Abstract
Background
Patient understanding, compliance with post-operative instructions, and follow-up are useful for obtaining good patient outcomes. Lack of understanding and non-compliance are common problems that significantly impact patients’ health. Understanding the level of compliance and identifying associated reasons are important for achieving successful patient outcomes.
Objective
This study evaluated patient understanding and compliance with post-operative instructions and follow-up after dental procedures at Yekatit 12 Hospital in Addis Ababa, Ethiopia.
Methods
An institutional cross-sectional study was conducted at the dental clinic of Yekatit 12 Hospital. Study participants were selected using a systematic sampling method. Over two months, trained data collectors administered a semi-structured questionnaire to 227 consenting patients attending the dental clinic. Patient records were reviewed to retrieve important information. Data collected included patient demographics, post-operative instructions, and frequency of attendance at follow-up appointments. The data were entered into the SPSS version 26 software package. A chi-square test was used to assess the relationships between the independent and dependent variables.
Results
The overall patient compliance rate with post-operative instructions was 67.9% and the follow-up appointment attendance rate was 66%. This study revealed that patients who missed follow-up appointments cited forgetfulness as their primary reason. The compliance rate with post-operative instructions varied based on the mode of instructional delivery and patient literacy level.
Conclusions
This study revealed suboptimal patient compliance with post-operative instructions and follow-up appointment attendance at Yekatit 12 Hospital. The most common reasons for missing appointments included forgetfulness and economic issues. Patient education and good communication are required to improve patient compliance and follow-up. Additionally, follow-up reminder systems such as text messages should be implemented to increase patient attendance at follow-up appointments.
Keywords: Attendance, Understanding, Compliance, Follow-up, Postoperative instructions
Introduction
Patient understanding, adherence to dental treatment instructions, and follow-up are critical to achieving positive oral health outcomes. Understanding of and compliance with postoperative care instructions may be influenced by the presentation of information by dental professionals. Certain information is not understood by patients [1]. Gaps in patients’ understanding of postoperative care provide opportunities for improvement in postoperative instructions [2]. Failure to attend scheduled appointments is a well-known problem in dental care and can pose serious risks to patient health and have a financial impact on dental clinics [3]. Adequate education after oral surgery increases patient satisfaction and reduces postoperative complications [4]. According to a study published in the Journal of the Royal Society of Medicine, patients tend to immediately forget 40–80% of the information provided to them by healthcare workers [5]. A study conducted among patients who underwent tooth extraction highlighted that many patients lacked an understanding of the importance of following instructions [6]. A study that evaluated patient compliance with postoperative instructions after an oral surgical procedure reported that 40% of patients did not remember receiving written and verbal instructions and 36% recalled only written instructions [7].
Various findings have reported missed dental appointments globally, such as in Denmark [8], 37.7%, Malaysia [9], 37.1%, Brazil [10],27.7%, the Kingdom of Saudi Arabia [11], 58.1%, Sweden [12], 3.9%. There are several reasons for missing appointments, such as forgetting the appointment, inability to get time off [11], deprivation status, sex, and patient age [13], low oral health literacy [14], difficulties with transportation [15, 16], personal matters [9, 15], forgetfulness [9, 17], miscommunication [9], fear of treatment [17], distance to the clinic [15], economic issues [15, 18], and lack of time [19, 20]. Studies indicate that some patients adhere well to postoperative instructions, whereas a significant proportion fail to follow the guidelines because of various personal and contextual factors [1, 21]. This underscores the need for healthcare providers to consider these variables when developing postoperative care plans. These studies have highlighted the complexity of treatment compliance and follow-up care.
There is limited evidence on patients’ understanding of and compliance with post-operative instructions and its implications for treatment outcomes. Without a clear understanding of how patients in Ethiopia retain and adhere to post-operative instructions, it is difficult to design effective interventions to improve compliance and treatment success. This study aimed to address this critical gap by investigating patient understanding and compliance with dental treatment instructions and follow-up. Understanding patient compliance with postoperative instructions and follow-up is useful for developing targeted interventions. Furthermore, this study will contribute to the broader literature in Ethiopia, where evidence-based interventions are urgently needed to improve patient compliance with post-operative instructions and promote better patient outcomes.
Materials and methods
Study setting
This study was conducted at Yekatit 12 Comprehensive Specialized Hospital in Addis Ababa, Ethiopia. The hospital is located in Yeka Subcity, Addis Ababa, Ethiopia. The hospital provided different health services to a diverse population. Data were collected from February 11 to April 13, 2024.
