Abstract
Objectives: COVID-19 infection control measures have been recommended for dental practices worldwide. This qualitative study explored barriers and enablers for the implementation of these measures in German dental practices. Methods: Semi-structured phone interviews were conducted in November/December 2020 (purposive/snowball sampling). The Theoretical Domains Framework (TDF) and the Capabilities, Opportunities and Motivations influencing Behaviors model (COM-B) were used to guide interviews. Mayring’s content analysis was employed to analyze interviews. Results: All dentists (28–71 years, 4/8 female/male) had implemented infection control measures. Measures most frequently not adopted were FFP2 masks, face shields (impractical), the rotation of teams (insufficient staffing) and the avoidance of aerosol-generating treatments. Dentists with personal COVID-19 experience or those seeing themselves as a role model were more eager to adopt measures. We identified 34 enablers and 20 barriers. Major barriers were the lack of knowledge, guidelines and recommendations as well as limited availability and high costs of equipment. Pressure by staff and patients to ensure infection control was an enabler. Conclusions: Dentists are motivated to implement infection control measures, but lacking opportunities limited the adoption of certain measures. Policy makers and equipment manufacturers should address these points to increase the implementation of infection control measures against COVID-19 and potential future pandemics.
Highlights
We developed an interview guide based on the Theoretical Domains Framework (TDF) [25,26] and the Behavior Change Wheel (BCW) [27]
The present study employed qualitative interviews and analyses along the TDF and the BCW to understand capabilities, opportunities and motivation shaping the implementation of ICM around COVID-19 in German dental practices
The interviewed dentists were highly motivated to implement ICM, but a lack of knowledge and opportunities limited the adoption of certain efficacious measures
Summary
The Robert Koch Institute (www.RKI.de; accessed on 26 January 2021) judged its risk to the German population as low to moderate in February 2020, and as high or—for risk groups—very high in March. Since these early days of the pandemic, governments have imposed various policies to contain the pandemic. Dental practices have been concomitantly subjected to various legislative and self-governing measures with the aim to reduce the risk of infection of patients, providers and staff These measures focus on adjusting infrastructure and organization (plexiglass walls, air ventilation, longer appointments, staff rotations, reduction of high-risk activities) and personal protection equipment of staff and patients (PPE) [1].
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