Polk Deborah, Shah Nilesh H, Dawson Tim, Gruß Inga, Pihlstrom Daniel J, Kaplan Charles D, Guerrero Erick G, Fellows Jeffrey L
University of Pittsburgh School of Dental Medicine.
The Art of Democracy.
Res Sq. 2023 May 4:rs.3.rs-2757518. doi: 10.21203/rs.3.rs-2757518/v1.
Dental caries affects billions worldwide and in the U.S. is among the most prevalent noncommunicable diseases in both children and adults. Early in the caries process, it can be arrested by dental sealants, which are non-invasive and thus tooth sparing, however, few dentists have adopted this approach. Deliberative engagement processes enable participants to engage with diverse perspectives on a policy issue and develop and share with policy makers informed opinions about the policy issue. We examined the effects of a deliberative engagement process on the ability of oral health providers to endorse implementation interventions and to apply dental sealants.
Using a stepped wedge design, 16 dental clinics were cluster randomized, and 680 providers and staff were exposed to a deliberative engagement process that included an introductory session, workbook, facilitated small group deliberative forum, and post-forum survey. Forum participants were assigned to forums to ensure diverse role representation. Mechanisms of action examined included sharing voice and diversity of opinion. Three months after each clinic's forum, the clinic manager was interviewed about implementation interventions deployed. There were 98 clinic-months in the non-intervention period and 101 clinic-months in the intervention period.
Compared with providers and staff in small clinics, providers and staff in medium and large clinics more strongly agreed that their clinic should adopt two of the three proposed implementation interventions targeting the first barrier and one of the two proposed implementation interventions targeting the second barrier. Compared with the non-intervention period, in the intervention period providers did not place more sealants on occlusal non-cavitated carious lesions. Survey respondents reported sharing both promotive and prohibitive voice. From the beginning to the end of the forums, most forum participants did not change their opinions about the possible implementation interventions. At the end of the forums, there was no significant within-group variability in implementation interventions endorsed.
Deliberative engagement intervention may help clinic leadership identify implementation interventions when there is a challenging problem, a network of semi-autonomous clinics, and autonomous providers within those clinics. It remains to be determined whether there is a range of perspectives within clinics.
This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.
龋齿影响着全球数十亿人，在美国，它是儿童和成人中最普遍的非传染性疾病之一。在龋齿形成的早期阶段，可以通过使用牙面窝沟封闭剂来阻止龋齿发展，这种方法是非侵入性的，因而能保留牙齿。然而，很少有牙医采用这种方法。审议参与过程能让参与者就政策问题接触到不同观点，并形成关于该政策问题的明智意见，与政策制定者进行交流。我们研究了审议参与过程对口腔健康服务提供者认可实施干预措施以及应用牙面窝沟封闭剂能力的影响。
采用阶梯楔形设计，对16家牙科诊所进行整群随机分组，680名提供者和工作人员参与了一个审议参与过程，该过程包括一次介绍会、一本工作手册、一个有主持人的小组审议论坛以及论坛后的调查。论坛参与者被分配到各个论坛，以确保不同角色的代表性。所考察的作用机制包括表达意见和意见多样性。在每个诊所的论坛结束三个月后，对诊所经理进行访谈，了解所实施的干预措施。非干预期有98个诊所月，干预期有101个诊所月。
与小诊所的提供者和工作人员相比，中大型诊所的提供者和工作人员更强烈地认同他们的诊所应采用针对第一个障碍的三项提议实施干预措施中的两项，以及针对第二个障碍的两项提议实施干预措施中的一项。与非干预期相比，在干预期提供者并没有在咬合面非龋性龋损上使用更多的封闭剂。调查受访者报告了促进性和抑制性意见的表达。从论坛开始到结束，大多数论坛参与者对可能的实施干预措施的看法没有改变。在论坛结束时，认可的实施干预措施在组内没有显著的变异性。
当存在具有挑战性的问题、半自主诊所网络以及诊所内的自主提供者时，审议参与干预可能有助于诊所领导层确定实施干预措施。诊所内是否存在多种观点仍有待确定。
该项目已在ClinicalTrials.gov注册，标识符为NCT04682730。该试验于2020年12月18日首次注册。https://clinicaltrials.gov/ct2/show/NCT04682730 。