Study design
This was a hospital-based cross-sectional study.
Population
The source population consisted of adult patients who visited the dental department of the Yekatit 12 Hospital in Addis Ababa. The study population included adult patients who visited the dental department of Yekatit 12 Hospital during the study period. Patients aged ≥ 18 years were included in this study, whereas those who were severely ill or unable to respond to the treatment were excluded.
Sample size determination and sampling method
The sample size was calculated using the single-population proportion formula. The following data elements were used in the calculations:
 |
n = Z α/22 * p (1 - p)/d2
Where p = prevalence; an estimated prevalence of non-compliance of patients to be 48.3% [22].
d = margin of error set at 5% (0.05) to ensure a reasonable level of precision in the estimates.
 |
To account for potential non-response or incomplete data, the sample size was adjusted by assuming a 10% non-response rate. The final sample size included 248 participants.
A systematic random sampling method was used to select the study participants. Every 4th patient who met the inclusion criteria was invited to participate until the required sample size was achieved.
Variables
Dependent variables
Patient compliance with post-operative instructions.
Patient post-operative follow-up.
Independent variables
Sociodemographic variables.
Communication methods.
Data collection procedure
A semi-structured questionnaire was used to collect quantitative data. The questionnaire was developed based on a review of relevant literature. The questionnaire included questions on demographic information, follow-up attendance, patient awareness of post-operative instructions, compliance with post-operative instructions, and factors influencing understanding and compliance with post-operative instructions. The questionnaire was prepared in English, translated into Amharic, and back-translated into English to maintain consistency. The data collection tool was pre-tested on 5% of the sample at the Babi-specialized dental clinic. Necessary adjustments were made based on the feedback to ensure clarity, validity, and reliability. Five trained data collectors conducted face-to-face interviews in a private clinical setting. Additional data were retrieved from the medical records using a checklist.
Data quality controls
Before data collection, the data collectors received training on the study objectives, data collection tools, and ethical considerations. A pre-test was performed on a similar population in a different area. The principal investigator conducted regular supervision to ensure data quality and consistency. In addition, the completed questionnaires were reviewed daily for completeness and accuracy.
Data entry and analysis
Data were checked for completeness and cleaned. Data were entered into SPSS version 26 for further analysis. Descriptive statistics were used to characterize the data, and the findings are presented in tables, figures, and text. The relationships between the dependent and independent variables were assessed using the chi-squared test.
Ethical considerations
Ethical approvalfor this study was obtained from the Ethics Committee of the Atlas College of Health Sciences. Permission to conduct this study was also obtained from Yekatit 12 Hospital. Written informed consent was obtained from all participants. All information was kept confidential, and no names were mentioned to maintain participants’ privacy.
Results
Sociodemographic characteristics of patients
A total of 227 patients were included, of whom 122 (53.7%) were male, 80 (35.2%) were aged 36–45 years, 86 (37.9%) had secondary education, and 162 (71.4%) were employed. Regarding the frequency of dental visits for routine check-ups, 19 (8.4%) patients visited the hospital regularly (every six months) (Table 1).
Table 1.
Sociodemographic characteristics of patients at Yekatit 12 hospital, addis Ababa, 2024
| Characteristics | Count | Percentage | |
|---|---|---|---|
| Age | 18–25 | 27 | 11.9% |
| 26–35 | 54 | 23.8% | |
| 36–45 | 80 | 35.2% | |
| 46–55 | 32 | 14.1% | |
| 56+ | 34 | 15.0% | |
| Sex | Male | 122 | 53.7% |
| Female | 105 | 46.3% | |
| Level of education | No formal education | 29 | 12.8% |
| Primary education | 46 | 20.3% | |
| Secondary education | 86 | 37.9% | |
| Degree and above | 66 | 29.1% | |
| How often do you visit the dentist for routine check-ups? | Regularly (every 6 months) | 19 | 8.4% |
| Occasionally (once a year) | 55 | 24.2% | |
| Rarely (less than once a year) | 85 | 37.4% | |
| Never | 68 | 30.0% | |
| Occupation | Student | 7 | 3.1% |
| Employed | 162 | 71.4% | |
| Unemployed | 58 | 25.6% | |
Patient awareness of post-operative instructions
Regarding post-operative instructions, 83.2% (n = 188) of patients received instructions. Among them, 66.1% (n = 125) received verbal instruction. The clarity of the instructions was rated excellent by 36.0% (n = 80) of patients. Regarding awareness of potential complications due to non-compliance, 39.6% (n = 88) were informed. Concerning postoperative care satisfaction, 32.3% (n = 73) were very satisfied and 23.0% (n = 52) were dissatisfied. Among them, 35.8% (n = 81) experienced complications due to noncompliance (Table 2).
