orthognathic Surgery: A Qualitative Study

In 2015 I applied to the BOSF to undertake a qualitative study to determine the format, content and usability of the new orthognathic information resource. My successful application provided my research team with £22,000 to investigate this taking into account patient experiences from across the United Kingdom. The web resource has been integrated into the BOS website and can be found at www.yourjawsurgery.com

BOSF Grant 2015

Primary investigator

Dr Andrew Flett


Following an evaluation of the British Orthodontic Society (BOS) DVD, the BOS commissioned a working party, consisting of a number of orthodontists and a maxillofacial surgeon to develop a new online information resource (OIR), ‘Your Jaw Surgery’. The OIR was designed to address the limitations identified with the DVD. It contains general information on the benefits and risks of orthognathic surgery, as well as videos showing stages in the treatment process (Patient Journey), patients narrating their own experiences, including before and after photos (Patient Stories), animations of surgery (Your Surgery Explained) and videos of retainers and aftercare advice (Other Resources). This report provides an analysis of patient perceptions of ‘Your Jaw Surgery’.


This was a cross-sectional qualitative study. Ethical approval was obtained from a proportionate review of the study by South East Coast – Brighton & Sussex Research Ethics Committee (Ref. 16/LO/0942, 2nd June 2016). Research governance approval was obtained from Sheffield Teaching Hospitals NHS Foundation Trust (the sponsor for the study) and Chesterfield Royal Hospital Foundation Trust, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Queen Victoria Hospital NHS Foundation Trust and Tayside University Hospitals NHS Trust, which covered the patient identification centres for the project.

Purposive sampling was undertaken, using a maximum variation approach, to include patients of different ages and genders, before, during and after treatment for facial skeletal discrepancy. Seventeen participants of different ages and genders were recruited in Sheffield, Chesterfield, Doncaster, East Grinstead and Dundee (see Table 1).

Semi-structured interviews were conducted, and analysed thematically using a framework approach.


Results of the study show three themes:

Theme 1: Overall usefulness of the OIR

Clear and easy to use

Participants in the current study were positive about the layout and usability of the OIR.

Benefits of being online

Participants were able to select the videos they wanted to watch, appreciated the ‘interactive’ nature of the website, and the potential for using it in a way that suited their needs.

Value of content

Participants were positive about the information provided on the OIR as a whole, and largely positive about the different specific sections.

Theme 2: Personal relevance of OIR

Relevance of timing

All participants thought the OIR was helpful for those considering surgery. Participants who had started treatment had mixed views about the ongoing usefulness of the OIR.

Looking for personally relevant resource

Participants spoke about looking for a resource that was personally relevant, and selected videos to watch on this basis.

Theme 3: Positive perceptions of OIR

Trusted resource

As a resource provided by the BOS and signposted by clinicians, Your Jaw Surgery was seen as trustworthy.

Benefits seen to outweigh likely side-effects and risks

Participants viewed the OIR as accurately reflecting their view that the benefits of orthognathic surgery outweigh the side-effects and risks.

Encouraged by seeing positive stories

Participants who had not yet had surgery viewed the patient stories as representing a range of experiences, and illustrating the positive outcomes of orthognathic surgery.

Reassuring patients

The most common response to viewing the OIR for patients who were pre-treatment or in treatment was a feeling of reassurance.


The OIR was seen to be clear, easy to use and provide valuable content, in the form of reliable information and patient experiences.

The OIR was seen as a useful resource for patients considering jaw surgery, and potentially useful for patients undergoing treatment, although some patients at this stage in the process may already feel sufficiently informed.

The OIR was a trusted online resource and reassured patients and potential patients by presenting what was perceived as a positive view of jaw surgery in which the benefits outweigh the risks.

Recommendations for BOS

·        Rearrange sections.

o   Adding a new section on Aftercare Resources, including Aftercare advice from Other Resources and Aftercare advice video from Patient Journey, in order to ensure patients in-treatment can easily find this information.

o   List Checklists for Clinicians separately on the menu and provide room for videos from Patient Journey and Patient Stories to be listed on the checklist.

·        Add additional information

o   Descriptions of the Patient Journey videos and information about patients (similar to Patient Stories, i.e. a brief sentence or two describing the video and patient malocclusion).

o   Add age range of patient during surgery to information in Patient Stories

·        Further research

o   Research with clinicians about using the OIR with patients.

o   Further evaluation of the OIR using a questionnaire.


Acknowledgements – I would like to thank my co-authors Jennifer Kettle, Zoe Marshman, Philip E Benson, Caroline McCarthy, Gurpreet Pye, Jonathan Sandler and Lindsay Winchester. I am also grateful for the BOSF in providing the funding to make this research possible.

This research has now been published in the September 2017 issue of the Journal of Orthodontics:

Kettle J, Marshman Z, Benson PE, McCarthy C, Pye G, Sandler J, Winchester L, Flett A. How do patients perceive the British orthodontic society online information resource about orthognathic treatment? A qualitative study. J. Orthod. 2017; 44: 174-182. 10.1080/14653125.2017.1349057

Electronic copies of the article can be accessed through the members’ section of the BOS website:



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