Barriers to and Facilitators for the Use of Research Evidence in Oral Health Policies and Guidelines: An International Qualitative Study
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<p>OBJECTIVES: To explore perceived barriers to and facilitators for using research evidence to inform guidelines and policies in oral health (OH) reported by guideline developers and policymakers.</p><p>METHODS: An abductive reasoning approach utilising in-depth semi-structured interviews was used. Interviewed individuals had a high-level understanding of the processes involved in developing OH evidence-informed guidelines and policy documents, including methodological steps and workflow. Purposive sampling was used to select participants with experience generating national or regional documents from different continents. Interviews were recorded and transcribed verbatim. After validation, data were analysed thematically using NVivo software. Transcriptions were coded and collated into themes and subthemes, with coding saturation achieved after coding all transcripts and confirming that no new codes emerged.</p><p>RESULTS: Participants worked in seven organisations across Europe, North America, and South America, including professional associations, scientific societies, governmental, and global organisations. Participants' perceptions were classified into seven main themes: research evidence (availability of evidence synthesis, direct and local evidence, certainty of the evidence and emerging research evidence), guidelines and policy documents (accessibility to guidelines, documents terminology, question scope and methodological rigour), organisational and system-level (costs, availability and accessibility to needed expertise, workload, health system characteristics, circumstances and events, and pressures), contact and collaboration (relationship with non-governmental organisations, research centers, governmental institutions and users), guidelines and policies users (evidence-informed decision-making (EIDM) expertise, attitudes toward EIDM, inclusion of patients' perspectives), guideline developers and policymakers (attitudes toward EIDM, autonomy, responsibility and expectations, and self-Interested behaviour), and others (OH in the context of overall health and use of technology). Several reported barriers were specific to the OH field, including dental professionals' resistance to changing practice (acquiring new dental materials), absence of patient advocacy organisations in OH, an overemphasis on personalised treatment planning, overvaluation of surrogated outcomes, challenges with dental device regulations, limitations in incorporating economic evaluation for decision-making at a population level, disconnect between evidence-based care and coverage, low priority given to OH by authorities and the public, and lack of communication between dental and non-dental professionals.</p><p>CONCLUSIONS: Understanding particular challenges hindering the integration of research evidence into guideline and policy document development processes is critical to improving their quality. Similarly, awareness of facilitators can aid in formulating strategies to enhance this process and counter barriers.</p><p>TRIAL REGISTRATION: Open Science Framework (DOI: 10.17605/OSF.IO/W4KG7).</p>
Keywords
clinical practice guidelines, evidence-based dentistry, evidence-informed guidelines, oral health policies, qualitative research