A major product of the Summit is the Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health. The Consensus Statement affirms the significant influence of behavioral and social factors on dental, oral, and craniofacial health. In addition, and most importantly, the Consensus Statement outlines the essential research focus areas and critical next steps that experts agree are most likely to maximize the impact of behavioral and social sciences for the promotion of oral health. The Consensus Statement is intended to stimulate future work that will achieve the Summit's vision of promoting oral health globally by advancing the robust application of behavioral and social sciences.
An initial, working draft of the Consensus Statement was developed by the Summit's Steering Committee, comprised of the same people who served as session chairs for the Summit. The Consensus Statement was proposed in draft form at the Summit, discussed there, and subsequently vetted online during a public open comment period that included submission of recommendations from interested stakeholders. All feedback then was considered by the Summit Steering Committee and the Consensus Statement was iteratively refined. The final version, which appears below, was unanimously approved by the Steering Committee. Following a month-long open endorsement period, the Consensus Statement will be submitted for publication. Members of the Summit Steering Committee will be listed as authors of the published Consensus Statement, and all endorsers will be acknowledged in a list that accompanies the Statement as a supplement.
The endorsement period is open until July 16, 2021. All interested parties are welcome to participate in the endorsement phase. That is, endorsements on behalf of an individual (i.e., personal endorsement) and endorsements on behalf of an organized group (e.g., research group, advocacy group, NGO, official agency, corporation, other stakeholder group) will both be accepted. It is not necessary for endorsers to have participated in the Summit or in the draft Consensus Statement feedback process in order to endorse the final Statement. It is hoped that there will be a broad, international constituency of endorsers.
The Consensus Statement appears below and on the online endorsement form; the published version will be linked here once available. Return to this site regularly for updates on the status of Consensus Statement production. For questions, contact Drs. Daniel W. McNeil (firstname.lastname@example.org) and Cameron L. Randall (CLR333@uw.edu).
CONSENSUS STATEMENT ON FUTURE DIRECTIONS FOR THE BEHAVIORAL AND SOCIAL SCIENCES IN ORAL HEALTH
Behavioral and social factors are critical interactive determinants of dental, oral, and craniofacial health (hereafter referred to as oral health). Behavioral and social factors also are central to oral health promotion efforts and oral healthcare service delivery—and, as such, oral health equity. A comprehensive understanding of such factors requires consideration of influences at individual, family, community, group, regional, national and global levels. The following factors, among others, interact in complex ways to determine oral health: psychological phenomena; social, historical, cultural, and environmental contexts; and commercial, economic, and political forces. To achieve optimal oral health globally, there is consensus that action is needed to advance and further integrate behavioral and social sciences as applied to oral health, healthcare, and training, specifically through research related to the following four areas of emphasis.
Behavioral and social theories and mechanisms related to oral health
The relevance of behavioral (e.g., knowledge, attitudes, beliefs, emotions) and social (e.g., economic, corporate, political, cultural) factors to oral health is widely accepted, but not well understood across disciplinary groups in dentistry, dental hygiene, allied oral healthcare, and beyond. The limited set of theories attempting to explain oral health behaviors focuses too heavily on individual, proximal explanations of behavior, often without attention to the broader determinants of health, including both the social determinants (e.g., gender, race, socioeconomic status, class) and the mid-range determinants (e.g., family networks, social groupings, community values). Research on the social determinants of health has adopted broad frameworks and theoretical models that propose causal pathways from social factors to oral health and disease, but these pathways are complex to test and frequently ignore social and political theories of power and inequalities. In order to advance the understanding of how behavioral and social factors shape oral health, more 'middle range' theories are needed, and these theories should be testable. Such theories would reach beyond the individual, and specify detailed causal pathways bridging the proximal and distal determinants, reflecting the complex nature of oral health.
Use of multiple and novel methodologies in social and behavioral research and practice related to oral health
As types and sources of data available in oral health research become broader and more complex, so do the methodological opportunities and challenges faced by oral health researchers. To reach beyond our current understanding of the multifactorial and multidimensional relationships that impact oral health and oral health disparities, several goals related to research methodology should be prioritized. First, efforts are needed to develop a theoretically based core of clinically relevant outcomes and health service delivery measures, incorporating value-based and patient-reported outcomes whenever possible. Relatedly, efforts to create and validate useful gold standard measures must continue and expand. Ideally, researchers will engage with diverse qualitative, quantitative, and mixed-methods data approaches. Moreover, researchers will adopt methods for testing theories related to the cognitive, affective, and motivational basis of behavior. Finally, those engaged in behavioral and social oral health research will utilize causal analyses, complex systems science, and community-engaged research to account for the individual, environmental, and structural factors, as well as policies, that all interact to produce oral health outcomes. A robust, efficient, and integrated research approach is required—one that assesses and calibrates methods in relation to the need for data which focuses on behaviors within clinical and public health settings. Researchers’ ultimate goal should be to improve oral health worldwide by producing high-quality research that is both theoretically sound and clinically and socially relevant, with subsequent translation into practice.
