Achieving consensus on priorities for future behavioural and social research into social inequalities—Results of polling attendees at the BEHSR/IADR Summit on Behavioral and Social Oral Health Sciences
Abstract
Aim
To explore the priority given by researchers working in the field of behavioural, epidemiological and health services research to key aspects of research in oral health and inequalities.
Method
Survey of registrants at the Behavioural Epidemiological and Health Services Research group of the International Association for Dental Research (BEHSR/IADR) Summit October 2020.
Findings
The highest ranking for priority was given to ‘Testing interventions to reducing oral health inequalities’, and within this area to the exploration of public health approaches to reducing such disparities. Lower ranking priorities included ‘Describing inequalities within countries’ and ‘Describing the mechanisms by which inequality produces poor health’.
Conclusions
Registrants at the (BEHSR/IADR) Summit October 2020 gave priority to testing interventions which will seek to reduce oral health inequalities, particularly through public health approaches such as creating policy change and community level interventions. Epidemiological research describing inequalities within countries was given a lower priority.
1 INTRODUCTION
- Application of social survey technology, namely, the public opinion poll, questionnaire construction and analysis:
- Development of health education research, primarily that concerning influences of mothers on children and pressures of peer groups for conformity:
- Orientation towards problem analysis and problem solving in human relations:
- Management by objectives and education by objectives, particularly in relation to dental curricula and the use of dental teams for treating patients:
- Testing procedures for recruitment of personnel and criteria for selecting dental and auxiliary students:
- Application of situation analyses to facilitate planning for large public efforts, such as community water fluoridation and national delivery of health care: (Ref. [1], p.251).
- Behavioural and social theories and mechanisms related to oral health.
- Use of multiple and novel methodologies in social and behavioural research and practice related to oral health.
- Development and testing of behavioural and social interventions to promote oral health.
- Dissemination and implementation research for oral health (Ref. [2], 2022).
There is a notable shift from the use of the methods of behavioural science to address specific topics towards a more general development of an approach to addressing issues of importance in dentistry and broader healthcare. The reasons for this are unclear but may reflect a greater awareness of the complex multi-disciplinary nature of the challenges faced by dental and oral researchers, and the necessity to develop theoretical and methodological approaches to the systematic observation and analysis of such issues. This may also be part of a movement from the contribution of behavioural and social sciences to dentistry (behavioural sciences for dentistry) towards what Exley3 has termed {behavioural sciences} ‘… of oral health and healthcare’ (our emphasis and application of Exley's argument from Sociology alone to the wider behavioural sciences).
A particular area of note is the interest in the development and testing of behavioural and social interventions to promote oral health. There have been advances in incorporating social, mid-level and individual level theory into our understanding, as well as methodological and epidemiological advances. With this increasing sophistication, we are driven to develop more sophisticated measures of key constructs, complex statistical modeling and qualitative approaches.4-6
The aim of this paper is to explore the priority given by researchers working in the field of behavioural, epidemiological and health services research to key aspects of research in oral health and inequalities.
2 METHOD
Behavioural, Epidemiological and Health Services Research group of IADR summit held on 29 and 30 October, 2020, provided the opportunity to present the findings of the consensus working group, to the researchers working in the fields of social behavioural sciences across the globe, and to ask for their priorities within the theme of ‘Behavioural & Social theories and mechanisms related to Oral Health’. Participants within the summit were asked their perceptions of various initiatives within this theme. For a full list of the polling questions, see Appendix 1. The questions and the a priori response categories were developed by the Summit workgroup through a process of group discussion and feedback.
A synchronous, online survey was conducted of all individuals attending the symposium, using the polling software within the online conference package. There were over 400 attendees (some of which were asynchronous and therefore would not have participated in the online survey) at the symposium, from 57 countries. For further details on the registrants and attendees at the symposium, see the supplemental material that accompanies McNeill et al.2
Unfortunately, the polling software did not record absolute numbers of respondents but gave percentage responses within each answer category. The data were summarized into tables giving proportion of responses for each of the answer categories.