Table 2.
Patient awareness of the post-operative instructions at Yekatit 12 Hospital, Addis Ababa, 2024
| Awareness questions | Count | Percentage | |
|---|---|---|---|
| Were you provided with post-treatment instructions after your last dental procedure? | Yes | 188 | 83.2% |
| No | 38 | 16.8% | |
| If yes, in that case, how were the instructions delivered | Verbal | 125 | 66.1% |
| Written | 46 | 24.3% | |
| Both verbal and written | 18 | 9.5% | |
| How would you rate the clarity and comprehensiveness of the provided instructions? | Excellent | 80 | 36.0% |
| Good | 81 | 36.5% | |
| Fair | 16 | 7.2% | |
| Poor | 12 | 5.4% | |
| Did not receive instruction | 33 | 14.9% | |
| Were you told of the complications if you did not follow the instructions? | Yes | 88 | 39.6% |
| No | 89 | 40.1% | |
| I do not remember | 45 | 20.3% | |
| Was the Dentist in a hurry? | Yes | 82 | 36.9% |
| No | 111 | 50.0% | |
| I do not remember | 29 | 13.1% | |
| How satisfied are you with postoperative care and follow-up appointments? | Very satisfied | 73 | 32.3% |
| Satisfied | 50 | 22.1% | |
| Neutral | 46 | 20.4% | |
| Dissatisfied | 52 | 23.0% | |
| Very dissatisfied | 5 | 2.2% | |
| Did you experience any complications or issues due to not following post-treatment instructions? | Yes | 81 | 35.8% |
| No | 145 | 64.2% |
Patient compliance with postoperative instructions
Regarding compliance with postoperative instructions, the overall patient compliance with post-operative instructions was 67.9%. Based on the type of instructions, 61.1% of patients followed the prescribed antibiotic regimen. Concerning dietary recommendations, 87.2% of the participants adhered to a soft diet for 24 h, and 76.9% avoided rinsing or spitting for 24 h. However, only 10.3% of smokers refrained from smoking for seven days, and 89.7% did not follow this advice. Among those who avoided alcoholic or carbonated beverages for seven days, 83.4% complied. The percentage of daily brushing after each meal was 10.2%, of which 89.8% failed (Table 3).
Table 3.
Patient compliance with the postoperative instructions at Yekatit 12 Hospital, Addis Ababa, 2024
| Compliance with instruction questionnaires | Count | Percent | |
|---|---|---|---|
| Did you strictly follow the antibiotic medication prescribed? | Yes | 138 | 61.1% |
| No | 88 | 38.9% | |
| Did you strictly follow the recommendation of maintaining a soft diet for 24 h? | Yes | 197 | 87.2% |
| No | 29 | 12.8% | |
| Did you strictly follow the recommendation of not rinsing or spitting for 24 h? | Yes | 173 | 76.9% |
| No | 52 | 23.1% | |
| Concerning smokers, did you strictly follow the recommendation of not smoking for 7 days? | Yes | 3 | 10.3% |
| No | 26 | 89.7% | |
| Did you strictly follow the recommendation of not drinking alcoholic/carbonated beverages for 7 days? | Yes | 181 | 83.4% |
| No | 36 | 16.6% | |
| Did you strictly follow the recommendation of brushing your teeth every day after each meal? | Yes | 23 | 10.2% |
| No | 203 | 89.8% | |
Patient follow-up appointment attendance and reasons for missed appointments
In this study, 78.0% (n = 177) of patients were scheduled for follow-up appointments after dental treatment. Among these patients, 66% (n = 117) attended scheduled follow-up. Reasons for missing appointments included forgetting appointments (45%, n = 27) and financial issues (28.3%, n = 17). Concerning missed appointments, 63.3% (n = 38) of respondents missed one appointment (Table 4).
Table 4.
