Development and validation of the Manipal Malocclusion Questionnaire (MMQ): a mixed-methods study among Indian adolescents

Background & objectives: To develop and validate a structured, reliable malocclusion-related quality of life-specific questionnaire and measure its reliability in adolescents of Indian population. Materials & methods: A mixed methods approach with the sequential exploratory design was followed. Focus group discussions were conducted with orthodontists attached to teaching hospitals, patients aged (12-18 years) and their guardians. The interviews were recorded, transcribed, and analyzed using framework analysis. Several themes and sub-themes identified were used to identify items for the new tool, which was tested on 282 adolescents for its validity and reliability. Normative need for treatment was measured using the Index of Orthodontic Treatment Need (IOTN) and Handicapping Malocclusion Assessment Record (HMAR) index. Results: Five themes generated from qualitative data collection were self-perception, social interaction, difficult experiences with malocclusion, Missed opportunities, Patient awareness and expectations. Cross-sectional testing of the new 51-item-MMQ was found to be reliable (Cronbach’s α of 0.899) and construct validation using IOTN–DHC (p < 0.05) and DAI (p < 0.01) was statistically significant. Conclusion: The new tool named Manipal Malocclusion Questionnaire (MMQ) contains 51 items arranged in 5 domains which along with the socioeconomic scale according to Kuppuswamy socio-economic status scale 2021 was found to be reliable and valid for the tested Indian population. This tool can be of clinical relevance to understand patient expectations, motivation and outcomes in orthodontics and also for better quality assurance.