3 FINDINGS
Table 1 below summaries perceptions of priorities for future research in oral health inequalities. Areas involved in taking action to address inequalities emerged as the most popular areas for development, with a very small proportion of respondents endorsing further description of inequalities at the country level as a priority.
| Response | % (Rank) |
|---|---|
| Describing the presence of inequalities in my country | 3% (5) |
| Exploring the relationship between inequalities in oral health and key psychological, behavioural and social factors | 22% (3) |
| Describing the mechanisms by which inequality creates poor health | 15% (4) |
| Testing interventions to reduce oral health inequalities | 32% (1) |
| Critically examining upstream action on inequalities in oral health | 28% (2) |
Taking each of the areas identified in Table 1 and exploring them in greater detail, Table 2 explores components of describing the presence of inequalities. Priority was given to identifying the economic burden of oral disease and producing standard measures of social and demographic characteristics. There was less interest in cross-country comparisons, perhaps reflecting the interest in interventions, which presumably would be enacted at the country level.
| Response | % Voting highesta (Rank) | % Voting lowesta (Rank) |
|---|---|---|
| Standardizing measures of disease | 29% (4) | 38% (2) |
| Standardizing measures of social and demographic characteristics | 41% (2) | 25% (5) |
| Standardizing the analytical approaches used | 23% (5) | 31% (3) |
| Providing regular surveys of the status of a country | 31% (3) | 30% (4) |
| Comparisons across countries | 18% (6) | 41% (1) |
| Identifying the economic burden of oral disease | 48% (1) | 16% (6) |
- a Since respondents could give either one or two responses, totals may add up to more than 100%.
Understanding the economic burden of oral disease and it is relationship to oral health, as well as the links between general and oral health were both identified as highly ranked within the research area exploring the relationship between oral health and social, behavioural and psychological factors (Table 3).
| Response | % Voting highesta (Rank) | % Voting lowesta (Rank) |
|---|---|---|
| Improving statistical methods to describe relationships (Multi-level modelling) | 38% (3) | 52% (1) |
| Increasing the range of variables included as correlates of oral health | 38% (3) | 52% (1) |
| Linking Oral Health and General Health | 56% (1) | 39% (3) |
| Identifying the correlates of the economic burden of oral disease | 52% (2) | 32% (4) |
- a Since respondents could give either one or two responses, totals may add up to more than 100%.
The area, ‘Describing the mechanisms by which inequality creates poor health’ was overall a lower priority area for researchers. Within this area, greatest emphasis was placed on incorporating causal mechanisms into interventions (reflecting the priority given to interventions) and translating models into theories of causality (Table 4).
| Response | % Voting highesta (Rank) | % Voting lowesta (Rank) |
|---|---|---|
| Increasing use of process measures and experimental designs to better understanding the causes of oral health inequalities | 33% (3) | 45% (1) |
| Supporting research that tests specific, falsifiable theories about the causes and outcomes of oral health inequalities | 29% (4) | 45% (1) |
| Translating multi-level, socioecological models into specific, testable theories of the causes of oral health inequalities | 47% (2) | 19% (5) |
| Incorporating tests of causal mechanisms into community-based and effectiveness research | 53% (1) | 22% (4) |
| Incorporating tests of causal mechanisms into dissemination and implementation research | 29% (4) | 42% (3) |
- a Since respondents could give either one or two responses, totals may add up to more than 100%.
The highest priorities for testing interventions were given to testing the impact of legislation and testing the impact of community-based interventions, suggesting a priority to public health focussed initiatives (Table 5) Traditional fluoride-based interventions were given a lower priority for research, perhaps reflecting a perception of a more established research base for such interventions.
| Response | % Voting highesta (Rank) | % Voting lowesta (Rank) |
|---|---|---|
| Testing interventions to change the behaviour of individuals delivered in a dental practice setting | 36% (3) | 37% (4) |
| Testing interventions to change the behaviour of individuals delivered in a general medical setting | 28% (4) | 34% (5) |
| Testing interventions based on water fluoridation | 10% (7) | 58% (1) |
| Testing interventions based on topical fluoride treatments delivered in a dental practice setting | 4% (8) | 49% (2) |
| Testing interventions based on topical fluoride treatments delivered in a community setting (schools etc.) | 28% (4) | 17% (6) |
| Testing the impact of changes in legislation (e.g., sugar tax) | 70% (1) | 11% (8) |
| Testing the impact of community-based interventions targeted at achieving social change (e.g., building social capital, increased employment, city wide initiatives) | 70% (1) | 12% (7) |
| Testing the impact of collaborations with industry (e.g., toothpaste, mouthwash composition) | 24% (6) | 39% (3) |
- a Since respondents could give either one or two responses, totals may add up to more than 100%.