Patient follow-up attendance at Yekatit 12 Hospital, Addis Ababa, 2024
| Count | % | ||
|---|---|---|---|
| Are the patients scheduled for a follow-up appointment after dental treatment? | Yes | 177 | 78.0% |
| No | 50 | 22.0% | |
| Did the patients attend the scheduled follow-up appointment? | Yes | 117 | 66% |
| No | 60 | 34% | |
| If you did not attend your follow-up appointment, what were the reasons? | Forgot the appointment | 27 | 45% |
| Felt it was unnecessary | 3 | 5% | |
| Transportation issues | 3 | 5% | |
| Financial issues | 17 | 28.3% | |
| Scheduling conflicts | 10 | 16.7% | |
| How many appointments did you miss? | 1 | 38 | 63.3% |
| 2 | 20 | 33.3% | |
| 3 or more times | 2 | 3.3% | |
Factors associated with follow-up attendance
Patient age was not associated with follow-up attendance (X2=1.748; p = 0.782), indicating no significant association between age and attendance at follow-up appointments. This finding suggests that age does not play a significant role in whether individuals attend scheduled follow-up appointments or not.
In contrast, the relationship between sex and follow-up appointment attendance had a p-value of 0.020, indicating a statistically significant association. This finding suggests that sex may influence the likelihood of attending follow-up appointments. Similarly, educational level was strongly associated with attendance (p = 0.000), suggesting that educational background significantly affected follow-up appointment attendance. However, occupation did not have a significant relationship (p = 0.185), implying that occupation did not significantly affect whether individuals attended scheduled follow-up appointments (Table 5).
Table 5.
Associations between sociodemographic characteristics and follow-up attendance at Yekatit 12 Hospital, Addis Ababa, 2024
| Pearson Chi-Square value | p Value | |
|---|---|---|
| Age * Follow-up Appointment | 1.748 | 0.782 |
| Sex * Follow-up Appointment | 5.446 | 0.020 |
| Level of Education * Follow-up Appointment | 80.966 | 0.000 |
| Occupation * Follow-up Appointment | 3.376 | 0.185 |
Factors associated with awareness of instructions
Perceived hurry of the dentist was significantly associated with instruction clarity and comprehensiveness (X2 = 66.3, df = 6; p = 0.000). These findings suggest that patients’ perceptions of the dentist being in a hurry significantly affected their ratings of instruction clarity and comprehensiveness.
The method of delivery of the instructions correlated with the clarity and comprehensiveness of the instructions (p = 0.000). This finding indicated a statistically significant relationship between the delivery method of instructions and perceived clarity and comprehensiveness. This suggests that the way instructions are delivered, whether verbally, in writing, or through other means, significantly influences patients’ clarity and comprehensiveness of instructions (Table 6).
Table 6.
Factors associated with awareness of instructions at Yekakit 12 Hospital, Addis Ababa, 2024
| Chi-Square Test Value | p-value | |
|---|---|---|
| Was the Dentist in a hurry? | 66.226 | 0.000 |
| If yes, how were the instructions delivered? | 66.226 | 0.000 |
| Were you told of the complications if you did not follow the instructions? | 73.248 | 0.000 |
Suggestions to improve follow-up attendance and compliance
Patients were asked to provide suggestions to improve follow-up attendance and compliance with post-treatment instructions. The most frequent recommendation, comprising 30% of the suggestions, was the implementation of better reminder systems, such as phone calls or text messages, to reduce missed appointments due to forgetfulness. Improved access and transportation options were suggested by 20% of the patients, reflecting the challenges faced in reaching the hospital. Financial support or more affordable treatment options were recommended by 15% of the participants, highlighting financial barriers to follow-up care. Another 15% of patients suggested more flexible scheduling options, including extended hours or weekend appointments, to accommodate their commitments. Clearer and more comprehensive post-treatment instructions were advocated by 10% of patients, emphasizing the need for easy-to-understand guidelines (Fig. 1).
Fig. 1.
Participants’ suggestions for improving follow-up attendance and compliance at Yekatit 12 Hospital, Addis Ababa, 2024
Discussion
This study determined patients’ follow-up attendance, awareness, and compliance with postoperative dental instructions and identified key factors influencing patient follow-up attendance and compliance with postoperative dental instructions. Understanding these behaviors is crucial for enhancing patient outcomes and improving the quality of dental care.
This study found that the overall patient compliance with post-treatment instructions was 67.9%. Regarding compliance with post-operative instructions, the overall patient compliance rate with post-treatment instructions was 67.9%. Regarding the type of instructions, 61.1% of patients complied with the prescribed antibiotic regimen. In terms of dietary recommendations, 87.2% of participants adhered to a soft diet for 24 h, and 76.9% avoided rinsing or spitting up for 24 h. In another study of oral surgery patients, 40% did not recall receiving both written and verbal instructions, 36% remembered only the written instructions, 12% did not adhere to postoperative mouthwash instructions, and 67% did not adhere to antibiotic prescriptions [7]. Atchison et al. [23]found that approximately 41% of patients recalled elements of postoperative instructions over a postoperative period. These findings suggest that adherence to post-treatment instructions varied considerably across studies, indicating differences in the populations included in the studies in terms of health literacy, education, clarity, and understanding of post-treatment instructions. These findings highlight the importance of clear communication and education to improve patient compliance and health outcomes.
