Dental Health Services Research Unit, University of Dundee, MacKenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
Implement Sci. 2009 Jun 5;4:31. doi: 10.1186/1748-5908-4-31.
Guidance on the cleaning of dental instruments in primary care has recently been published. The aims of this study are to determine if the publication of the guidance document was enough to influence decontamination best practice and to design an implementation intervention strategy, should it be required.
A postal questionnaire assessing current decontamination practice and beliefs was sent to a random sample of 200 general dental practitioners.
Fifty-seven percent (N = 113) of general dental practitioners responded. The survey showed large variation in what dentists self-reported doing, perceived as necessary or practical to do, were willing to do, felt able to do, as well as what they planned to change. Only 15% self-reported compliance with the five key guideline-recommended individual-level decontamination behaviours; only 2% reported compliance with all 11 key practice-level behaviours. The results also showed that our participants were almost equally split between dentists who were completely unmotivated to implement best decontamination practice or else highly motivated. The results suggested there was scope for further enhancing the implementation of decontamination guidance, and that an intervention with the greatest likelihood of success would require a tailored format, specifically targeting components of the theory of planned behaviour (attitude, perceived behavioural control, intention) and implementation intention theory (action planning).
Considerable resources are devoted to encouraging clinicians to implement evidence-based practice using interventions with erratic success records, or no known applicability to a specific clinical behaviour, selected mainly by means of researchers' intuition or optimism. The methodology used to develop this implementation intervention is not limited to decontamination or to a single segment of primary care. It is also in accordance with the preliminary stages of the framework for evaluating complex interventions suggested by the medical research council. The next phases of this work are to test the intervention feasibility and evaluate its effectiveness in a randomised control trial.
最近发布了关于初级保健牙科器械清洁的指南。本研究旨在确定发布指导文件是否足以影响去污最佳实践，并在需要时设计实施干预策略。
通过邮寄问卷评估了 200 名普通牙医的当前去污实践和信念。
57%（N=113）的普通牙医做出了回应。调查显示，牙医自我报告的做法、认为必要或实际的做法、愿意做的做法、感到有能力做的做法以及计划改变的做法存在很大差异。只有 15%的人自我报告符合五项关键指南推荐的个人层面去污行为；只有 2%的人报告符合所有 11 项关键实践层面行为。结果还表明，我们的参与者在完全没有动力实施最佳去污实践的牙医和高度有动力的牙医之间几乎平分秋色。结果表明，进一步增强去污指南的实施还有很大的空间，并且最有可能成功的干预措施将需要采用定制格式，专门针对计划行为理论（态度、感知行为控制、意图）和实施意图理论（行动计划）的各个方面。
大量资源用于鼓励临床医生使用干预措施来实施基于证据的实践，这些干预措施的成功记录不稳定，或者对特定的临床行为没有已知的适用性，主要是通过研究人员的直觉或乐观主义选择的。用于开发这种实施干预措施的方法不仅限于去污或初级保健的单一领域。它还符合医学研究委员会建议的复杂干预措施评估框架的初步阶段。这项工作的下一阶段是在随机对照试验中测试干预措施的可行性并评估其有效性。
