Evaluating Evidence-Based Practices in a Community Dental Clinic Network

Thesis Abstract

This study investigates the integration and impact of evidence-based practices (EBPs) within a network of community dental clinics serving diverse urban and peri-urban populations, addressing persistent gaps between guideline development and routine clinical decision-making. The problem is the underutilization of EBPs in primary dental care, which may contribute to variability in treatment quality and health outcomes. The aim is to evaluate how EBPs are adopted, implemented, and sustained across the network, and to identify determinants, barriers, and facilitators influencing adherence. Specific objectives include (1) quantifying the prevalence of guideline-concordant procedures across clinics, (2) examining clinicians’ knowledge, attitudes, and self-reported practices related to EBPs, (3) assessing organizational factors—leadership, teamwork, and information systems—that predict EBP uptake, (4) exploring patient outcomes associated with EBP use, and (5) generating actionable recommendations to strengthen implementation. The study will employ a mixed-methods design underpinned by the Knowledge-to-Action (KTA) framework and the Diffusion of Innovations theory to capture the multi-level processes involved in moving EBPs from evidence to practice. A convergent parallel design will be used, with quantitative data collected from 15 community clinics within the network and their 180 participating clinicians, alongside qualitative data from 40 semi-structured interviews with clinicians, managers, and governing board members, and 12 focus groups with patients. The target population comprises licensed dental clinicians, clinic managers, and patients who receive routine dental care in the network over a 12-month period. A stratified random sampling approach will recruit 60 clinicians and 12 clinic managers, complemented by purposive sampling for interview and focus group participants to ensure representation by clinic size, urban/rural location, and clinician discipline. Data collection will utilize standardized instruments and records review. Quantitative measures include (a) a clinic-level EBPs adherence index derived from chart audits of 1,200 patient records (covering preventive, restorative, and periodontal guidelines), (b) the Evidence-Based Practice Knowledge and Attitudes Scale for Oral Health Professionals, (c) the Organizational Readiness for Change scale, and (d) electronic health record (EHR) data on patient outcomes such as caries incidence, periodontal status, and preventive service uptake. Qualitative data will be generated through semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) and focus groups, with thematic analysis conducted to extract barriers, enablers, and contextual nuances. Validity and reliability will be ensured via triangulation, inter-rater coding checks (Cohen’s kappa > 0.80 for coding consistency), pilot testing of instruments, and data provenance through audit trails. Statistical analyses will include descriptive statistics to profile EBP adherence, multilevel linear and logistic regression to examine associations between organizational determinants and EBP uptake, and hierarchical modeling to assess patient outcomes while accounting for clustering at clinic and provider levels. Subgroup analyses will explore differences by clinic size, location, and clinician discipline. The qualitative component will use thematic analysis with constant comparison, generating a conceptual matrix that maps CFIR constructs to observed implementation processes and outcomes. Integration of quantitative and qualitative findings will occur at interpretation, using a joint display to illustrate convergent, divergent, and complementary results. Expected findings include (a) variable but generally moderate adoption of EBPs across the network, with higher fidelity in clinics with strong leadership support and robust EHR prompts; (b) positive associations between organizational readiness, access to continuing education, and EBP adherence; (c) improved patient outcomes in clinics demonstrating higher EBP fidelity, particularly in caries prevention and periodontal maintenance; (d) identified barriers such as time constraints, perceived patient noncompliance, and limited access to decision support tools, balanced by enablers including formal protocols, multidisciplinary teams, and targeted feedback mechanisms; and (e) evidence that patient engagement and trust mediate the relationship between EBP use and outcomes. The study contributes to knowledge by integrating organizational science with clinical dentistry to elucidate how EBPs diffuse in community settings, identifying modifiable determinants at clinician, clinic, and network levels, and providing a validated measurement framework for EBP adherence in dental care. The findings will inform practical recommendations for policy and practice, including the development of standardized EBP implementation checklists, enhanced EHR-based decision support, tailored continuing education, and leadership development programs. The main conclusion anticipates that sustaining EBPs in community dental networks requires a systemic alignment of leadership, resources, process redesign, and continuous performance feedback, with patient-centered engagement as a critical mediator. Recommendations emphasize scalable implementation strategies, investment in data infrastructure, and ongoing evaluation cycles to close the gap between evidence and everyday practice.