IJCRR - Vol 12 Issue 11, June, 2020
Date of Publication: 03-Jun-2020
Download XML Download PDF
Patient Preferences for Dental Clinical Attire, Hairdo and Infection Control Measures: A Cross Sectional Survey
Author: Jaya Pandey, Harneet Kaur, Arisha Izhar, Panchali Batra
Abstract:Aim: The objective of this cross-sectional descriptive study was to survey patients' preferences to the factors which contribute to the overall looks of the dentist like dental clinical attire, hairdo, makeup, jewelry, presence of beard, preference for name badges, commonly used cross-infection control measures and attributes to be present in clinician.
Method: The sample size included 150 patients in the age group of 20-35 years reporting to the out-patient department. A 12 points questionnaire was developed to gather the data accompanied by photographs.
Result: Majority of patients in the study considered dental clinical attire was important (68%). Scrubs (46%) followed by white coats (45.3%) were the clinical attires of choice. The white coat was ranked highest in attributes of cleanliness, authority, trustworthiness, approachability and professionalism. 50.7% reported it did not matter what attire was worn under the white coat. Pony or braided hair (39.3%) was rated highest, make up (57.3%) and jewelry (54%) was felt as not important. Males preferred their dentist to be clean shave (53.3%) whereas female subjects said it does not matter (53.3%).90.7% preferred name badges. Majority expected their dentist to wear a face mask and head cap. Amongst the attributes that should be present in clinician, knowledge of the clinician was rated highest (70.7%) followed by trustworthiness, approachability, cleanliness and authority.
Conclusion: The results of this study have relevance for clinicians, policy makers and students and will further help in strengthening the bond with the patients who continue to prefer a professionally dressed clinician.
Keywords: Dental attire, Hairdo, Infection control Measures, Clinical attire, White coat
Professionalism is an image to encourage a successful doctor-patient relationship thereby empowering the base of effective patient care1. The patient forms an initial impression of the clinician at the first meeting and a fundamental connection is established2. Substantial research regarding the professional image of doctors has been done,3-7 but it is more specifically relating to the medical professionals, little literature has been produced specifically to dental profession.8-10 No such study has been conducted in North India, and only a few studies have been conducted in South India to find out the preferences of Indians toward various professional outfits.11-13
Traditionally, the white coat has been worn by the medical personnel, but nowadays, scrubs are also worn in many parts of the world. The concept of white coat and aseptic surgery was introduced by Lister in the late 19th century as a shield to prevent contamination.8 Nowadays, professionals and students have become more casual about selecting their clinical professional appearances. Although professional appearance is the first impression that may in?uence patients’ expectations of the professional’s care and competence, it has also been linked to dental anxiety, confidence, authority, friendliness, compliance and trust.14,15
While we are aware that the attire and the attitude of a healthcare professional are very important, there are other factors also affecting the appearance, like hairdo, makeup, jewelry and accessories worn as part of the infection control measures. To the best of our knowledge, no study has considered all these factors as they together make an impact on the dentists’ appearance. This study is an effort to find out the patients’ preferences to the factors which contribute to the overall looks of the dentist. The results of this study would help us in striking a balance as to what should be an essential part of the appearance and on which factors the dentist can take some liberty following patient opinion. It will also help us in reinforcing these facts to the dental students.
The present cross-sectional descriptive study was conducted using survey methodology on new patients attending the out-patient department of the Institute (Faculty of Dentistry, Jamia Millia Islamia). A self-completion bilingual (Hindi and English) questionnaire was developed to know the patients' views on dental clinical attire, appearance, hairdo, and several cross-infection control procedures (Annexure 1). A pilot run for the study was done on 30 patients to validate the questionnaire.
The sample included 150 new patients (80 males and 70 females) between the age group of 20-35years and having a minimum graduation level of education. The questionnaires were distributed to the patients by nonclinical reception staff in the waiting area before an initial consultation appointment and written informed consent was taken. The survey was conducted for over four weeks. The questionnaire included the patients’ demographic information (age, sex, and education) and the questions (along with relevant photographs attached to the back of the question) framed to gain information on patients' preferences in the following areas:
Attire (question 1-4, Annexure 1),
appearance (question 5-9, Annexure 1),
cross-infection measures, (question 10-11, Annexure 1) and
attributes to be present in clinician.(Question 12, Annexure 1)
In the attire group the first question (Question 1) was asked to rate how important they felt dental clinical attire was by using a modi?ed Likert scale (1 = very important, 2 = important, 3 = quite important, 4 = unimportant). The second question (Question 2) was related to patients' preference for different clinical attire (Fig.1), the photographs displayed male and female models wearing white coats, formals, casuals, and dental scrubs. The background, hairdo, models were the same in all the attires and only the clinical attire was different to remove bias.
