ORCID

Abstract

Background:Uncertainty is an inherent part of healthcare, particularly in decision-making. Shared decision-making in many Asian contexts faces challenges due to language barriers, religious practices, hierarchical clinical norms, and collectivist approaches to decision-making. Under uncertain conditions, these challenges become even more complex and may be influenced by individuals’ tolerance of uncertainty. Understanding how both patients and dentists of multi-ethnolinguistic groups experience and respond to uncertainty is therefore essential to support context-sensitive, culturally responsive dental decision-making.Aim:To explore how multi-ethnic patients and dentists in Malaysia, with varying levels of uncertainty tolerance, perceive and respond to uncertainty in oral health decision-making, and how they make trade-offs to enable shared decision-making under uncertain conditions.Methods:A mixed methods research design was used, comprising three interrelated studies:• Study 1: Participatory workshop with patients using the walking method, autophotography, and photo elicitation.• Study 2: Discrete choice experiment (DCE) with patients to examine trade-offs in hypothetical uncertain dental scenarios.• Study 3: Participatory interactions with dentists Findings were integrated through meta-inference to develop a unifying conceptual model.Findings:Patients experienced uncertainty as an 'affect', a contextual gap entangled with emotional components making it difficult to differentiate between its various sources. Language played a critical role in shaping the understanding, meaning, and interpretation of words. Distinct patterns in how uncertainty was perceived were influenced by both ethnicity and levels of uncertainty tolerance. Key sources of uncertainty included past negative experiences, unfamiliarity, associations, inherent uncertainty, spatial and sensory triggers within the dental environment.Dentists perceived uncertainty arising from practice management issues, communication challenges, skill-related concerns, treatment-related ambiguity, and patient bias. While no major differences were found across ethnic or uncertainty tolerance groups, differences were evident between dentists working in public and private sectors. A mismatch was observed between how patients and dentists perceived and interpreted uncertainty.In response to uncertainty, patients tended to either accept treatment, seek clarification, or delay or avoid care. Dentists typically responded by continuing treatment or referring patients to other providers. Among patients, spatial and experience driven uncertainty had the greatest impact. For dentists, the highest impact arose from uncertainty linked to clinical skills and practice-related concerns.Patients made dynamic trade-offs depending on the situation and the type of uncertainty they encountered. Ethnicity and uncertainty tolerance influenced these patterns. Good explanations were consistently prioritised. During periods of community-level uncertainty, patients placed greater value on urgency of care. Conversely, after negative prior experiences, there was a change in preference to specialist care. When personal uncertainty overlapped with broader community-level uncertainty, such as during a pandemic, the preference for specialist care over urgency became even more pronounced. Dentists chose patient safety, informed consent, and respect for patient preferences as key trade-offs.Four meta-inferences were generated by integrating qualitative and quantitative findings. These informed the development of the ‘Uncertainty Loop’ Model, which visually maps how uncertainty is experienced and responded to in dental environments through a cultural lens. The model captures the non-linear, dynamic, layered, and spatial nature of uncertainty and illustrates how both patients and dentists navigate it through evolving trade-offs.Conclusion:This study offers new insights into how uncertainty is perceived and managed among multi-ethnic populations in Malaysia, shaped by ethnicity, language, and levels of uncertainty tolerance. Spatial and environmental factors also emerged as significant sources of uncertainty. The Uncertainty Loop Model provides an initial framework for conceptualising and supporting shared decision-making under uncertain conditions. Future research should explore its application in real-world clinical settings and its integration into multi-ethnolinguistic models of shared decision-making.

Document Type

Thesis

Publication Date

2025

Embargo Period

2025-06-03

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