This study revealed that patients’ follow-up appointment attendance was 66%, whereas a study conducted in Nigeria reported that the overall prevalence of patient compliance with follow-up visits was 55% [24]. Another study conducted in India reported that 38.6% of the patients missed appointments [25]. In a study conducted in the United Arab Emirates, 22.5% of dental appointments were missed [3]t. These discrepancies could be attributed to the population variations in these studies.
This study revealed that many patients failed to attend follow-up appointments because of forgetfulness, transportation issues, perceptions of treatment as unimportant, financial constraints, or scheduling conflicts. This study revealed that transportation issues are cited as the cause of missed appointments. This finding is consistent with that of a study conducted in Saudi Arabia [26]. This study revealed that forgetfulness causes missed appointments. Similarly, a study conducted in Saudi Arabia reported that patients missed appointments because of forgetfulness [27]. This study revealed that patients’ perceived unimportance of treatment was a cause of missed appointments. This finding is consistent with a study conducted in the United Arab Emirates, which reported that patients did not perceive any benefit from dental treatment as a reason for missed appointments [3]. These results suggest that nonattendance at appointments is a highly complex and multifactorial problem among dental patients, and needs to be addressed appropriately to improve patient care. Implementing better reminder systems, improving transportation options, providing financial support, and offering more flexible scheduling could significantly increase follow-up attendance rates.
This study revealed that clarity and comprehensiveness of post-treatment instructions are crucial for ensuring compliance. Patients who received clear and detailed instructions were more likely to be followed up at their appointments. This finding aligns with a study from Australia, where clear communication between healthcare providers and patients was identified as a key factor in patient adherence to medical advice [28]. Among the patients, 40% did not remember receiving written and verbal instructions, and 36% remembered only written instructions [7]. Another study [29] mentioned that no clear instructions about the importance of completing the full course was a major reason for non-compliance.
These findings suggest that improving patient follow-up attendance and compliance requires a multi-faceted approach. Enhancing communication between dental professionals and patients, providing clear and understandable instructions, and addressing financial barriers are critical steps. This study also underscores the importance of using multiple formats to deliver post-treatment instructions to optimize patient compliance and improve health outcomes. This study identified the need to use technology for reminders, more personalized patient care approaches, and broader health policy changes to support patient adherence to dental-care recommendations.
While there is a paucity of literature on patient awareness and compliance with post-operative instructions in Ethiopia and similar settings, the findings of this study can serve as a foundation for future research in this area. This study highlights the importance of conducting more localized studies to develop context-specific interventions.
This study has the following limitations. First, the sample size and specific setting in Addis Ababa may limit the generalizability of the results to the general population. Second, reliance on self-reported data on reasons for non-attendance and non-compliance may introduce bias, as patients may not accurately remember or misreport their reasons. Lastly, the lack of localized literature makes it difficult to compare the findings with those of previous studies.
Conclusions
This study revealed that the proportion of patients who attended the scheduled follow-up appointments was suboptimal. Education level and type of instruction were related to attendance at follow-up and adherence to posttreatment instructions. The main barriers to missed appointments include forgetfulness, transportation issues, financial constraints, and scheduling conflicts. The clarity of post-treatment instructions and dentists’ perceived attentiveness are key to adherence.
Recommendations
To improve patient compliance with treatment and follow-up care, healthcare systems should implement reminder systems such as text messages and mobile app notifications. In addition, healthcare providers should prioritize patient education and promote effective communication, and work to remove barriers that hinder compliance with follow-up appointments and post-treatment instructions.
Acknowledgements
The authors thank the staff at the Dental Department of Yekatit 12 Hospital for their cooperation and support. We are also grateful to the participants for their valuable contribution to this study.
Author contributions
KM conceived the idea, developed the method, collected, analyzed, and interpreted the data, and wrote and approved the manuscript. YA developed the method, collected, analyzed, and interpreted the data, and wrote and approved the manuscript.
Funding
None.
Data availability
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was reviewed and approved by the Atlas College of Health Sciences Ethics Committee (Ref. No: ACHS/049/24). All the participants provided written informed consent. This study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Consent for publication was obtained from the study participants.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request.