The final set of questions asked about the priority area exploring upstream actions on inequalities. There was an even distribution of priorities, with all suggestions obtaining at least 25% of the votes. The top priority areas reflect approaches to involving key stakeholders (political actors and the public) in creating change (see Table 6).
| Response | % Voting highesta (Rank) | % Voting lowesta (Rank) |
|---|---|---|
| The development of new approaches to critical policy analysis to examine the role of political actors (parties, corporate bodies, NGOs) in the development of upstream interventions | 48% (1) | 28% (3) |
| An examination of the role of power in relation to upstream action | 25% (5) | 50% (1) |
| To evaluate participatory approaches to change in the social determinants of health (co-production, decolonizing methodologies) | 48% (1) | 27% (4) |
| Developing and testing complex interventions that draw on emerging theories and approaches in social science (social practice theory, normalization process theory, the social model of health) | 42% (3) | 26% (5) |
| Examination of the use of big data and simulation studies for the design of complex interventions | 36% (4) | 47% (2) |
- a Since respondents could give either one or two responses, totals may add up to more than 100%.
4 DISCUSSION
The 74th World Health Assembly approved a resolution on oral health that recommends a shift towards a preventive approach and asked that the World Health Organization develop a draft global strategy on tackling oral diseases and an action plan for oral health including the development of effective and economically viable interventions.7 The priorities identified by respondents reflect this call for action. The traditional, and important areas, for epidemiological inquiry of describing inequalities and the mechanisms by which they create poor oral health were given a relatively low priority in comparison to future research exploring the impact of interventions designed to reduce inequalities in oral health. The respondents gave particular emphasis to interventions based on creating change at policy and public health levels, including environments to promote community level physical, social and psychological well being. The lower emphasis placed on epidemiological research describing inequalities within countries may reflect a perception that the evidence base for such inequalities is well established (see for example https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm).
It is important to note that the rankings made by the registrants, were forced choice ratings and therefore reflect relative rather than absolute priorities. Therefore, it is more correct to interpret the findings as speaking to the priority for particular areas of research rather than the absolute priority given to each area. It is also a potential limitation that areas other than those identified by the Summit workgroup are perceived as important by the research community. This may be particularly the case for topics that are of high importance for particular communities, but not for the more general global research community.
The findings of this survey support the trend in oral epidemiological, behavioural and health services research towards a more sophisticated understanding of the multi-level nature of the causal networks underlying the relationship between social inequality and poor oral health.5 Having moved from the goals outlined by Cohen1 whereby the descriptive analyses offered by social and behavioural science supported the efforts to improve oral health, to a situation where social and behavioural science is seen as fully integrated and essential in understanding, developing and testing interventions to reduce social health inequalities.
ACKNOWLEDGEMENTS
The author acknowledges the insights and contributions of Barry Gibson, The University of Sheffield and Melissa Riddle, from the National Institutes of Health/National Institute of Dental and Craniofacial Research as well as the many researchers, clinicians, academics, policy makers and others who attended the Behavioural, Epidemiological and Health Services Research group of IADR summit held on 29 and 30 October 2020.
FUNDING INFORMATION
The authors received no financial support for the research, authorship and/or publication of this article.
CONFLICT OF INTEREST
The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
APPENDIX 1: POLLING QUESTIONS
- Describing the presence of inequalities in my country.
- Exploring the relationship between inequalities in oral health and key psychological, behavioural and social factors.
- Describing the mechanisms by which inequality creates poor health.
