Community Oral Health Section, School of Medicine, Dentistry and Nursing, College of Medicine, Veterinary and Life Sciences (MVLS), University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
Dental Health Services Research Unit, Dundee Dental Education Centre, Frankland Building, Small's Wynd, Dundee, DD1 4HN, UK.
Implement Sci. 2018 Jul 11;13(1):95. doi: 10.1186/s13012-018-0775-0.
Financial incentives are often used to influence professional practice, yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood. In keeping with clinical guidelines, Childsmile (Scotland's oral health improvement programme) advocates twice yearly fluoride varnish application (FVA) for children in dental practice. To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2-5-year-olds' teeth through a pilot. In October 2011 payment was extended to all dental practitioners. This paper compares FVA pre- and post-roll-out and explores the financial incentive's behavioural mechanisms.
A natural experimental approach using a longitudinal cohort of dental practitioners (n = 1090) compared FVA pre- (time 1) and post- (time 2) financial incentive. Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2-5-year-old patients (novel incentive group) were compared with all other responses (continuous incentive group). The Theoretical Domains Framework (TDF) was used to measure change in behavioural mechanisms associated with the incentive. Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups.
At time 2, 709 74%, of eligible responders, were followed up. In general, FVA rates increased over time for both groups; however, the novel incentive group experienced a greater increase (β [95% CI] = 0.82 [0.72 to 0.92]) than the continuous incentive group. Despite this, only 33% of practitioners reported 'always' varnishing increased risk 2-5-year-olds' teeth following introduction of the financial incentive, 19% for standard risk children. Domain scores at time 2 (adjusting for time 1) increased more for the novel incentive group (compared to the continuous incentive group) for five domains: knowledge, social/professional role and identity, beliefs about consequences, social influences and emotion.
In this large, prospective, population-wide study, a financial incentive moderately increased FVA in dental practice. Novel longitudinal use of a validated theoretical framework to understand behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems. While financial incentives are useful in narrowing the gap between clinical guidelines and FVA, multiple intervention approaches are required.
财务激励措施通常被用来影响专业实践，但影响其有效性和行为机制的因素还没有得到充分的理解。为了遵循临床指南，Childsmile（苏格兰口腔健康改善计划）提倡在牙科实践中每年两次为儿童应用氟化物漆（FVA）。为了支持实施，Childsmile 通过试点为牙医提供了每涂一次 2-5 岁儿童牙齿的费用。2011 年 10 月，支付范围扩大到所有牙医。本文比较了 FVA 在推出前后的情况，并探讨了财务激励的行为机制。
使用纵向的牙医队列（n=1090）进行自然实验方法，比较了 FVA 在财务激励前后（时间 1 和时间 2）的情况。对在考虑 2-5 岁患者时没有在 Childsmile 试点实践工作的牙医（新激励组）的反应与所有其他反应（连续激励组）进行了比较。使用理论领域框架（TDF）来衡量与激励相关的行为机制的变化。使用协方差分析来研究两组的 FVA 率和相关行为机制。
在时间 2，有 709 名符合条件的应答者（74%）被跟踪。总的来说，两组的 FVA 率随着时间的推移而增加；然而，新激励组的增加幅度更大（β[95%CI]为 0.82[0.72 至 0.92]）。尽管如此，只有 33%的牙医报告说，在引入财务激励后，他们“总是”为增加风险的 2-5 岁儿童涂氟漆，而标准风险儿童的比例为 19%。在时间 2 时（调整了时间 1），新激励组的五个领域的得分（与连续激励组相比）增加得更多：知识、社会/职业角色和身份、对后果的信念、社会影响和情感。
在这项大规模的、前瞻性的、全国性的研究中，财务激励措施适度地增加了牙科实践中的 FVA。新的纵向使用验证过的理论框架来理解行为机制表明，财务激励措施通过复杂的相互关联的信念系统运作。虽然财务激励措施在缩小临床指南和 FVA 之间的差距方面很有用，但需要多种干预措施。
