Barriers to the adoption of the ART approach as perceived by dental practitioners in governmental dental clinics, in Tanzania

OBJECTIVES: This study aimed to determine the magnitude of the barriers to the practice of Atraumatic Restorative Treatment (ART) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of ART. MATERIAL AND METHODS: A validated and tested questionnaire on barriers that may hinder the practice of ART was administered to 20 practitioners working in 13 pilot clinics. Factor analysis was performed to generate barrier factors. These were patient load, management support, cost sharing, ART skills and operator opinion. The pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by ART approach. These treatment records were used to compute the percentage of ART restorations to total teeth treated, percentage of ART restorations to total teeth restored and percentage of total restorations to total teeth treated. The mean barrier scores were generated and compared to independent variables, using the t-test. The influence of barriers to ART-related dependent variables was determined using Pearson correlation coefficients. RESULTS: Mean barrier values were low, indicating low influence on ART practice. Female practitioners had higher scores on patient load than male practitioners (p = 0.003). Assistant Dental Officers had higher scores on cost sharing than Dental Therapists (p = 0.024). Practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). All barrier factors were negatively correlated with ART practice indices but all had insignificant association with ART practice indices. CONCLUSION: The barriers studied were of low magnitude, with no significant impact on practice of ART in dental clinics in the pilot area.

Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART) in Tanzania

The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5 percent. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2 percent of dental practitioners felt that ART was worth introducing in Tanzania, 92.8 percent recommended ART training for all dental practitioners and 97.8 percent recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3 percent, 28.1 percent and 90.6 percent of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.