Improving Show Rates in Dental Care Settings Serving Underserved Populations

No-Show Prevention Practices in Dental Care Settings Serving Underserved Populations

The goal of this study is to compare different no-show interventions in dental clinics serving underserved populations. The main question it seeks to answer is

• How do different no-show intervention methods compare in reducing no-shows?

Participants will be asked to

• Implement different interventions
• Report a limited set of data to researchers

Study Overview

• Status: Active, not recruiting
• Conditions: Dental Care
• Intervention / Treatment: Behavioral: Reminder Messages; Behavioral: Walk-in Visits; Behavioral: Motivation-enhanced Communication

Detailed Description

Persistent no-show rates contribute to the oral health disparities and inadequate access to dental care that disproportionately affect underserved populations. The proposed research will test the impact of three different strategies on improving show rates using a full factorial design. Specifically, the study is designed as a 2×2×2 factorial cluster-randomized trial of reminder messaging, motivation-enhanced communication, and walk-in visit. The unit of intervention and randomization will be dental clinic sites (clusters). Forty clinics will be randomized between eight possible combinations of receiving or not receiving the three study interventions, with five clinics receiving each intervention. Findings from this study seek to provide an evidence-based approach to reducing no-shows and increasing access to dental care for underserved populations.

• Study Type: Interventional
• Enrollment (Estimated): 48
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Madison, Wisconsin, United States, 53705
      • University of Wisconsin - Madison

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Sites must be:

• Serve at least a 51 percent self-pay and Medicaid patients
• Be willing to provide limited data sets of clinic data to the research team
• Be willing to undertake and support and organizational improvement project to improve show rates

Staff must be:

• A paid staff member at a participating clinic
• Be able and willing to provide written or verbal consent

Exclusion Criteria:

