Targeted implementation strategies are needed to fully realize the benefits of evidence-based practice and the appropriate use of dental sealants by dental providers. The long-term goal of our program of research is to foster the effective implementation of evidence-based guidelines in large, multi-site dental practices. The first step and objective of this proposal is to design an implementation strategy for the American Dental Association?s (ADA) pit-and-fissure sealant guideline targeting root causes of low rates of adherence by dental providers. The central hypothesis is that guiding clinics in selecting their own implementation strategy, based on the EPIS implementation framework and Lewin?s theory for organizational change, will increase dental providers? uptake of this guideline. The rationale for our proposal is that once we identify an effective implementation process for this guideline, we can adapt the process for other evidence-based guidelines in dental practice. By the completion of the study, we expect to have evaluated the feasibility and acceptability of a process for developing site-specific implementation strategies and the effectiveness of an implementation strategy to increase implementation of the ADA?s pit-and-fissure sealant guideline among providers in a large, multi-site dental practice. Determining the effectiveness of the process and strategies is expected to have an important positive impact, because it is likely that the findings will contribute toward better oral health for patients through the development of implementation strategies for other guidelines. The goal of Aim 1 is to identify the forces and group dynamics influencing Permanente Dental Associates (PDA) providers? current clinical practices relative to the ADA?s pit and fissure guideline. Our approach will be to conduct interviews, run focus groups, and conduct surveys at each level of four levels of influence. The goal of Aim 2 is to assess the feasibility and acceptability of a process for developing an implementation strategy for the ADA?s guideline. Our approach will be to pilot test the process in one PDA clinic. The goal of Aim 3 is to determine the effectiveness of an implementation strategy for the ADA?s guideline. Our approach will be to compare the percentage of 8 experimental PDA clinics meeting their target implementation goal with the percentage of 8 control PDA clinics meeting the lowest of the experimental clinics? goals. The immediate contribution of this study is expected to be the development of a process that creates an implementation strategy that is effective in increasing the implementation of the ADA?s pit-and-fissure sealant guideline in a large, multi-site dental practice. This contribution will be significant in a broader manner because it is expected to have broad applicability in facilitating the prevention and treatment of a wide range of oral diseases through enhanced implementation of effective practices.
The proposed research is relevant to public health because with improved implementation of evidence-based clinical practice guidelines, a wide range of oral diseases will be prevented or treated more effectively. The project is relevant to NIDCR?s mission which includes supporting translational research: the need that the new treatments and research knowledge that the NIDCR supports through its basic and clinical research programs actually reach the patients or populations for whom they are intended and are implemented correctly.