Development and testing of behavioral and social interventions to promote oral health
Twenty-first century interventions to promote oral health should focus on both the individual and population levels to address person-centric, community, societal, structural, systemic, and environmental factors affecting oral health. Interventions should be scalable—yet customized and tailored to individuals and systems, while also attending to cultural factors—in order to promote optimal dissemination, implementation, engagement, behavior change, and sustainability. Technological approaches, such as mobile health, telehealth, bioinformatics, precision medicine, and predictive analytics/ machine learning have the potential to contribute to both intervention customization and diffusion through large systems, expanding reach to underserved populations, including those who are affected by health inequities. Effectiveness of interventions is enhanced by involving multiple groups (e.g., the target population, key stakeholders, external advisors in separate but related fields) at every stage of intervention development and testing, by designing interventions using a theoretical framework, by measuring the requisite testable mechanisms of change, and by ensuring treatment fidelity. Interventions should focus not only on individuals and systems that are ready and resourced for change, but also on building motivation and skills among individuals and systems that are not motivated to change, ambivalent about change, or are unaware that change is needed. In addition to interventions that leverage traditional contexts and existing infrastructure (e.g., dental and medical settings), interventions that involve novel and innovative channels for reaching both individuals and populations (e.g., in the context of public housing, use of social media) need further study. Priority should be given to the development of new interventions, or culturally-adapted existing evidenced-based interventions, for at-risk and disadvantaged communities, including racialized and ethnicized groups, refugees, rural populations, people with disabilities, those with low income and low literacy, and others who are minoritized or marginalized. Future oral health intervention research should also involve the application and testing of theories and intervention elements that have been shown to be effective in other healthcare disciplines.
Dissemination and implementation research for oral health
Rigorous and systematic research on how to implement evidence-based information and practices is essential for accelerating the rate at which scientific developments reach individuals and communities. In some cases—and given the complexity of healthcare delivery and daily life—such research will be necessary for ensuring that the benefits of science are realized at all. Impactful dissemination and implementation (D&I) research in oral health will prioritize meaningful involvement of stakeholders, consideration of global and local context, contemporary study designs, characterization of causal mechanisms, and precisely specified and high-quality methods. Moreover, this research will be interdisciplinary and will embrace multidirectional interactions among researchers, community members, practitioners, and public policy makers. There are significant opportunities at the intersection of D&I science and oral health to: (1) apply recent advances in D&I research to improve dental care delivery, oral health programs, and the use of robust behavioral approaches for oral health promotion in both clinical and community settings; and (2) advance D&I theory, methods, and practice by carrying out such research to improve oral health. There are also opportunities to use D&I research to leverage behavioral and social “big data” to reduce oral health inequities, as well as to inform public health and policy approaches that support upstream action and a commitment to equity. In taking advantage of these opportunities, the match of evidence-based practices and policies to people, their communities, and health service delivery systems will be maximized to achieve optimal oral health for all.
Overarching Considerations and Conclusions
The behavioral and social sciences have an essential role in oral health. Promoting oral health maximally and globally requires the sustained robust application of behavioral and social sciences. Furthermore, as knowledge evolves, the advancement and refinement of concepts and methodologies—and the effective and efficient translation of research to practice—is critical. Moreover, to continue to advance science and practice, integration of the behavioral and social sciences in the education, training, and mentoring of all oral health clinicians and researchers is vital.
Historically, the behavioral sciences have been closely aligned with dentistry as a profession. Up to now, major focus areas of this alignment have been patient communication, fear assessment and reduction, evaluation and amelioration of pain, and adherence, among other topics. Sociological approaches historically have emphasized dentistry as a profession, dental public health policy, and oral healthcare access, utilization, and experiences among various groups. These issues, which were emphasized with early conferences, remain important in oral health research and practice; they should continue to be investigated and new or refined assessment tools and interventions should be developed. Nevertheless, the inclusion of the behavioral and social sciences as applied to oral health must be further extended.
Multi- and trans-disciplinary collaborative and integrative efforts (including interprofessional ones) will be required to achieve the advances outlined in this Consensus Statement. Such work often is complex, as it requires dissolving academic, professional, industry, and systems-based silos. Truly integrating behavioral and social sciences in dental disciplinary, public health, and health services research is particularly challenging and may best be accomplished by the full inclusion of behavioral and social scientists and practitioners on research and other teams and dental program faculties, including in leadership positions.
The behavioral and social sciences encompass numerous fields, and so their application in oral health should be broad and far-reaching. The ideal application would be inclusive of those disciplines historically and typically involved in oral health (e.g., psychology, sociology, economics) and also ones that are less often included (e.g., anthropology, communications, geography, history, linguistics, political science). These and other disciplines (e.g., public health, medicine, law, user experience) can offer their own frameworks and methods to oral health research, sparking new, integrative ideas. Inclusion of a diverse community of constituents, including patients, dental, medical, and other healthcare providers, and policy advocates, will broaden the questions asked and potential answers to be considered.
In these efforts, equitable inclusion across population groups, particularly those who have been marginalized and under-served in oral healthcare and research, is much needed. Involvement of minority racial, ethnic, and cultural groups in research—and sometimes a singular focus on them—is essential for the validity and relevance of research findings for all. Additionally, full inclusion of marginalized people in the oral health research and practice workforce is a pressing need, as representation benefits those served by research and practice. Existing inequities related to social gradients can be addressed, in part, by harnessing the behavioral and social sciences to further change at various system levels, ranging from individual utilization to policy-determined access to even broader social determinants of health. Only with an intentional and increased focus on inequities and inclusivity, and facilitated by the application of behavioral and social science perspectives, can disparities be eliminated to achieve good oral health for all.
Ultimately, it will be imperative to optimize the translation of oral health research evidence related to the behavior of individuals, families, communities, and groups into improved clinical approaches, systems-level practices, and effective public policies for prevention and treatment. Robustly applying and integrating behavioral and social sciences in oral health research, training, and practice has the potential to shift the predominant current focus on dental, oral, and craniofacial diseases and disorders (even if prevention oriented) to include more positive aspects of oral health (e.g., wellness, resilience). Broadly, the behavioral and social sciences have much to offer in promoting oral health globally. Their full integration into oral health research and practice will require multifaceted approaches as well as sustained intensive efforts; however, the effects will be transformative.