Concept mapping as a promising method to bring practice into science.

OBJECTIVE: Concept mapping is a method for developing a conceptual framework of a complex topic for use as a guide to evaluation or planning. In concept mapping, thoughts and ideas are represented in the form of a picture or map, the content of which is determined by a group of stakeholders. This study aimed to explore the suitability of this method as a tool to integrate practical knowledge with scientific knowledge in order to improve theory development as a sound basis for practical decision-making. METHOD: Following a short introduction to the method of concept mapping, five Dutch studies, serving different purposes and fields in public health, will be described. The aim of these studies was: to construct a theoretical framework for good regional public health reporting; to design an implementation strategy for a guideline for integral local health policy; to guide the evaluation of a local integral approach of overweight and obesity in youth; to guide the construction of a questionnaire to measure the quality of postdisaster psychosocial care; and to conceptualize an integral base for formulation of ambitions and targets for the new youth healthcare programme of a regional health service. RESULTS: The studies showed that concept mapping is a way to integrate practical and scientific knowledge with careful selection of participants that represent the different perspectives. Theory development can be improved through concept mapping; not by formulating new theories, but by highlighting the key issues and defining perceived relationships between topics. In four of the five studies, the resulting concept map was received as a sound basis for practical decision-making. CONCLUSIONS: Concept mapping is a valuable method for evidence-based public health policy, and a powerful instrument for facilitating dialogue, coherence and collaboration between researchers, practitioners, policy makers and the public. Development of public health theory was realized by a step-by-step approach, considering both scientific and practical knowledge. However, the external validity of the concept maps in place and time is of importance.

Using the Maslach Burnout Inventory among dentists: burnout measurement and trends.

OBJECTIVES: To extend our knowledge about the applicability of the Maslach Burnout Inventory (MBI) among dentists and to investigate trends in burnout risk among dental professionals. METHODS: The structure of the MBI is examined among two independent, representative samples of dentists (n = 493 and 497, respectively). Moreover, results are compared to those of other independently-practicing health professionals (i.e., general practitioners and physiotherapists). In addition, the percentage of dentists that are at risk for burnout are compared in samples from 1997, 2000, and 2001. RESULTS: Correlations between the Emotional Exhaustion and Depersonalization subscales among dentists were higher than those found elsewhere. Additionally, a considerable increase in burnout risk was found since 1997. CONCLUSIONS: It was confirmed that the MBI can be considered a suitable instrument for use among dentists. It is argued that certain specific aspects of entrepreneur-like occupations are reflected in deviating responses to the MBI. Given the clear increase in burnout risk found, this topic should remain under investigation among dentists.

Outcome of career expectancies and early professional burnout among newly qualified dentists.

OBJECTIVES: To measure burnout development, outcome of expectations with regard to dental career and feelings of being unprepared for practice among newly graduated general dental practitioners. METHODS: In 1997, 50 dentists were approached to fill in the Maslach Burnout Inventory, Dutch version (UBOS) and some additional variables between six months and one year after graduation at the Academic Centre for Dentistry Amsterdam (ACTA) (76% response). Six years later, in 2003, the same 50 dentists, plus another 60 who had graduated in the same period at ACTA, were approached (78% response). RESULTS: Using Repeated Measures analysis, mean scores of dentists for whom two measurements were available on the three UBOS subscales (N=24) showed no statistically significant changes over six years on Emotional Exhaustion, Depersonalisation, or Personal Accomplishment. The same was true for group means of all in 1997 (N=33) compared with all in 2003 (N=82). However, according to manual criteria, varying percentages (7.2% - 24.4%) of dentists showed an unfavourable level on either one of the UBOS dimensions. Factors most frequently mentioned to be responsible for being unprepared for practice were: law and insurance matters (61.2%), practice organisation (56.6%) and staff management (55.2%). Most frequently reported factors that came out (much) worse than expected were: stressfulness of work (45.1%), and staff management (43.4%). CONCLUSIONS: Burnout appears no threat for the average newly qualified dentist. However, some individuals report alarmingly high burnout scores at an early professional stage. Practice management is the professional aspect about which young professionals worry most. It is recommended that dental schools pay attention to practice management skills and the stressfulness of work in the curriculum. Also, longitudinal monitoring of dental students and newly qualified dentists on burnout development is strongly advocated.

Job resources in Dutch dental practice.

AIM: To develop an instrument measuring job resources among dentists, and to assess the relative importance of these resources and relate them to job satisfaction. METHODS: 848 Dutch general dental practitioners (GDPs) received a questionnaire to monitor work experiences, including the Dentists' Experienced Job Resources Scale (DEJRS, 46 items, score range: 1 (not satisfying) to 5 (very satisfying), and the Dentist Job Satisfaction Scale (DJSS, 5 items, Cronbach's alpha = 0.85). RESULTS: A total of 497 (58.6%) dentists responded. Factor analysis (PCA) on the DEJRS resulted in 8 factors (Cronbach's alpha: 0.75 > alpha < 0.89), representing distinguishable categories of job resources. In rank order: Immediate Results / Aesthetics (M = 4.04, sd = 0.5); (Long-term) Patient Results (M = 4.03, sd = 0.6); Patient Care (M = 3.90, sd = 0.6); Craftmanship (M = 3.77, sd = 0.7); Idealism / Pride (M = 3.65, sd= 0.6); Entrepreneurship (M = 3.55, sd = 0.9); Material Benefits (M = 3.05, sd = 0.7); and Professional Contacts (M = 3.03, sd = 0.7). MANOVA indicated gender differences on: (Long-term) Patient Results (F(1,548) = 10.428, p = .001), and Patient Care (F(1,548) = 11.036, p < .001). Subscale correlations with the total DEJRS are: 0.57 > r < 0.88. All subscales show a positive correlation with the DJSS. DISCUSSION: The DEJRS is a valuable and psychometrically sound instrument to monitor job resources as experienced by GDPs. Dentists report immediate results and aesthetics, and long-term results of working with patients to be the most rewarding aspects. All job resources showed a positive correlation with job satisfaction. The discussion includes conjecture that stimulating a greater awareness of job resources serves a major role in burnout prevention.