Back to Journals » Patient Preference and Adherence » Volume 12

Reasons for low adherence to diet-diaries issued to pediatric dental patients: a collective case study

Authors Arheiam A, Albadri S, Laverty L, Harris R

Received 8 February 2018

Accepted for publication 16 April 2018

Published 1 August 2018 Volume 2018:12 Pages 1401—1411


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Arheiam Arheiam,1,2 Sondos Albadri,3 Louise Laverty,2 Rebecca Harris2

1Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya; 2Department of Health Services Research, University of Liverpool, Liverpool, UK; 3Department of Paediatric Dentistry, School of Dentistry, University of Liverpool, Liverpool, UK

Objective: Dietary habits are an important etiological factor in the development of dental caries. Several tools, such as 24-h dietary recall (retrospective) and diet-diaries (prospective), have been recommended for dietary assessment in dental practice. Diet-diaries are commonly advocated as a tool for oral health education; however, low adherence is found to be a recognized downside of their use in dental settings, as well as nutritional research more widely. However, the reasons for poor adherence to diet-diaries remain unclear. This study aimed to explore the reasons for poor adherence to diet-diaries issued to children in a dental hospital setting.
Methods: A qualitative collective case study design was employed to explore the use of diet-diaries as a health education tool. Twenty-eight data sources across 11 appointments included: observation of dentist–patient interactions, semi-structured interviews with child–parent dyads and dentists, in addition to documentary analysis of returned diet-diaries (this included 11 observations of dentist–patient interactions, 14 interviews with the child/parent dyads and dentists, and documentary analysis of three completed diet-diaries). Data from these multiple sources were integrated in a thematic analysis to identify themes and sub-themes.
Results: Two overarching themes were identified: 1) the diet-diary is perceived as a test which carries a potential for embarrassment and blame, which in turn generates defensive behavior from parents; and 2) parents’ values, priorities, and circumstances affect the level of commitment to completing a diet-diary.
Conclusion: Low adherence to diet-diary completion in clinical dentistry results from interacting factors related to the diet-diary itself, the patient, and the clinician. This study identifies a need for a more appropriate tool for dietary assessment that is patient-centered and compatible with modern lifestyles.

Keywords: adherence, diet, health education, children, dental, dietary advice

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]