Results from a cluster-randomized, stepped-wedge trial testing a deliberative engagement intervention to increase guideline adherence among U.S. oral health providers

Dental sealants, an evidence-based clinical practice, can arrest occlusal non-cavitated carious lesions (NCCLs); however, U.S. oral health providers rarely provide this treatment. To increase providers' adoption of the practice, clinic leaders need to identify implementation strategies to deploy. Using a stepped wedge design across 16 cluster-randomized dental clinics, we examined whether small-group deliberative engagement enabled 680 oral health providers and staff to endorse implementation strategies and to increase placement of dental sealants on occlusal NCCLs. Participants deliberated about two barriers and eight implementation strategies. Sealant placement for occlusal NCCLs was extracted from the electronic health record. After deliberating, 49% of participants endorsed the first barrier and 37% endorsed the second barrier. Of those, 26% indicated a strategy was needed for the first barrier and 28% indicated a strategy was needed for the second. Consistent with this perceived lack of need for strategies, leaders did not deploy implementation strategies. Compared with the non-intervention period (98 clinic-months), in the intervention period (101 clinic-months), providers did not increase placement of sealants on occlusal NCCLs. Deliberative engagement may help clinic leaders efficiently evaluate support for implementation strategies, but future research is needed to determine how to increase guideline adoption.Trial Registration: This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 18/12/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.