Nonpharmacological techniques to support patients with intellectual developmental disorders to receive dental treatment: A systematic review of behavior change techniques.

Abstract

To identify the nonpharmacological patient-support techniques (nPSTs) reported, used or recommended for people with intellectual-developmental-disorders (IDD) to receive dental treatment; to identify their active ingredients and evaluate their effectiveness by adopting an existing taxonomy of behavior-change techniques (BCTs). Following a protocol, a search strategy was undertaken using Medline, Embase, Cochrane Library, Scopus, Cinahl, and Psychinfo (EBSCO). Selection criteria were applied, with review and extraction in duplicate. A comprehensive list of nPSTs were identified and coded by their constituent behavior-change techniques (BCTs), where BCT-taxonomy-Version-1 criteria were satisfied. Quality assessment was undertaken and effectiveness of BCTs reported. From 915 screened articles, 23 were included. In 207 instances nPSTs were identified, representing 46 distinct nPST techniques, such as positive-reinforcement (n=18) and tell-show-do (n=9). Of the 207 nPST codes, 135 were coded as BCTs (65.2%). The most commonly coded BCT was demonstration of the behavior (BCT6.1; n=25). Considering studies of interventions (n=11), all were at moderate to critical risk of bias. No interventions or outcome measures were comparable across studies. This is the first review to bring together techniques dentists use in practice and theory-driven BCTs. A significant overlap between nPSTs and BCTs was evident supporting the use of BCT taxonomy to code dental interventions. No strong evidence supporting any intervention was identified.