The next question (Question 3) was regarding the attribute that was most linked to each clinical attire. The fourth question (Question 4) was related to their preferences for different outfits worn under the white coats. The photographs portrayed a female dressed in 3 most commonly worn attires (Fig 2) in India: saree, suit, and western outfits in trousers.
The fifth question (Question 5) was framed to find out the patients' preference for different hairstyles. The photograph (Figure 3) displayed 3 hairstyles viz: loose hair, braided pony, and bun.
The sixth question was framed to anticipate the patient's preference for makeup worn by the dentist. The accompanying photo showed commonly used makeup items like lipstick, nail paint, foundation and bindi (forehead dot wore by Indian females)
The next question (Question 7) related to the appearance of the male dentist in which the patients were asked for their preference for a clean-shaven or dentist with the beard. The eighth and ninth questions asked about the patients' preference for name badges and jewelry (necklace, bangles, rings, and earrings) worn by the dentist respectively. The tenth and eleventh questions asked about their preference to cross-infection measures like facemask and head cap (Fig.4). The last question (question 12) was framed to find the hierarchy of importance, in the patients' perspective, for the followings attributes: cleanliness, authority, trustworthiness, approachability, and Knowledge.
After the completion of the questionnaires, they were collected and checked for their completeness and sent for statistical analysis.
The data were analyzed by SPSS (21.0 version). A chi-square test was used for frequency analysis. The level of statistical significance was set at a p-value of less than 0.05. A p-value <0.05 was accepted as significant with 95% CI. Summarized data is presented using Tables 1-10.
The study was done to assess patient preference for clinical attire, hairdo, and cross-infection control measures. A total of 150 questionnaires were filled. The first question was to find out the importance of the dentist's dress in the patients' perspective. 68% of patients rated the signi?cance of a dentist dresses as very important or important, while only twelve patients (8%) felt it was unimportant. There was no statistically significant difference in responses among males and females (p>0.05). (Table 1)
When asked about which clinical attire amongst white coat, casuals, formals, or scrubs, (Figure 1, question 2) was appropriate for a dentist to wear in clinics, significant differences were seen as p<0.05. 91.3% of the study subjects selected either white coats or scrubs. Males (52%) voted more for white coats whereas females (49.3%) voted more for scrubs. (Table 2)
When asked about which clinical attire best-portrayed attributes of cleanliness, authority, trustworthiness, approachability, and professionalism, (Table 3) the white coat was ranked highest for all attributes. White coat conveyed the attributes in the following sequence: cleanliness>trustworthiness>approachability followed by authority and professionalism which were rated similarly. Significant differences were seen in the response rate among males and females for an outfit that best portrays for professionalism, where the majority of the males (50.7%) linked it with scrubs whereas females 50.7% said its best portrayed by white coats.20.7% linked formals to professionalism whereas this attire was ranked low in other attributes. Casuals were ranked least for all the attributes amongst all the attires. Scrubs were rated the second-highest in the attires amongst all the attributes. Scrubs conveyed the attributes in the following sequence: professionalism > trustworthiness > approachability > cleanliness >authority.
When patients were asked about the outfit of choice for a female dentist from amongst saree, suit, and western formals (trousers and shirt), 50.7% reported it does not matter, followed by 36% who responded for Indian suit. No difference was seen in the distribution rates among males and females as p>0.05. (Table 4)
When patients were asked about the choice of hairstyle for a female dentist, pony, or braided hair (39.3%) was rated highest, followed by hair bun (34.7%). No significant difference was seen in the response rate of males and females, though males opted the highest for braided hair and females opted the bun as the highest preference (Table 5). When study subjects were asked whether female dentists should wear makeup or not, the majority of them responded it does not matter (57.3%) and no significant difference was observed in the males’ and females’ responses (Table 6). Significant differences were seen in the response when subjects were asked about which style (clean-shaven or bearded) do you prefer for your male dentist as p<0.05. The majority of the males preferred their dentist to be clean shave (53.3%) whereas the majority of the female subjects said it does not matter (53.3%) (Table 7).
When patients were asked whether dental professional should wear name badges or not, (90.7%) responded yes (Table 8). Regarding the patients' preference for their female dentist to wear jewelry, 54% of patients said it did not matter and 32% said no to jewelry. (Table 9)
All the patients (100%) said they expected their dentist to wear a face mask while treating them (Table 10) whereas 83.3% expected the dentist to wear a head cap (Table 11).
