A Survey of the Barriers Affecting the Career Practice and Promotions of Female Dentists in Saudi Arabia.

INTRODUCTION: Over the last 40 y, the proportion of women in the profession of dentistry has been growing steadily. The extant literature, although limited, demonstrates that gender differences exist in choice of specialization, practice pattern, and professional attitudes, revealing that women are more likely to work in primary dental care and are less prominent in other dental specialties. Female Saudi dentists, working in the government sector, tend to occupy lower positions in the occupational hierarchy, are paid less, and are less likely to hold consultant positions as compared with men. OBJECTIVES: The objectives of this study were to identify barriers faced by female dentists practicing in Saudi Arabia in seeking professional advancement and to determine the variables that influenced respondents' promotions. METHODS: In February 2017, a web-based cross-sectional survey was emailed to all female dentists registered with the Saudi Dental Society ( N = 2,651). Completed questionnaires ( N = 130, response rate = 7.1%) were analyzed with simple summary statistics and a logistic regression analysis to evaluate the association between the dependent variable (promotion) and independent variables (family, environmental, interpersonal, and cultural factors). RESULTS: Most female dentists believed that family, environmental, and cultural factors are challenges to their career practice and progression. Other factors included interpersonal challenges, such as gender discrimination and male dominance in the field of dentistry. Results of the regression analysis revealed that family and environmental factors were significant predictors of whether female dentists would be promoted. CONCLUSION: Saudi female dentists continue to face significant obstacles in their career practice and advancement. Their role in the workplace needs to be recognized. Factors that obstruct their career advancement should be well understood by dental institutions and efforts should be made to move more female dentists into leadership positions. KNOWLEDGE TRANSFER STATEMENT: Policy makers can use the results of this study to develop strategies to overcome the barriers faced by female dentists in Saudi Arabia with respect to their professional and personal (family) needs. This study could lead to the development of employment incentives and a supportive workplace for female dentists.

Towards an assessment for organizational participatory research health partnerships: A systematic mixed studies review with framework synthesis.

Within the health sciences, organizational participatory research (OPR) is defined as a blend of research and action, in which academic researchers partner with health organization members. OPR is based on a sound partnership between all stakeholders to improve organizational practices. However, little research on the evaluation of OPR health partnership exists. This systematic mixed studies review sought to produce a new theoretical model that structures the evaluation of the OPR processes and related outcomes of OPR health partnerships. Six bibliographic databases were searched together with grey literature sources for OPR health partnership evaluation questionnaires. Six questionnaires were included, from which a pool of 95 OPR health partnership evaluation items were derived. The included questionnaires were appraised for the quality of their origin, development and measurement properties. A framework synthesis was performed using an existing OPR framework by organizing questionnaire items in a matrix using a hybrid thematic analysis. This led to our proposed Organizational Participatory Research Evaluation Model (OPREM) that includes three axes, Trust, Collective Learning and Sustainability (with specific dimensions) and 95 items. This model provides information to help stakeholders comprehensively structure the evaluation of their partnerships and subsequent improvement; thus, potentially helping to improve health organization practices.

Ecological content validation of the Information Assessment Method for parents (IAM-parent): A mixed methods study.

This mixed methods study content validated the Information Assessment Method for parents (IAM-parent) that allows users to systematically rate and comment on online parenting information. Quantitative data and results: 22,407 IAM ratings were collected; of the initial 32 items, descriptive statistics showed that 10 had low relevance. Qualitative data and results: IAM-based comments were collected, and 20 IAM users were interviewed (maximum variation sample); the qualitative data analysis assessed the representativeness of IAM items, and identified items with problematic wording. Researchers, the program director, and Web editors integrated quantitative and qualitative results, which led to a shorter and clearer IAM-parent.

Are There Barriers for Professional Development of Women Dentists? A Qualitative Study in Saudi Arabia.

Globally, there is an upward trend in the number of women applying to dental schools and entering the profession of dentistry. Women dentists aim to advance their careers; however, differences exist between men and women dentists regarding leadership positions and work titles. For example, in Saudi Arabia, women usually occupy lower ranked positions than men in the Saudi public sector, and they are, therefore, paid less than their male counterparts. This study aimed to explore the possible barriers to Saudi women dentists' professional advancement using a qualitative descriptive study design. Specifically, semistructured in-depth interviews were conducted with 13 women practicing dentistry in the Makkah region of Saudi Arabia. The interviews were audio-recorded and transcribed verbatim, and the data were interpreted using qualitative content analysis (NVivo 11; QRS International). The results revealed 4 challenges that might delay the participants' career development. These include family-related challenges, sociocultural challenges, workplace challenges, and transportation issues. From this perspective, some perceived barriers to the professional development of women dentists were found that might not be unique to Saudi Arabia, and the article's suggestions and recommendations aim to minimize the effects of these barriers impeding women's advancement in dentistry in Saudi Arabia. Knowledge Transfer Statement: This study makes an important contribution to knowledge on this topic. These results will aid policy makers' efforts to create supportive work environments through gender-specific incentives that meet the current professional and family needs of women dentists, particularly those in Saudi Arabia.

