Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
School of Health, Science and Wellbeing, Staffordshire University, Stoke on Trent, UK.
Community Dent Oral Epidemiol. 2023 Dec;51(6):1118-1129. doi: 10.1111/cdoe.12842. Epub 2023 Feb 3.
There are multifaceted reasons for a social gradient in planned dental visiting involving various psycho-social variables that interact with each other and the environment. Interventions in this area are therefore inevitably complex interventions. While guidance recommends undertaking theory and modelling work before experimental work is done, there is a shortage of descriptions of how this is done, especially in the field of oral health.
To describe theory, qualitative and public engagement work, and identification of behaviour change techniques (BCTs) to define features of an opportunistic dental visiting intervention for adult users of urgent dental care services.
A systematic review and synthesis of theory, qualitative and quantitative work, along with expert input, generated a list of psycho-social determinants linked to planned dental visiting intentions. Modelling involved ethnographic work in urgent dental care settings and work with members of the community from the targeted demographic. This enabled verification, in the context of their idiosyncratic expression for the target population in question, of behavioural determinants (BDs) identified in the theory phase. It also facilitated generating intervention material which was infused with the identity of the end user. BDs identified were then mapped to BCTs using an accepted BCT taxonomy and an intervention prototype developed. The prototype then underwent iterative testing with target users before it was ready for a feasibility trial.
Theory and modelling identified five key intervention focuses: affordable resources (time/ cost), the importance of oral health, trust in dentists, embarrassment of having poor oral health and dental anxiety. Short videos were developed to incorporate role modelling which were well received. Prototype testing resulted in shifting from 'if-then' plans to action planning.
Complex intervention development involves an iterative rather than sequential process of combining theory, empirical work and user involvement, of which the article provides an example.
计划看牙的社会梯度存在多方面的原因，涉及到各种相互作用并与环境相互作用的心理社会变量。因此，该领域的干预措施必然是复杂的干预措施。虽然指南建议在进行实验工作之前进行理论和模型工作，但缺乏如何做到这一点的描述，尤其是在口腔健康领域。
描述理论、定性和公众参与工作，并确定行为改变技术（BCT），以定义针对紧急牙科护理服务的成年使用者的机会性牙科就诊干预措施的特征。
系统综述和理论、定性和定量工作的综合，以及专家意见，生成了一系列与计划看牙意图相关的心理社会决定因素列表。建模涉及在紧急牙科护理环境中的民族志工作以及与目标人群的社区成员合作。这使得可以在特定于目标人群的背景下验证理论阶段确定的行为决定因素（BD）。它还促进了生成干预材料，这些材料注入了最终用户的身份。然后使用公认的 BCT 分类法和干预原型将确定的 BDs 映射到 BCTs。然后，对目标用户进行原型迭代测试，然后再进行可行性试验。
理论和模型确定了五个关键干预重点：负担得起的资源（时间/成本）、口腔健康的重要性、对牙医的信任、对口腔健康不佳的尴尬和牙齿焦虑。开发了包含角色扮演的短视频，受到了好评。原型测试导致从“如果-那么”计划转向行动计划。
复杂干预措施的制定涉及到理论、实证工作和用户参与的迭代而不是顺序的过程，本文提供了一个例子。
