Public health and private healthcare: a directed content analysis of citizenship behavior in transcripts from online deliberative engagement among oral healthcare providers considering implementation of an evidence-based clinical practice guideline

This study is one component of a multi-year research project directed at increasing oral health providers’ adoption of an evidence-based clinical practice guideline. Research-to-practice gaps present a significant barrier to patients’ receiving quality oral healthcare. Moreover, increasingly in the US, oral healthcare is provided by private corporations employing contracted providers. The relative autonomy of the actors working in these healthcare contexts presents challenges to efforts that support adoption of evidence-based practices. Participatory engagement can usefully support efforts to implement evidence-based practice. How providers orient towards participatory engagement is one challenge not yet considered by researchers. Our analysis sought to discover whether oral health providers exhibited evidence of citizenship behavior (i.e., oriented as citizens) in their deliberations over how to implement an evidence-based clinical practice guideline. We devised and employed a coding scheme based in an Occupational Citizenship Behavior framework to conduct a directed content analysis of transcripts from online deliberative forums among oral healthcare workers who practice within a network of clinics managed by a private healthcare system. In their deliberations, participants exhibited three citizenship behavior types; these behaviors were directed at reinforcing the status quo of relationships, practices, and norms operating in their specific clinics. Further, participants expressed suspicion and fear of outside forces influencing their practice; outside forces included the organization that employs them and professional organizations for oral health providers. An analysis focused on citizenship behavior revealed the reasoning providers advance in relation to their choices about whether and how to implement evidence-based practice guidelines. Moreover, it captured information about barriers and facilitators operating in these providers’ localized contexts (i.e., specific clinics) that had not been captured by other methods. More needs to be learned about the citizenship orientation exhibited by participants. The sense of allegiance expressed by participants to their clinic-as-community and their expressions of suspicion and fear about outside forces seem to pose significant barriers to efforts to implement evidence-based guidelines and to close research-to-practice gaps. The Dissemination and Implementation of Sealant Guidelines in Organizations (DISGO) project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730 .