A systematic review of interventions promoting clinical information retrieval technology (CIRT) adoption by healthcare professionals.

PURPOSE: This paper presents the evidence on the effectiveness of interventions promoting the use of clinical information retrieval technologies (CIRTs) by healthcare professionals. METHODS: We electronically searched articles published between January 1990 and March 2008 using following inclusion criteria: (1) participants were healthcare professionals; (2) specific intervention promoted CIRT adoption; (3) studies were randomised controlled trials, controlled clinical trials, controlled before and after studies or interrupted time series analyses; and (4) they objectively reporting measured outcomes on CIRT use. RESULTS: We found nine studies focusing on CIRT use. Main outcomes measured were searching skills and/or frequency of use of electronic databases by healthcare professionals. Three studies reported a positive effect of the intervention on CIRT use, one showed a positive impact post-intervention, and four studies failed to demonstrate significant intervention effect. The ninth study examined financial disincentives, and found a significant negative effect of introducing user fees for searching MEDLINE in clinical settings. A meta-analysis showed that educational meetings were the only type of interventions reporting consistent positive effects on CIRT adoption. CONCLUSION: CIRT is an information and communication technology commonly used in healthcare settings. Interventions promoting CIRT adoption by healthcare professionals have shown some success in improving searching skills and use of electronic databases. However, the effectiveness of these interventions remains uncertain and more rigorous studies are needed.

Tensions associated with the use of electronic knowledge resources within clinical decision-making processes: a multiple case study.

CONTENT AND OBJECTIVE: Health professionals now routinely use electronic knowledge resources (EKRs). Few studies have considered EKR-related tensions which may arise in a clinical decision-making context. The present study aims to explore three types of tension: (1) user-computer tension, (2) social tensions, and (3) organizational tensions (constraints associated with organizational routines and health policies). DESIGN, PARTICIPANTS, INTERVENTION, SETTING: We conducted a multiple case study, examining Family Medicine residents' searches for information in everyday life. Cases were defined as critical searches for information among 17 first year family medicine residents using InfoRetriever 2003/2004 on a PDA over 1.5 months at McGill University. InfoRetriever-derived information was used within a resident-patient decision-making context in 84 of 156 cases. For each case, residents were interviewed, and extracts of interview transcripts were assigned to themes using specialized software (presence of tension; type of tension). Further computer-assisted lexical-semantic analysis was performed on transcripts. Authors reached consensus on assignments. RESULTS: Twenty-five cases with tension were identified (one case had two types of tension), and illustrate the above mentioned types of tensions: (T1) tension between the resident and InfoRetriever (N=16); (T2) InfoRetriever-related tension between the resident and other social actors, specifically supervisors, other health care professionals and patients (N=7); (T3) InfoRetriever-related tension between the resident and the health organization/system (N=3). CONCLUSIONS: Results suggest EKR usage in a clinical decision-making context may have negative consequences when three types of tension arise in a clinical decision-making context. Illustrated types of tension are interrelated and not mutually exclusive. Awareness of EKR-related tensions may help clinicians to integrate EKRs in practice.

[Assessing program sustainability in public health organizations: a tool-kit application in Haiti]. / Evaluer la pérennité des programmes de santé publique: un outil et son application en Haïti.

BACKGROUND: Public health stakeholders are concerned about program sustainability. However, they usually conceive sustainability in accordance with financial criteria for at least one reason. No simple frameworks are operationally and theoretically sound enough to globally evaluate program sustainability. The present paper aims to describe an application of one framework assessment tool used to evaluate the sustainability level and process of a Nutritional Care Unit managed by a Swiss humanitarian agency to fight against severe child malnutrition in a Haitian area. The managing agency is committed to put this Unit back into the structure of a local public hospital. METHODS: The evaluation was performed within the sustainability framework proposed in a former article. Data were collected with a combination of tools, semi-structured interviews (n=33, medical and support staff from the agency and the hospital), participatory observation and document review. Data concerned the four characteristics of organizational routines (memory, adaptation, values and rules) enabling assess to the level of sustainability. In addition, data were related to three types of events distinguishing routinization processes from implementation processes: specific events of routinization, routinization-implementation joint events, and specific events of implementation. Data analysis was thematic and results were validated by actors through a feed-back session and written comments. RESULTS: The current level of sustainability of the Nutritional Care Unit within the Hospital is weak: weak memory, high adaptation, weak sharing of values and rules. This may be explained by the sustainability process, and the absence of specific routinization events. The relevance of such processes is reasonable, while it has been strongly challenged in the troublesome Haitian context. Riots have been widespread over the last years, creating difficulties for the Hospital. CONCLUSION: This experience suggests the proposed framework and sustainability assessment tools are useful when the context permits scrutinization of program sustainability.

Program sustainability: focus on organizational routines.

