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

Abstract

ObjectivesSelecting 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.DesignQualitative analysis of online chat transcripts of facilitated deliberations from 31 small group sessions.SettingKaiser Permanente Dental (KP Dental) in the USA.ParticipantsAll staff from 16 dental offices.ResultsThe 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.ConclusionsThe 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 numberThis project is registered at ClinicalTrials.gov with IDNCT04682730. The trial was first registered on 18 December 2020.https://clinicaltrials.gov/ct2/show/NCT04682730.