Ochshorn Jennie, Daly Kelly A, Zaninovic ViniNatalie, Heyman Richard E, Smith Slep Amy M, Wolff Mark S
New York University College of Dentistry, New York, New York, United States of America.
University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2025 May 9;20(5):e0322884. doi: 10.1371/journal.pone.0322884. eCollection 2025.
Over fifteen percent of the global population experiences dental fear, and although evidence-based treatments exist, adoption of these treatments is almost non-existent. Informed by our prior research examining barriers to adopting face-to-face behavioral treatments in dental operatories, this study examined dentists' responses to three stepped-care Cognitive Behavioral Therapy for Dental Fear (CBT-DF) formats that use technology. All approaches offer an automated component as the first step (a mobile app) and either an in-person, virtual reality (VR), or video telehealth session as the second step. This study aims to understand which of these approaches would most likely be adopted by private practice dentists and why. Eight focus groups/solo interviews with a total of 13 private practice dentists were conducted with the aim to assess barriers and facilitators to implementing three stepped-care approaches of CBT-DF. The qualitative data obtained from these interviews was coded and analyzed according to Rogers' framework of innovation (relative advantage, compatibility, complexity, trialability, and observability). The results indicated that participants acknowledged the value of interventions to address dental fear, as they had personal experiences with fearful patients that impacted their practices. Participants responded positively to the automated component of treatment (the app) and were more wary of treatment options requiring office space and staff time (in-person VR and in-person mental health provider). The telehealth option received the most favorable response, although some doubts were expressed regarding relative efficacy and patient accountability. Thus, dissemination of an app-telehealth treatment model that allows dentists to serve as referral partners is promising, given dentists' incentives to decrease patient fear while avoiding opportunity cost (e.g., occupied chairs and staff time).
全球超过15%的人口患有牙科恐惧症，尽管存在循证治疗方法，但这些治疗方法几乎未被采用。基于我们之前关于牙科诊疗室采用面对面行为治疗的障碍的研究，本研究考察了牙医对三种采用技术的阶梯式护理牙科恐惧认知行为疗法（CBT-DF）形式的反应。所有方法都将自动化组件作为第一步（移动应用程序），第二步则采用面对面、虚拟现实（VR）或视频远程医疗会话。本研究旨在了解这些方法中哪种最有可能被私人执业牙医采用以及原因。对总共13名私人执业牙医进行了8次焦点小组/单人访谈，目的是评估实施CBT-DF的三种阶梯式护理方法的障碍和促进因素。根据罗杰斯的创新框架（相对优势、兼容性、复杂性、可试用性和可观察性）对从这些访谈中获得的定性数据进行编码和分析。结果表明，参与者认识到干预措施对解决牙科恐惧症的价值，因为他们有过与恐惧患者打交道的个人经历，这些经历影响了他们的诊疗工作。参与者对治疗的自动化组件（应用程序）反应积极，而对需要办公空间和员工时间的治疗选项（面对面VR和面对面心理健康服务提供者）则更为谨慎。远程医疗选项得到了最积极的回应，尽管有人对其相对疗效和患者责任表示怀疑。因此，鉴于牙医有减少患者恐惧同时避免机会成本（如占用的诊疗椅和员工时间）的动机，推广一种允许牙医充当转诊伙伴的应用程序-远程医疗治疗模式是有前景的。
