Patient-, organization-, and system-level barriers and facilitators to preventive oral health care

a convergent mixed-methods study in primary dental care

Anna Rose Templeton, Linda Young, Alison Bish, Wendy Gnich, Heather Cassie, Shaun Treweek, Debbie Bonetti, Douglas Stirling, Lorna Macpherson, Sharon McCann, Jan Clarkson, Craig Ramsay, PMC study team

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care.

METHODS: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies.

RESULTS: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6-12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours.

CONCLUSIONS: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.

Original languageEnglish
Article number5
Pages (from-to)1-14
Number of pages14
JournalImplementation Science
Volume11
DOIs
Publication statusPublished - 12 Jan 2016

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Preventive Health Services
Deciduous Tooth
Dental Care
Oral Health
Primary Health Care
Organizations
Pit and Fissure Sealants
Tooth
Interviews
Topical Fluorides
Preventive Medicine
National Health Programs
Dental Caries
Scotland
Health Promotion
Dentists
Administrative Personnel
Practice Guidelines
Chronic Disease
Public Health

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Patient-, organization-, and system-level barriers and facilitators to preventive oral health care : a convergent mixed-methods study in primary dental care. / Templeton, Anna Rose; Young, Linda; Bish, Alison; Gnich, Wendy; Cassie, Heather; Treweek, Shaun; Bonetti, Debbie; Stirling, Douglas; Macpherson, Lorna; McCann, Sharon; Clarkson, Jan; Ramsay, Craig; PMC study team.

In: Implementation Science, Vol. 11, 5, 12.01.2016, p. 1-14.

Research output: Contribution to journalArticle

Templeton, AR, Young, L, Bish, A, Gnich, W, Cassie, H, Treweek, S, Bonetti, D, Stirling, D, Macpherson, L, McCann, S, Clarkson, J, Ramsay, C & PMC study team 2016, 'Patient-, organization-, and system-level barriers and facilitators to preventive oral health care: a convergent mixed-methods study in primary dental care', Implementation Science, vol. 11, 5, pp. 1-14. https://doi.org/10.1186/s13012-015-0366-2
Templeton, Anna Rose ; Young, Linda ; Bish, Alison ; Gnich, Wendy ; Cassie, Heather ; Treweek, Shaun ; Bonetti, Debbie ; Stirling, Douglas ; Macpherson, Lorna ; McCann, Sharon ; Clarkson, Jan ; Ramsay, Craig ; PMC study team. / Patient-, organization-, and system-level barriers and facilitators to preventive oral health care : a convergent mixed-methods study in primary dental care. In: Implementation Science. 2016 ; Vol. 11. pp. 1-14.
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author = "Templeton, {Anna Rose} and Linda Young and Alison Bish and Wendy Gnich and Heather Cassie and Shaun Treweek and Debbie Bonetti and Douglas Stirling and Lorna Macpherson and Sharon McCann and Jan Clarkson and Craig Ramsay and {PMC study team}",
note = "Acknowledgements This study was funded by the Chief Scientist Office of Scotland on Health Care Improvement Grant CZH/3/27. We are greatly appreciative of all the dental team members, patients, and policy-level stakeholders who participated in the study components and intervention planning. Further acknowledgements include the TRiaDS methodology group and the following individuals: David Conway, Colin Tilley, and Claire Tochel for the contributions to the study design, oversight, and conduct; Ruth Floate and Tina Halford-Mcguff for serving as lay representatives within the study design, management, and conduct; Susan Michie for refining the study design, providing the study oversight, and facilitating the operationalization and application of the TDF and Behaviour Change Wheel; Lou Atkins, Eilidh Duncan, and Maria Prior for assisting with the operationalization and application of the TDF and Behaviour Change Wheel; Paula Elouafkaoui for the linkage and analysis of the routine data; Gillian Forbes for the qualitative analysis and double coding; and the NHS National Services Scotland, Information Services Division, for the provision of routine data.",
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T1 - Patient-, organization-, and system-level barriers and facilitators to preventive oral health care

T2 - a convergent mixed-methods study in primary dental care

AU - Templeton, Anna Rose

AU - Young, Linda

AU - Bish, Alison

AU - Gnich, Wendy

AU - Cassie, Heather

AU - Treweek, Shaun

AU - Bonetti, Debbie

AU - Stirling, Douglas

AU - Macpherson, Lorna

AU - McCann, Sharon

AU - Clarkson, Jan

AU - Ramsay, Craig

AU - PMC study team

N1 - Acknowledgements This study was funded by the Chief Scientist Office of Scotland on Health Care Improvement Grant CZH/3/27. We are greatly appreciative of all the dental team members, patients, and policy-level stakeholders who participated in the study components and intervention planning. Further acknowledgements include the TRiaDS methodology group and the following individuals: David Conway, Colin Tilley, and Claire Tochel for the contributions to the study design, oversight, and conduct; Ruth Floate and Tina Halford-Mcguff for serving as lay representatives within the study design, management, and conduct; Susan Michie for refining the study design, providing the study oversight, and facilitating the operationalization and application of the TDF and Behaviour Change Wheel; Lou Atkins, Eilidh Duncan, and Maria Prior for assisting with the operationalization and application of the TDF and Behaviour Change Wheel; Paula Elouafkaoui for the linkage and analysis of the routine data; Gillian Forbes for the qualitative analysis and double coding; and the NHS National Services Scotland, Information Services Division, for the provision of routine data.

PY - 2016/1/12

Y1 - 2016/1/12

N2 - BACKGROUND: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care.METHODS: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies.RESULTS: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6-12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours.CONCLUSIONS: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.

AB - BACKGROUND: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care.METHODS: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies.RESULTS: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6-12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours.CONCLUSIONS: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.

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DO - 10.1186/s13012-015-0366-2

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JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

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