Gruß Inga, Dawson Tim, Kaplan Charles D, Pihlstrom Daniel J, Fellows Jeffrey L, Polk Deborah E
Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR, 97227, USA.
The Art of Democracy, LLC. 51 Roycroft Avenue, Pittsburgh, PA, 15228, USA.
Implement Sci Commun. 2023 Sep 21;4(1):119. doi: 10.1186/s43058-023-00496-2.
Selecting effective implementation strategies to support guideline-concordant dental care is a complex process. We are drawing on data collected during the DISGO study to reflect on barriers we encountered in implementing a deliberative engagement process for discussing implementation strategies relevant to the evidence-based guideline targeted in this intervention. The goal is to identify factors that may influence the success of deliberative engagement as a technique to involve healthcare staff in identifying priorities for implementation strategies.
We drew on online chat transcripts from the deliberative engagement forums collected during the DISGO study. The chat transcripts were automatically generated for each discussion and captured the written exchanges between participants and moderators in all participating dental clinics. Chat transcripts were analyzed following a content analysis approach.
Our findings revealed barriers to the successful implementation of deliberative engagement in the context of the DISGO study. Participants were not familiar with the materials that had been prepared for the forum and lacked familiarity with the topic of deliberation. Participants also did not share divergent viewpoints and reinforced existing ideas rather than introducing new ideas.
In order to ensure that obstacles that were encountered in this study are not repeated, it is important to carefully consider how staff can effectively be prepared for the deliberations. Participants must be familiar with the content of the guideline, and most questions about the content and evidence should be answered before the deliberative engagement sessions. If perspectives among staff on a guideline are homogenous, briefing materials should introduce perspectives that complement existing views among staff. It is also necessary to create an environment in which staff are comfortable introducing opinions that may not be held by the majority of colleagues.
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 .
选择有效的实施策略以支持符合指南的牙科护理是一个复杂的过程。我们正在利用DISGO研究期间收集的数据，反思在实施一个审议参与过程中遇到的障碍，该过程旨在讨论与本干预措施所针对的循证指南相关的实施策略。目标是确定可能影响审议参与成功的因素，审议参与是一种让医护人员参与确定实施策略优先级的技术。
我们利用了DISGO研究期间收集的审议参与论坛的在线聊天记录。每次讨论都会自动生成聊天记录，记录了所有参与牙科诊所中参与者与主持人之间的书面交流。聊天记录采用内容分析法进行分析。
我们的研究结果揭示了在DISGO研究背景下成功实施审议参与的障碍。参与者不熟悉为论坛准备的材料，对审议主题也缺乏了解。参与者也没有分享不同的观点，而是强化了现有想法，而非引入新想法。
为确保本研究中遇到的障碍不再出现，仔细考虑如何让工作人员为审议做好有效准备很重要。参与者必须熟悉指南的内容，并且在审议参与会议之前，应回答大多数关于内容和证据的问题。如果工作人员对指南的观点较为一致，简报材料应引入与工作人员现有观点互补的观点。还必须营造一种环境，让工作人员能够自在地提出大多数同事可能不持有的意见。
该项目已在ClinicalTrials.gov上注册，注册号为NCT04682730。该试验于2020年12月18日首次注册。https://clinicaltrials.gov/ct2/show/NCT04682730 。
