Exploring dental hygiene clinical decision making: a mixed methods study of potential organizational explanations
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Background and Purpose: Dental hygienists are targeted for practice expansion to improve public access to oral health care and, therefore, must demonstrate decision making capacity. This study aimed to identify and test the impact of factors influential in dental hygiene decision making. Organizational and gender factors were hypothesized to be most influential. Methods: A phased mixed methods approach was used. Phase I: A series of focus groups were conducted to inform a dental hygiene decision making model, which included key predictor variables and the outcome variable: decision making capacity. Phase II: Aspects of the model were tested via an electronic questionnaire and key informant interviews. Statistical and qualitative thematic analyses were conducted and then findings were merged for interpretation. Results and Interpretation: Focus groups yielded over 75 codes and 6 themes (+ 1 theme from the literature) comprising the model and guiding the survey. The survey had a 38% response rate, and moderate to weak correlations between predictors and the outcome measure were shown. The final statistical model demonstrated Individual Characteristics and graduating from a 3-year program together significantly predicted decision making capacity. When merged with the key informant qualitative data, Individual Characteristics were shown to be a product of broad environmental factors and educational preparation had a particularly strong influence. Conclusions: Individual characteristics and education are predictive of decision making capacity but are outcomes of broad structural influences. Thus, it is recommended that modifications are made to these structures to support dental hygiene decision making in expanded practice.