在审议性参与中分享意见以提高牙科诊所的指南遵循率：对在线审议论坛讨论进行定性评估的结果。

Sharing voice during deliberative engagement to improve guideline adherence in dental clinics: findings from a qualitative evaluation of an online deliberative forum discussion.

机构信息

Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA

The Art of Democracy, LLC, Pittsburgh, Pennsylvania, USA.

出版信息

BMJ Open. 2023 Jul 5;13(7):e072727. doi: 10.1136/bmjopen-2023-072727.

DOI:10.1136/bmjopen-2023-072727

PMID:37407045

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10335412/

Abstract

OBJECTIVES

Selecting effective implementation strategies to support guideline-concordant dental care is a complex process. For this research project, an online deliberative forum brought together staff from dental clinics to discuss the strengths and weaknesses of implementation strategies and barriers to implementation of a component of a dental (pit-and-fissure) guideline. The goal was to determine whether deliberative engagement enabled participants' sharing of promotive and prohibitive voice about implementation strategies to promote guideline-concordant care.

DESIGN

Qualitative analysis of online chat transcripts of facilitated deliberations from 31 small group sessions.

SETTING

Kaiser Permanente Dental (KP Dental) in the USA.

PARTICIPANTS

All staff from 16 dental offices.

RESULTS

The directed content analysis revealed that participants shared prohibitive and promotive voice when offering critique of the barriers and the implementation strategies suggested by the researchers. The analysis also revealed that the focus of the deliberations often was not on the aspect of the pit-and-fissure guideline intended by the research team for deliberation.

CONCLUSIONS

The deliberative forum discussions were a productive venue to ask staff in dental clinics to share their perspectives on strategies to promote guideline-concordant care as well as barriers. Participants demonstrated prohibitive voice and engaged critically with the materials the research team had put together. An important limitation of the deliberation was that the discussion often centred around an aspect of the pit-and-fissure guideline that already was implemented well. To ensure a deliberation oriented towards resolving challenging aspects of the pit-and-fissure guideline, greater familiarity with the guideline would have been important, as well as more intimate knowledge of the current discrepancies in guideline-concordant care.

TRIAL REGISTRATION NUMBER

This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 18 December 2020. https://clinicaltrials.gov/ct2/show/NCT04682730.

摘要

目的

选择有效的实施策略来支持符合指南的牙科护理是一个复杂的过程。在这个研究项目中，一个在线审议论坛聚集了来自牙科诊所的工作人员，讨论了实施牙科（窝沟裂）指南的一个组成部分的实施策略的优缺点和实施障碍。目的是确定审议是否使参与者能够分享有关实施策略的促进性和禁止性意见，以促进符合指南的护理。

设计

对来自 31 个小组会议的在线聊天记录进行定性分析。

地点

美国 Kaiser Permanente Dental（KP Dental）。

参与者

来自 16 家牙科办公室的所有工作人员。

结果

有针对性的内容分析显示，参与者在提出研究人员提出的障碍和实施策略的批评时，分享了禁止性和促进性的意见。分析还显示，审议的重点往往不是研究小组希望审议的窝沟裂指南的方面。

结论

审议论坛讨论是一个富有成效的场所，可以要求牙科诊所的工作人员分享他们对促进符合指南的护理的策略以及障碍的看法。参与者表现出禁止性的意见，并批判性地参与了研究小组整理的材料。审议的一个重要限制是，讨论往往集中在窝沟裂指南中已经很好地实施的一个方面。为了确保审议的方向是解决窝沟裂指南的具有挑战性的方面，熟悉该指南以及更深入地了解目前在符合指南的护理方面的差异将非常重要。