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Aims: To discover whether dental visiting behavior can be understood as a dichotomy of planned versus problem based, or whether there were a range of different types of understanding and patient behavior, recognizable as patterns of dental visiting behavior. Methods: Secondary analysis drawing on 2 qualitative studies of patients’ accounts of dental attendance and oral health, with 1) opportunistic interviews with people attending urgent dental care services ( n = 43; including 19 with follow-up) and 2) home-based, in-depth interviews with people attending a dental practice with a mixture of improved or deteriorated/poor periodontal health ( n = 25). Results: Four distinguishable patterns of dental visiting were identified in patients’ accounts: Accepting and Active Monitoring, as well as Ambivalent and Active Problem-based dental visiting behavior. Individuals’ patterns were relatively stable over time but could shift at turning points. Accepting Monitors were characterized as accepting dentists’ recommendations and dental practice policies relating to oral health and visits, whereas Active Monitors were more independent in judging how often to attend for preventive appointments, while still valuing anticipatory care. Ambivalent Problem–based visitors placed a relatively low value on anticipatory care for oral health maintenance and drifted into lapsed attendance, in part because of service-related factors. This contrasted with Active Problem–based visitors, for whom using services only in an emergency was a conscious decision, with low value placed on anticipatory care. Conclusion: This article demonstrates the dynamic nature of patterns of dental visiting where the dental system itself is partly instrumental in shaping patterns of utilization in an ecological way. Thus, service-related factors tend to combine with patients’ behavior in expanding inequalities. This illuminates the reasons why risk-based recalls are challenging to implement as a dental policy. Knowledge Transfer Statement: The results of this analysis can be used by clinicians and policymakers to inform policy around supporting uptake of preventive health care visits, contributing in particular to understanding how risk-based preventive visiting policies may be better adapted to patients’ understanding of the purpose of visits, taking into account that this is in part shaped by service-related factors in an ecological way, arising from patients’ and dental teams’ expectations.

OBJECTIVESEvidence suggests that, in specific circumstances, the EQ-5D is insensitive to changes or differences in health status. One possible solution is to add 'bolt-on' dimensions to the core EQ-5D dimensions, to provide additional information about the impact of certain conditions or symptoms on health. In this study, we developed EQ-5D-5L bolt-ons for cognition (5L-Cog) and vision (5L-Vis).METHODSThe development process involved three stages. First, systematic literature reviews were conducted for outcome measures used in cognitive impairment and visual impairment. Items were extracted from existing measures and mapped to a set of dimensions.Common terminology was also recorded. Second, we conducted focus groups in the UK with people who have experience of either impairment. Participants were encouraged to describe the impact of their own experience of cognitive impairment or visual impairment, with reference to dimensions and terminologies identified in the literature reviews. The findings were used to develop candidate 5L-Cog and 5L-Vis descriptors. Third, we conducted interviews in the UK and Australia with people who have experience of either impairment. Interviewees were asked to complete the EQ-5D-5L with candidate 5L-Cog or 5L-Vis descriptors,followed by cognitive debriefing.RESULTSCandidate descriptors related to dimensions such as memory (for 5L-Cog), visual acuity (for 5L-Vis), mood (for both), and social functioning (for both). Various terminologies were identified in the review, with 'problems', 'limitations', 'difficulties', and 'feelings' being used in both contexts. Focus group participants expressed preferences for different terms and identified problematic words.CONCLUSIONSQualitative research methods can be used to develop bolt-on descriptors for the EQ-5D that are meaningful to people with lived experience. However, it is challenging to identify a suitable range of participants where people with relevant lived experience constitute a heterogeneous population. In a subsequent phase of the study, 5L-Cog and 5L-Vis descriptors will be tested quantitatively.