Communication of treatment information is critical in orthodontics. The challenge lies in doing so effectively such that patients will understand and remember, which is the definition of true informed consent. Previous studies have established that information is more readily remembered when presented using multimedia presentations. Likewise, humor has been shown to increase information retention.
Two videos, 1 humorous (H) and 1 unhumorous (U), were produced with identical information about orthodontic treatment consent. Thirty-eight new orthodontic patients were randomly selected and divided into H (n = 20) and U (n = 18) video groups. Identical questionnaires with multiple-choice responses to judge memory of the content were completed by both groups immediately after watching the video (T1) and 6 weeks later (T2). A one-tailed Welch’s t test was used to analyze the scores.
At T1, there was no significant difference in the scores of the questionnaire between H and U groups, whereas at T2, there was a significant difference between groups. The intragroup score difference was also analyzed, with a significant decrease from T1 to T2 in the U, but not H, group. Subjective questions were also asked regarding content. No significant differences were found between the groups regarding the informativeness of each video; however, willingness to watch again and memorability of the content were significantly higher in the H group.
Patients who received orthodontic treatment information presented with humor retained significantly more of that information after 6 weeks compared with patients who received the same information without humor. Patients who received the humorous content subjectively stated they were more likely to rewatch the video and also found the information presented in this manner to be more memorable.
The first study to examine the effect of humor on the memory of orthodontic treatment information.
Patients rated humorous and unhumorous videos equally informative.
Patients who watched the humorous video had higher quiz scores after 6 weeks.
Patients who watched the humorous video had a higher rating for memorable.
Patients who watched the humorous video had a higher rating for willingness to rewatch.
Communication, which is critical in medicine and dentistry, is complicated in orthodontics because patients are often young, and a caregiver must be included. Successful communication of orthodontic treatment plans, goals, risks, benefits, and compliance avoids issues with the rejection of treatment, unreasonable expectations, poor compliance, and legal issues.
Ley and Spelman reported that effective communication occurs when a message is understood and remembered. This skill is seldom taught in dental schools and residencies. , There are significant discrepancies between what doctors and patients perceive in their interactions, including how much information was relayed and how clearly. , Patients often find doctors use overly technical language, whereas doctors believe the language is plain. Pratelli et al studied patients who had orthodontic treatment or had children undergoing treatment and reported that 59% were unaware that caries could form under brackets and about one-third did not know about postorthodontic relapse. Brattström et al surveyed patients with compliance problems or early termination, who cited their issues stemmed from lack of information regarding the nature of the treatment, poor communication with their orthodontist, and lack of motivation.
Generally, orthodontic patients are presented with treatment plans, goals, risks and benefits, and instructions via support staff or the doctor, with information sheets or demonstrations often supplementing. Patel et al showed that patients receiving both verbal and written instructions have significantly improved recall of that information compared with those who only receive verbal instruction. Patient satisfaction improves with standardized, scripted information, even if less overall time is spent with the patient. , Multimedia presentations also have been shown to improve patient memory , and patient comfort in decision making regarding orthognathic surgery. Moreover, rather importantly in dental settings, lowered stress levels lead to better information recall.
Orthodontic patients could see a tremendous benefit if the established evidence is combined with creativity. Humor, for instance, has been demonstrated to increase both attention toward and memory of information. , Humor’s impact on memory is also independent of a subject’s mood and reduces stress, even on subjects who do not use humor as a stress mediator. , With modern technology, a structured, humorous delivery of orthodontic information may significantly improve the retention of that information for orthodontic patients and their caregivers.
The aim of this study was to investigate whether humor would improve a subject’s memory of information regarding orthodontic treatment, as outlined by the American Association of Orthodontists (AAO) informed consent form, in both the short term and after 6 weeks, compared with those who received the same information presented without humor.
Material and methods
This prospective, questionnaire-based study was conducted at the orthodontic clinic at Jacobi Medical Center in Bronx, NY, and a private orthodontic office in New York, NY. Institutional review board approval was obtained before initiating the study. Information sheets regarding the study were developed to obtain informed consent.
Two video presentations were produced, with scripts based on the content from the AAO Informed Consent for the Orthodontic Patient (AAO, St Louis, Mo). The control video was designed to mimic an in-office presentation and featured a subject wearing a white coat, in a dental office, describing the content in common language. The experimental video featured the same information but used animated characters to illustrate the topics and an off-screen narrator. Similar to the protocol used in Schmidt, 2 experienced comedians, with 10 years of experience writing and performing, were employed to add humor to the script for the experimental video. Freeze-frames from each video are shown in the Figure .
A questionnaire ( Supplementary Material ) was developed, to be administered immediately after watching the video (T1) and 6 weeks after watching the video (T2). Twelve multiple-choice questions were included, based on the content of the videos, with 1 verification question included to ensure that the subjects were reading each question. Additional subjective questions were included and rated on a scale of 1 ( least ) to 10 ( most ). There were 3 subjective questions included at T1 to assess how memorable, informative, and rewatchable the video was to the subject. At T2, subjects were asked to rate how much they thought they remembered. The order of all questions was randomized for all subjects at both time points.
The minimum sample size was calculated (80% power, α of .05, and an effect size of 0.75), with a result of 32. Subjects were selected from a pool of pretreatment orthodontic patients. Subjects had a consultation, but they had not initiated treatment and would not initiate treatment until the completion of the study. Subjects had to be native English speakers. Those younger than 18 years needed parental consent to participate. A total of 43 subjects were recruited (20 males, 23 females; age range, 10.6-33.5 years; mean age [SD], 17.8 [5.76] years).
Subjects were assigned using a random number generator to watch either a live-action video without humor (U; n = 21) or an experimental animated video with humor (H; n = 22). Subjects were brought to a private operatory and watched on an iPad (Apple, Cupertino, Calif) with the video queued to play. The end of the video launched a Google Form (Alphabet Inc, Mountview, Calif) with the initial questionnaire. After 6 weeks, subjects were sent an e-mail with a link to the follow-up questionnaire on Google Forms. Reminder e-mails were sent to those who did not complete the follow-up after 3 days. After 1 week, any remaining nonrespondents were contacted via telephone. Videos were not available for subjects to review after the initial viewing in the operatory.
Results were tabulated, and statistical analyses were performed. The mean questionnaire score for the groups was calculated for T1 and T2, and the one-tailed t test was used to compare intra- and intergroup means at each time point. Separately, the mean scores for the subjective questions were compared between groups using t tests.
Of the 43 subjects, 5 dropped out of the study for failing to respond to repeated follow-up contacts (2 from H group and 3 from U group). The mean results and t tests are summarized in Table I . Subjects in the H group completed the second questionnaire an average of 45.7 days after the initial, whereas the U group responded an average of 47.0 days later. The mean scores at T1 were 90.50% and 86.58% for the H and U groups, respectively, with the t test indicating no significant difference between the groups. The mean scores at T2 were 89.55% and 77.78% for the H and U groups, respectively, with the t test indicating a significant difference between the groups. The intragroup differences between T1 and T2 were also evaluated by t test and showed that the change in mean scores for H group was not significant, whereas a significant decrease was noted for the U group.