• No exclusion criteria for clinics or staff

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

8

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control
Active Comparator: Reminder Messages	Behavioral: Reminder Messages; Dental clinic staff will use scripts to contact patients 24 and 48 hours before appointments. These scripts will guide staff in confirming the patient will appear for their appointment.
Active Comparator: Walk-in Visits	Behavioral: Walk-in Visits; When contacting patients to schedule an appointment (by phone, email, text, or other methods), dental clinic staff will notify patients of times during which patients can walk-in for a dental visit, if convenient for them; otherwise, a regular appointment will be arranged. Scheduled appointments will continue to be available in addition to the walk-in hours.
Active Comparator: Motivation-enhanced Communication	Behavioral: Motivation-enhanced Communication; Participating clinic site staff will be trained in motivation-enhanced communication techniques using the guide for dental clinic sites and coaching. Topics to be included in the motivation-enhanced communication training are a) to determine what patients hope to gain from their dental care, steps needed to succeed, how the agency and client will work together to attain the goals, and b) to identify patient barriers to attending their visit (e.g., transportation, payment, do not understand need for visit, etc.), and what the agency and patient will do to overcome those barriers. Staff will be instructed to use these techniques with patients at every contact about an upcoming appointment.
Active Comparator: Reminder Messages & Walk-in visits	Behavioral: Reminder Messages; Dental clinic staff will use scripts to contact patients 24 and 48 hours before appointments. These scripts will guide staff in confirming the patient will appear for their appointment.; Behavioral: Walk-in Visits; When contacting patients to schedule an appointment (by phone, email, text, or other methods), dental clinic staff will notify patients of times during which patients can walk-in for a dental visit, if convenient for them; otherwise, a regular appointment will be arranged. Scheduled appointments will continue to be available in addition to the walk-in hours.
Active Comparator: Reminder Messages & Motivation-enhanced Communication	Behavioral: Reminder Messages; Dental clinic staff will use scripts to contact patients 24 and 48 hours before appointments. These scripts will guide staff in confirming the patient will appear for their appointment.; Behavioral: Motivation-enhanced Communication; Participating clinic site staff will be trained in motivation-enhanced communication techniques using the guide for dental clinic sites and coaching. Topics to be included in the motivation-enhanced communication training are a) to determine what patients hope to gain from their dental care, steps needed to succeed, how the agency and client will work together to attain the goals, and b) to identify patient barriers to attending their visit (e.g., transportation, payment, do not understand need for visit, etc.), and what the agency and patient will do to overcome those barriers. Staff will be instructed to use these techniques with patients at every contact about an upcoming appointment.
Active Comparator: Walk-in visits & Motivation-enhanced Communication	Behavioral: Walk-in Visits; When contacting patients to schedule an appointment (by phone, email, text, or other methods), dental clinic staff will notify patients of times during which patients can walk-in for a dental visit, if convenient for them; otherwise, a regular appointment will be arranged. Scheduled appointments will continue to be available in addition to the walk-in hours.; Behavioral: Motivation-enhanced Communication; Participating clinic site staff will be trained in motivation-enhanced communication techniques using the guide for dental clinic sites and coaching. Topics to be included in the motivation-enhanced communication training are a) to determine what patients hope to gain from their dental care, steps needed to succeed, how the agency and client will work together to attain the goals, and b) to identify patient barriers to attending their visit (e.g., transportation, payment, do not understand need for visit, etc.), and what the agency and patient will do to overcome those barriers. Staff will be instructed to use these techniques with patients at every contact about an upcoming appointment.
Active Comparator: Reminder Messages, Walk-in visits, & Motivation-enhanced Communication	Behavioral: Reminder Messages; Dental clinic staff will use scripts to contact patients 24 and 48 hours before appointments. These scripts will guide staff in confirming the patient will appear for their appointment.; Behavioral: Walk-in Visits; When contacting patients to schedule an appointment (by phone, email, text, or other methods), dental clinic staff will notify patients of times during which patients can walk-in for a dental visit, if convenient for them; otherwise, a regular appointment will be arranged. Scheduled appointments will continue to be available in addition to the walk-in hours.; Behavioral: Motivation-enhanced Communication; Participating clinic site staff will be trained in motivation-enhanced communication techniques using the guide for dental clinic sites and coaching. Topics to be included in the motivation-enhanced communication training are a) to determine what patients hope to gain from their dental care, steps needed to succeed, how the agency and client will work together to attain the goals, and b) to identify patient barriers to attending their visit (e.g., transportation, payment, do not understand need for visit, etc.), and what the agency and patient will do to overcome those barriers. Staff will be instructed to use these techniques with patients at every contact about an upcoming appointment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in proportion of scheduled appointments for which the patient attends, pre-to-post intervention	To test the efficacy of motivation-enhanced communication, reminder messaging, and walk-in visits as compared to treatment as usual For each of the three interventions, the pre-to-post intervention change in show rates. Show rate is defined as the proportion of scheduled appointments for which the patient attends their scheduled clinic appointment. Appointments cancelled or rescheduled more than 24 hours in advance are not included in the calculation. Outcome will be measured by data exported from the clinical electronic health records monthly.	6 months pre-intervention to 12 months post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Organizational Change Manager (OCM) Score	To examine whether Organizational Readiness for Change moderates the efficacy of the targeted evidence-based practices. Organizational readiness for change will be assessed by a validated 16-item index called the Organizational Change Manager (OCM) For each clinic site, a group of 5 people that includes clinicians, dental hygienists, manager, and scheduler each team member will provide their own OCM responses. Outcome will be measured by combined responses to Organizational Change Manager survey tool. Total possible ranges of scores will be 0-104, with a higher score indicating increased readiness. The responses to the Organizational Change Manager survey from each clinic staff respondent will be added and an average of those scores will be calculated.	Survey will be administered at 3 months
Statistical Comparison of Interventions for Effectiveness Analysis	Evaluate the efficacy of motivation-enhanced communication, reminder messaging, and walk-in visits compared to each other. Comparative effectiveness analyses: Evaluate the efficacy of motivation-enhanced communication, reminder messaging, and walk-in visits compared to each other For each of the interventions, the difference in the pre-to-post intervention change in show rates in clinics receiving the different interventions Outcomes will be measured by data exported from the clinical electronic health records monthly.	6 months pre-intervention to 12 months post-intervention
Statistical Comparison of Combining Multiple Interventions for Interaction Analysis	Evaluate the synergy of combining multiple interventions. For each pair of interventions, the difference in the pre-to-post intervention change in show rates in clinics receiving both interventions compared to clinics receiving only one of them. Outcomes will be measured by data exported from the clinical electronic health records monthly.	6 months pre-intervention to 12 months post-intervention

Collaborators and Investigators

• Sponsor: University of Wisconsin, Madison
• Collaborators: National Institute of Dental and Craniofacial Research (NIDCR)
• Investigators: Principal Investigator: Todd Molfenter, PhD, University of Wisconsin, Madison; Principal Investigator: Chris Okunseri, BDS, MSc, MLS, DDPHRCSE, Marquette University

Study record dates

Study Major Dates

• Study Start (Actual): April 4, 2025
• Primary Completion (Estimated): January 31, 2029
• Study Completion (Estimated): January 31, 2029

Study Registration Dates

• First Submitted: August 22, 2024
• First Submitted That Met QC Criteria: August 29, 2024
• First Posted (Actual): September 3, 2024

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 13, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Underserved; Patients That Don't Attend Appointments; Dental Patients; No-Show
• Other Study ID Numbers: 2024-1502; A195010 (Other Identifier: UW Madison); 2024-1086 (Other Identifier: Previous IRB number); 4UH3DE030531-03 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No