Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics

Deborah E Polk, Erick G Guerrero, Inga Gruß, Nilesh H Shah, Nadia M Yosuf, Tim Dawson, Charles D Kaplan, Daniel J Pihlstrom, Jeffrey L Fellows, Deborah E Polk, Erick G Guerrero, Inga Gruß, Nilesh H Shah, Nadia M Yosuf, Tim Dawson, Charles D Kaplan, Daniel J Pihlstrom, Jeffrey L Fellows

Abstract

Background: The American Dental Association (ADA) recommends dental providers apply dental sealants to the occlusal surfaces of permanent molars for the prevention or treatment of non-cavitated dental caries. Despite the evidence-based support for this guideline, adherence among general dentists is low, ranging from less than 5 to 38.5%. Thus, an evidence-to-practice gap exists, and it is unclear which implementation strategies would best support providers in adopting and implementing the evidence-based practice. One potential approach to selecting and tailoring implementation strategies is a deliberative loop process, a stakeholder-engaged approach to decision-making. This trial aims to test the acceptability, feasibility, and effectiveness of using a deliberative loop intervention with stakeholders (i.e., providers and staff) to enable managers to select implementation strategies that facilitate the adoption of an evidence-based dental practice.

Methods: Sixteen dental clinics within Kaiser Permanente Northwest Dental will be cluster randomized to determine the timing of receiving the intervention in this stepped-wedge trial. In the three-part deliberative loop intervention, clinic stakeholders engage in the following activities: (1) receive background information, (2) participate in facilitated small-group discussions designed to promote learning from each other's lived experiences and develop informed opinions about effective clinic-level implementation strategies, and (3) share their informed opinions with clinic leaders, who may then choose to select and deploy implementation strategies based on the stakeholders' informed opinions. The primary outcome of Reach will be defined as patient-level receipt of guideline-concordant care. Secondary outcomes will include the cost-effectiveness, acceptability, and feasibility of the deliberative loop process. Implementation strategies deployed will be catalogued over time.

Discussion: These results will establish the extent to which the deliberative loop process can help leaders select and tailor implementation strategies with the goal of improving guideline-concordant dental care.

Trial registration: This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://ichgcp.net/clinical-trials-registry/NCT04682730.

Keywords: Dental caries; Dental sealants; Implementation strategy; Oral health; Study protocol.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Conceptual model. Note. Blue denotes barriers targeted by the deliberative process intervention, gold denotes facilitators, and red denotes mechanisms proposed to be influenced by the intervention
Fig. 2
Fig. 2
Schedule of exposure of clinics by cluster to the intervention
Fig. 3
Fig. 3
CONSORT flow diagram
Fig. 4
Fig. 4
Example of information provided in the workbook for one implementation strategy. Note. (a) A rating of the level of evidence supporting the strategy. (b) A brief description of the strategy. (c) An anchor to the barrier(s) the strategy could address. (d)Who delivers the strategy. (e) Who engages in the strategy. (f) A summary of existing assets at KPD relevant to the strategy. (g) A unique badge for the strategy

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Source: PubMed

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