Using interviews to construct and disseminate knowledge of oral health policy.

OBJECTIVES: Policymakers worldwide are challenged by the problem of oral health inequities. The goal of an interprovincial partnership in Canada was to guide policy aimed at improving the oral health of vulnerable populations. Insights regarding barriers and enablers to developing such policy in one province (Newfoundland & Labrador, Canada) were required to enhance collaboration between decision makers and researchers and to contribute to the evidence informing policy development. METHODS: Snowball technique identified fourteen key informants. Semistructured audio-recorded interviews were conducted in person or by telephone. Two researchers independently conducted the analyses of the transcribed interviews, one using NVivo software and the second, manual coding. Triangulation of the analyses confirmed the findings. RESULTS: Agreement between the two approaches showed that most key informants believed that oral health is an important policy issue; however, most felt it was not a high priority among the general public and most were unable to articulate the policy process. Barriers to oral health becoming a governmental priority were related to resource allocation and to poor communication among some groups including dentists and dental hygienists. Current government programmes and initiatives were praised but considered weak in health promotion strategies. Recommendations for enhancing oral health priority varied. CONCLUSIONS: Attention to the methodological considerations of qualitative research enhanced the credibility of the method and confidence in the findings. Leveraging of existing programmes and improving communication were recommended to contribute to raising the priority of oral health within the government, thereby increasing their commitment to address oral health care, particularly for vulnerable populations.

Dental hygienists' research utilization: influence of context and attitudes.

BACKGROUND: Research use is a core component of evidence-based practice (EBP), contributing to improved patient outcomes; however, we know little about factors influencing research use among dental hygienists. The purpose of this study is to examine whether individual's attitudes and organizational context influence dental hygienists' research use. METHODS: A cross-sectional survey design was used to study research use among a geographically stratified probability sample of 1100 Canadian dental hygienists. A translated French-language version was provided for Francophone dental hygienists. Descriptive and inferential analyses were performed using SPSS. RESULTS: Mean responses were highest for conceptual research use (RU) (4.1), followed by overall RU (3.7), direct RU (3.3), and persuasive RU (3.3), on a five-point Likert scale. Internal consistency reliability for attitude and context scales was high (Cronbach's alpha 0.86 and 0.83, respectively). Repeated measures t-tests found significant differences between willingness to implement research and frequency of actually implementing research (P < 0.001 for paired comparisons), and ratings of importance of supportive practice characteristics were significantly higher than their actual presence (P < 0.001 for paired comparisons). A multiple linear regression model found the variables attitude, context, and years of practice explained 19.0% of the variation in responses. DISCUSSION: Significant differences between willingness to implement research and actual implementation, and between perceived importance of supportive practice characteristics and their presence, require exploration of these differences. CONCLUSION: These findings support the importance of the practice context and individual attitudes for research uptake by dental hygienists. Knowledge translation theories can inform further research and contribute greater explanatory power to this preliminary model.

A dialectical analysis of an art of dental hygiene practice.

OBJECTIVE: There has been little in the literature to date that speaks of an art of dental hygiene compared to science. Yet, science, conceived as the findings from research, does not apply itself; it is the knowledge, judgement and skill of practitioners to apply these findings in a particular setting that, at its highest level, informs artful dental hygiene practice. The purpose of this paper is to question whether an art of dental hygiene exists, if it is important, and how it relates to science. METHODS: The method used in the analysis contained in this paper is a dialectical approach used to examine contrary positions, i.e. whether art exists or does not exist, by outlining the structure of each position and clarifying explicit and implicit similarities and dissimilarities. A framework of conceptualizations of art from nursing has been used to examine dental hygiene literature for evidence of art. RESULTS: A preliminary conceptualization, substantiated within dental hygiene, sees the art of dental hygiene as abilities to grasp meaning in client encounters, establish meaningful connections with clients, perform dental hygiene actions skillfully and proficiently, rationally determine courses of dental hygiene action, and conduct dental hygiene practice morally and ethically. CONCLUSIONS: That an art of dental hygiene exists is not in doubt and the analysis is presented. To understand better how dental hygienists make practice decisions to develop this process to its optimum - the pursuit of perfection and excellence in dental hygiene practice, we must pursue understanding the art of dental hygiene practice.

A discourse on the nature of dental hygiene knowledge and knowing.