- Testing interventions to reduce oral health inequalities.
- Critically examining upstream action on inequalities in oral health.
- Standardizing measures of disease.
- Standardizing measures of social and demographic characteristics.
- Standardizing the analytical approaches used.
- Providing regular surveys of the status of a country.
- Comparisons across countries.
- Identifying the economic burden of oral disease.
- Standardizing measures of disease.
- Standardizing measures of social and demographic characteristics.
- Standardizing the analytical approaches used.
- Providing regular surveys of the status of a country.
- Comparisons across countries.
- Identifying the economic burden of oral disease.
- Improving statistical methods to describe relationships (Multi-level modelling).
- Increasing the range of variables included as correlates of oral health.
- Linking Oral Health and General Health.
- Identifying the correlates of the economic burden of oral disease.
- Improving statistical methods to describe relationships (Multi-level modelling).
- Increasing the range of variables included as correlates of oral health.
- Linking Oral Health and General Health.
- Identifying the correlates of the economic burden of oral disease.
- Increasing use of process measures and experimental designs to better understanding the causes of oral health inequalities.
- Supporting research that tests specific, falsifiable theories about the causes and outcomes of oral health inequalities.
- Translating multi-level, socioecological models into specific, testable theories of the causes of oral health inequalities.
- Incorporating tests of causal mechanisms into community-based and effectiveness research.
- Incorporating tests of causal mechanisms into dissemination and implementation research.
- Increasing use of process measures and experimental designs to better understanding the causes of oral health inequalities.
- Supporting research that tests specific, falsifiable theories about the causes and outcomes of oral health inequalities.
- Translating multi-level, socioecological models into specific, testable theories of the causes of oral health inequalities.
- Incorporating tests of causal mechanisms into community-based and effectiveness research.
- Incorporating tests of causal mechanisms into dissemination and implementation research.
- Testing interventions to change the behaviour of individuals delivered in a dental practice setting.
- Testing interventions to change the behaviour of individuals delivered in a general medical setting.
- Testing interventions based on water fluoridation.
- Testing interventions based on topical fluoride treatments delivered in a dental practice setting.
- Testing interventions based on topical fluoride treatments delivered in a community setting (schools).
- Testing the impact of changes in legislation (e.g., sugar tax).
- Testing the impact of community-based interventions targeted at achieving social change (e.g., building social capital, increased employment, city wide initiatives).
- Testing the impact of collaborations with industry (e.g., toothpaste, mouthwash composition).
- Testing interventions to change the behaviour of individuals delivered in a dental practice setting.
- Testing interventions to change the behaviour of individuals delivered in a general medical setting.
- Testing interventions based on water fluoridation.
- Testing interventions based on topical fluoride treatments delivered in a dental practice setting.
- Testing interventions based on topical fluoride treatments delivered in a community setting (schools etc).
- Testing the impact of changes in legislation (eg sugar tax).
- Testing the impact of community -based interventions targeted at achieving social change (e.g., building social capital, increased employment, city wide initiatives).
- Testing the impact of collaborations with industry (eg toothpaste, mouthwash composition).
- The development of new approaches to critical policy analysis to examine the role of political actors (parties, corporate bodies, NGOs) in the development of upstream interventions.
- An examination of the role of power in relation to upstream action.
- To evaluate participatory approaches to change in the social determinants of health (co-production, decolonizing methodologies).
- Developing and testing complex interventions that draw on emerging theories and approaches in social science (social practice theory, normalization process theory, the social model of health).
- Examination of the use of big data and simulation studies for the design of complex interventions.
- The development of new approaches to critical policy analysis to examine the role of political actors (parties, corporate bodies, NGOs) in the development of upstream interventions.
- An examination of the role of power in relation to upstream action.
- To evaluate participatory approaches to change in the social determinants of health (co-production, decolonizing methodologies).
- Developing and testing complex interventions that draw on emerging theories and approaches in social science (social practice theory, normalization process theory, the social model of health).
- Examination of the use of big data and simulation studies for the design of complex interventions.
Open Research
DATA AVAILABILITY STATEMENT
Data are not available.