When study subjects were asked about the hierarchy of importance of attributes that should be present in a dentist, amongst cleanliness, authority, trustworthiness, approachability, and knowledge (Table 12), the knowledge of the patient out rightly was rated highest (70.7%) followed by trustworthiness, approachability, cleanliness, and authority.
Though there are many studies that have evaluated the importance of clinical attire, to the best of our knowledge this is the first study to take holistic approach towards the clinical appearance of a dentist and patients' preferences for the same.
The purpose of this study was to gain information on patients' preferences in the following areas: Attire, hairdo, appearance, cross-infection measures, and attributes to be present in clinicians, all of which make an impact on the appearance of the dentist.
The first question was to find out the importance of dentist's dress in the patients' perspective. 68% of patients rated dentist dresses as very important or important, whereas only twelve patients (8%) felt it was unimportant. The results are similar to the study conducted by McKenna, however, there was no difference in the male and female opinions in this study.8
When asked about which clinical attire amongst white coat, casuals, formals, or scrubs, (Figure 1, question 2) was appropriate for a dentist to wear in clinics, significant differences were seen and 91.3% of the study subjects selected either white coats or scrubs. Males (52%) had a higher preference for white coats whereas females (49.3%) had scrubs as their first choice (Table 2). Overall, dental scrubs were the first choice closely followed by white coats. Formals were the third choice and casuals the last though both were voted for in very less percentage. Only 4 patients out of 150 preferred casuals as clinical attire, which strongly points that though the dentists have become more relaxed in choosing their clinical attire, but the patients continue to expect a scrub or white coat as the choice of clinical attire and casual clothing is strongly disliked by the patients. Males preferred white coats over dental scrubs and vice versa for females. The majority of the previous studies have reported that white coat is the attire of choice as per the patients,1,3,4,8 but in this study, there was not much difference between dental scrubs and white coat which shows that scrubs are gaining equal acceptance as white coats.
The white coat was ranked highest when linked to attributes of cleanliness, authority, trustworthiness, approachability, and professionalism, followed by scrubs. (Table 3). However, the attire under the white coat did not matter for 50.7% of the population. Amongst the rest, the Indian suit was the attire of choice and both sari and western outfits were ranked very low. This could be because this study was conducted in a government institute where subjects are mainly from low to middle socioeconomic status. The results might vary if patients from different socioeconomic status are evaluated. Also, India has so much cultural diversity that this result can be influenced by their religious and cultural believes across the country.
Three questions were asked related to the appearance of the dentist. Two were related to hairstyle and makeup of the female dentist and one was related to the presence of beard by male dentists. Both braided hair and bun were acceptable to the patients and 24% of the patients felt it was not important.(Table 5) However, loose hair was rated poorly which depicts that even patients relate hairstyle to professionalism. 57.3% of the patients felt that wearing makeup did not influence their choice of the clinician and was not important, however, 28.7% of the patients felt that it was not required. (Table 6) Male clinicians were preferred to be clean-shaven, with males opting more for this (53.3%) whereas the majority of the female subjects said it did not matter (53.3%) (Table 7).
The results indicate that the patients preferred dental professionals to wear a name badge while treating them. (Table 8) This is in accordance with the previous studies found in medical literature.8,16,17 However, name badges are considered a cross-infection risk and hence other alternatives could be an embroidered name tag in the attire.8 Regarding the patients' preference for their female dentist to wear jewelry, 54% of patients said it did not matter and 32% said no to jewelry. (Table 9) The results also point towards the fact that though makeup and jewelry do not influence the patients, still simplicity is more desirable for this noble profession.
Cross infection control measures:
Various protective equipment and cross infection control measures are recommended to be used such as face mask, gloves, head cap, safety glasses, drapes, shoe cover. We asked for their preference regarding face Mask and head cap. All the patients (100%) said they expected their dentist to wear a face mask while treating them (Table 10) whereas 83.3% expected the dentist to wear a head cap.(Table 11) This shows that even in developing countries like India, there is complete awareness in the patients regarding face mask and head cap, though in future studies other factors like patients drape, shoe cover and protective eye wears can also be included.
When study subjects were asked about hierarchy of importance of attributes that should be present in a dentist, amongst cleanliness, authority, trustworthiness, approachability, and knowledge (Table 12), the knowledge of the patient out rightly was rated highest (70.7%) followed by trustworthiness, approachability, cleanliness, and authority. The results of this last question indicate that knowledge of the clinician is the most important attribute and all other factors have very minor importance.