OBJECTIVE: Historically, dental hygiene has adopted theory and research from other health disciplines, without adequately modifying these concepts to reflect the unique dental hygiene practice context, leaving dental hygiene's research and theory base underdeveloped. Dental hygiene has yet to articulate its epistemological assumptions--the nature, scope and object of dental hygiene knowledge--or to fully describe the patterns of knowing that are brought to practice. METHODS: This paper uses a method of inquiry from philosophy to begin the discourse about dental hygiene ways of knowing. In nursing, Carper identified four fundamental patterns of knowing: empirics or the science of nursing; aesthetics or the art of nursing; personal knowledge and ethical or moral knowledge. These patterns were used to explore this concept within dental hygiene. RESULTS: There is more to the nature of dental hygiene knowledge and knowing than rote application of technique-related or research-based information in practice, including judgements about when and how to use different types of information that are used. Currently, empirical forms of knowledge seem to be disproportionately valued, yet evidence was found for all of Carper's four patterns of knowing. CONCLUSIONS: Carper's work on patterns of knowing in nursing provided a useful framework to initiate the discourse on ways of knowing in dental hygiene. These results are submitted for others to challenge, refine and extend, for continuing the discussion. Dental hygiene leaders and scholars need to engage in discourse about extending the epistemological assumptions to reflect reality.

A pilot study of research utilization practices and critical thinking dispositions of Alberta dental hygienists.

UNLABELLED: In order to test interventions for increasing uptake of research findings into dental hygiene practice, we must first identify factors that influence research use. There has been little work on this topic in dental hygiene, but much in other disciplines that can provide exemplars of how others have approached the study of this phenomenon. OBJECTIVES: A pilot study was conducted to determine if protocols used to study research utilization (RU) behaviours and critical thinking dispositions (CTD) in nursing could also be applied to dental hygiene. METHODS: A cross-sectional survey design was used with a random sample of 640 practicing dental hygienists in Alberta, Canada. Three questionnaires were included: one to capture measures of RU including direct, indirect and symbolic RU; the California Critical Thinking Dispositions Inventory (CCTDI) and a demographics questionnaire. RESULTS: Mean responses for the three types of RU were highest for indirect at 3.52 (SD 0.720), followed by direct at 3.13 (SD 0.903) and symbolic 2.86 (SD 0.959). The majority (74.8%) scored between 280 and 350 on the CCTDI (maximum 420). Cronbach's alpha reliability for the RU measures and four of the seven sub-scales were over .7, indicating internal consistency reliability. CONCLUSIONS: The instruments proved reliable for this population, but other challenges, including a low response rate, were identified during the process of using the RU questionnaire in the context of dental hygiene practice. Pilot testing identified the need for improvements to the presentation of scales to reduce cognitive load and improve the response rate.

An argument for dental hygiene to develop as a discipline.

UNLABELLED: The practice of dental hygiene was developed to provide oral health education and preventive oral health care, originally for children. It has grown to provide oral health services valued by a broad spectrum of society, but has not attained the desired respect and status accorded to other professional groups. OBJECTIVE: Professional disciplines link actions of practitioners with the science that is the foundation of practice. The purpose of this paper is to examine whether dental hygiene practice could benefit from pursuit of development as a discipline. METHODS: Literature on professionalization and disciplines, related to dental hygiene in general and the North American context specifically, was retrieved from databases and grey sources, such as organizational reports. Dental hygiene's current characteristics relative to a discipline were examined. RESULTS: Dental hygiene has developed some characteristics of a discipline, such as identifying a metaparadigm that includes concepts of the client, the environment, health/oral health and dental hygiene actions, with a perspective that includes a focus on disease prevention and oral health promotion. However, research production by dental hygienists has been limited, and often not situated within theoretical or conceptual frameworks. CONCLUSION: Dental hygiene draws its knowledge for practice from a variety of sources. Dental hygiene could strengthen its value to society by prioritizing development of highly skilled researchers to study interventions leading to improved oral outcomes, and transferring that knowledge to practitioners, strengthening links between practice and science. Intentional pursuit of knowledge for practice would lead to dental hygiene's eventual emergence as a professional discipline.

A proposed model for a collaborative approach to dental hygiene research.

As dental hygiene responds to the increased need for quality oral health services, dental hygienists seek quality research findings on which to base their practice decisions. However, the amount of research published by dental hygienists, and addressing dental hygiene interventions, remains limited. There are few dental hygienists in Canada working in positions that have time dedicated to research activities. To increase the amount of dental hygiene research, innovative approaches such as collaborative research must be considered. This paper considers measures that facilitate the conduct of collaborative research, and discusses challenges to the process that should be considered during the design. An example of a group investigation is presented, involving dental hygiene educators who collaborated on a research project implemented within their respective educational institutions. A model for a collaborative approach to future research initiatives is proposed. Lessons learned are shared and recommendations are put forward. It is suggested that innovative collaborations such as this may help to increase the body of knowledge for dental hygiene in Canada.