Program sustainability is an ongoing concern for most people in health promotion. However, the current notion of sustainability in organizations, namely routinization, needs refinement. This article examines organizational routines. In so doing, it refines the notion of sustainability and the assessment of routines. Drawing on the organizational literature, a routinized program is defined by the presence of routinized activities, meaning that these activities exhibit four characteristics of organizational routines: memory, adaptation, values and rules. To answer the question of how these characteristics are useful, we conducted an empirical study of the routinization of the Quebec Heart Health Demonstration Project in five community health centers. Our method consisted of a multiple-case study. We observed project activities in each center in 2000. The data came from documents and interviews with project actors. Our results show that, in one of the centers, no resources had been officially committed to project activities. Even so, the actors continued some activities on an informal basis. In another center, the activities satisfied three of the four routine characteristics. In the three others, activities satisfied all of the characteristics. These results suggest focusing the study of program sustainability on the routinization of activities resulting from it. They indicate four distinct degrees of sustainability: (1) the absence of sustainability; no program activity is continued; (2) precarious sustainability; some residual activities are pursued, at least unofficially; (3) weak sustainability; the program produces some official activities that are not routinized; and (4) sustainability through routinization; routinized activities result from the program.

How information retrieval technology may impact on physician practice: an organizational case study in family medicine.

RATIONALE: Information retrieval technology tends to become nothing less than crucial in physician daily practice, notably in family medicine. Nevertheless, few studies examine impacts of this technology and their results appear controversial. AIMS AND OBJECTIVES: Our article aims to explore these impacts using the medical literature, an organizational case study and the literature on organizations. METHODS: The case study was embedded in an evaluation of the implementation of medical and pharmaceutical databases on handheld computers in a Canadian family medicine centre. Six physicians were interviewed on specific events relative to the use of these databases and on their general perception of impacts of this use on clinical decision making and the doctor-patient relationship. A thematic data analysis was performed concomitantly by both authors. RESULTS AND CONCLUSION: Findings indicate six types of impact: practice improvement, reassurance, learning, confirmation, recall and frustration. These findings are interpreted in accordance with both a medical and organizational perspective. The fit with the literature on inter-organizational memory supports the transferability of the findings. In turn, this fit suggests how information retrieval technology may change physician routine. This study suggests a new basis for evaluating the impact of information retrieval technology in daily clinical practice. In conclusion, our paper encourages policy-makers to develop, and physicians to use, this technology.

[Mental and behavior disorders in children placed in long term care institutions in Hunedoara, Cluj and Timis, Romania]. / Les troubles mentaux et les troubles du comportement des enfants placés en établissement de long séjour dans les judets de Hunedoara, Cluj et Timis, Roumanie.

This article originated from a descriptive study done in 1992-1993 in Romania. The study was initiated and coordinated by the French NGO "Médecins du Monde", was directed by three health organizations (the "Observatoire régional de la santé de Languedoc-Roussillon", the "Unité 265 INSERM", the Romanian League for Mental Health) and was granted by the Romanian government and the European Community Commission. There are many publications about children's mental and behavioural disorders. But there are few epidemiological studies concerning the prevalence of these disorders among children suffering from social difficulties. This article explores the prevalence of mental and behavioral disorders among Romanian children institutionalized and examines specifically the prevalence among children in homes for children ("Casa de Copii") to compare it with similar data published in other countries. First, this article explores the prevalence of mental and behavioral disorders among a population of 4.692 children institutionalized in three Romanian districts in 1992. Second, this article examines the prevalence of these disorders among a population of 1.610 children institutionalized in homes for children ("Casa de Copii"), i.e. 1,610 children ages ranging from 4 to 18 years and suffering from social difficulties. Homes for children are out of home care institutions which are specialised neither in physical deficiencies nor in mental disorders. From this population, a randomized sample of 508 children has been screened by physicians and psychologists based on an evaluation protocol. Then each disorder has been coded as a diagnosis, according to the Tenth International Disease Classification (WHO). Fifty-four percent (54%) of the children institutionalized in homes for children in three Romanian districts in 1992 had a main diagnosis of mental or behavioural disorder. Third, this article compares our results to the prevalence found in other studies. Only three studies could be selected for comparison because they were the only ones with the three following criteria: 1) a focus on a population of children or a randomized sample of children ages ranging from 4 to 18 years, 2) a focus on children suffering from social difficulties and living in out of home care, 3) disorders evaluated by health professionals or a validated methodology. Our results lies within the range of prevalence found in the literature (41-70%). A discussion follows regarding methodological matters and critiques that may be launched from such a comparative designs. Finally, the high frequency of institutionalization in Romania in 1992 illustrates how few solutions there were to social difficulties and how exaggerated institutionalization was. This was a very different situation compared to Western Europe and Northern America. This should not hide, however, the actual modifications that took place in Romania. This article concludes with a brief description of the modifications which have been generated by the evaluation protocol used here.

[How to favor clinical research in pedopsychiatry? An experience of a cooperative action-research.]. / Comment favoriser la recherche clinique en pédopsychiatrie? Une expérience de recherche-action collaborative.

Clinical evaluative research are far too few. In this article, the authors describe a research process likely to favor its multiplication. They report on a case study of a process resembling a cooperative action-research led by a group of clinicians in pedopsychiatry. With the results and in the light of caracteristics of action-research, they explain why and how this group of clinicians has succeeded in establishing a research process. The lessons drawned from this experience are numerous. The authors conclude by proposing a cooperative action-research as a model that all clinicians could apply to a clinical study.