The present study was conducted in young adults however the results could be different in various age groups and people of different anxiety levels as white coat anxiety is a well-known phenomenon. Also, future studies can be done comparing urban and rural viewpoints and how the questions are perceived across India where different cultural and religious believes exist.
This study has relevance for all specialties of dentistry and especially in today's world where services have become patient-centric. Though students and clinicians have become casual in their dressing, patients continue to prefer a professionally dressed clinician and are aware of the importance of cross infection control measures like head cap and facemasks. They also preferred their clinicians to wear name badges. Factors like jewelry and make up make little importance and white coats and scrubs are the attires of choice for the dental clinician. This understanding of patient preferences should enable individuals and organizations both in government and corporate setup to frame standards for professionalism for clinicians in the dental profession. The results of this study are also important for dental students who should understand the values of professionalism which will help them in making stronger bonds with patients in their future careers.
Conflict of interest: None
Brosky ME, Keefer OA, Hodges JS, Pesun IJ, Cook G. Patient perceptions of professionalism in dentistry. J Dent Educ. 2003 Aug;67(8):909-15.
Short D. First impressions. Br J Hosp Med 1993; 50: 270-271.
Petrilli CM, Saint S, Jennings JJ, Caruso A, Kuhn L, Snyder A, Chopra V. Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centers in the USA. BMJ Open. 2018 May 29;8(5):e021239.
Jennings JD, Ciaravino SG, Ramsey FV, Haydel C. Physicians' Attire Influences Patients' Perceptions in the Urban Outpatient Orthopaedic Surgery Setting. Clin Orthop Relat Res. 2016 Sep;474(9):1908-18.
Zahrina AZ, Haymond P, Rosanna P, Ho R, Rajini AR, Low BT, Lee PY. Does the attire of a primary care physician affect patients' perceptions and their levels of trust in the doctor? Malays Fam Physician. 2018 Dec 31;13(3):3-11.
Clark M, Shuja A, Thomas A, Steinberg S, Geffen J, Malespin M, de Melo SW Jr. Patients' perceptions of gastroenterologists' attire in the clinic and endoscopy suite. Ann Gastroenterol. 2018 Mar-Apr;31(2):237-240.
Aldrees T, Alsuhaibani R, Alqaryan S, Alzahrani H, Alharethy S, Alghunaim A, Alohali S, Bawazeer M. Physicians' attire. Parents preferences in a tertiary hospital. Saudi Med J. 2017 Apr;38(4):435-439.
McKenna G, Lillywhite GR, Maini N. Patient preferences for dental clinical attire: a cross-sectional survey in a dental hospital.Br Dent J. 2007 Dec 22; 203(12):681-5.
Tong HJ, Khong J, Ong C, Ng A, Lin Y, Ng JJ, Hong CH. Children's and parents attitudes towards dentists' appearance, child dental experience and their relationship with dental anxiety. Eur Arch Paediatr Dent. 2014 Dec;15(6):377-84.
Souza-Constantino AM, Cláudia de Castro Ferreira Conti A, Capelloza Filho L,Marta SN, Rodrigues de Almeida-Pedrin R. Patients' preferences regarding age, sex, and attire of orthodontists. Am J Orthod Dentofacial Orthop. 2018 Dec;154(6):829-834.
Kamavaram Ellore VP, Mohammed M, Taranath M, Ramagoni NK, Kumar V, Gunjalli G. Children and Parent's Attitude and Preferences of Dentist's Attire in Pediatric Dental Practice. Int J Clin Pediatr Dent. 2015 May-Aug;8(2):102-7
Nirmala SV, Veluru S, Nuvvula S, Chilamakuri S. Preferences of Dentist's Attire by Anxious and Nonanxious Indian Children. J Dent Child (Chic). 2015 May-Aug;82(2):97-101.
Asokan A, Kambalimath HV, Patil RU, Maran S, Bharath KP. A survey of the dentist attire and gender preferences in dentally anxious children. J Indian Soc Pedod Prev Dent. 2016 Jan-Mar;34(1):30-5.
Rehman S U, Nietert P J, Cope D W, Kilpatrick A O. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med 2005; 118: 1279-1286.
Brase G L, Richmond J. The white-coat effect: physician attire and perceived authority, friendliness and attractiveness. J Appl Soc Psychol 2004; 34: 2469-2481.
Taylor P G. Does the way house staff physicians dress influence the way patients initially perceive their competence? Paediatric Notes 1985; 9: 1.
Gjerdingen D K, Simpson D E, Titus S L. Patients’ and physicians’ attitudes regarding the physician’s professional appearance. Arch Intern Med 1987; 147: 1209-1212.