A Realist Review on Implementation Strategies in Increasing Teledentistry Adoption in Dental Practices
K. Arunagiri, P. Allison, P. Kengne Talla.
Faculty of Dental Medicine and Oral Health Sciences, Ï㽶ÊÓƵ.
Rationale: Timely access to oral health care that aligns with patients’ expectations is paramount for a robust oral health care system. Teledentistry has emerged as a promising and cost-effective approach to enhance equity and improve the quality of care. Despite evidence supporting teledentistry's effectiveness, its adoption remains challenging. Understanding the dynamics of clinical environments in teledentistry implementation is crucial to distinguishing what strategies work for whom and under what circumstances, highlighting the necessity of a theory-based approach to enhance evidenceinformed practices and policies.
Objectives: The purpose of this review is to understand the critical contextual factors, mechanisms, and outcomes (CMOs) to successful teledentistry implementation in dental practices and to provide recommendations to maximize its adoption. Specifically, we will outline: i) implementation strategies to improve the adoption of teledentistry; ii) mechanisms by which teledentistry results in its intended or unintended outcomes; and iii) contextual factors that result in successful outcomes for teledentistry. Methodology: We will conduct this realist review, a theory-based approach, following Pawson and Tilley’s framework. The search strategy will be done with an expert librarian. Data sources will include Medline (Ovid), Embase, CINAHL, PsychInfo, the Cochrane Library, and grey literature from ProQuest. We will not apply any restrictions on population, language, publication date, or study design. We will include any teledentistry modalities, such as synchronous and asynchronous approaches. Two independent people will screen, select, and extract data. Data synthesis will be conducted according to Realist and Meta-review Evidence Synthesis: Evolving Standards (RAMESES) guidelines.
Expected results: This review is expected to delineate effective implementation strategies to foster widespread adoption of teledentistry. It will provide a comprehensive understanding of the contextual factors and mechanisms influencing teledentistry’s implementation, offering explicit insights into how and why teledentistry may or may not work within specific contexts, along with a list of relevant outcomes.
Conclusion: To our knowledge, this first realist review of teledentistry will uncover critical components to fill the gap regarding teledentistry’s adoption. These findings will also provide valuable evidence to inform dental practice, dental education, and policymaking.