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IN BRIEF
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This is the first in a series of articles describing how general dental practitioners can get
involved in research and how to go about this.
This article identifies the barriers to conducting research in primary dental care and explores
how these barriers can be overcome.
A useful list of sources of advice for those planning to undertake research in the primary
dental care setting is provided.
1
Research in primary dental care
Part 1: Setting the scene
J. T. Newton1, E. J. Bower2 and A. C. Williams3

There is a growing trend for research to be conducted in primary health settings, to the benefit of patients and healthcare
workers. This article provides an introduction and overview of a series which aims to facilitate research in general dental
practice and to encourage general dental practitioners and other members of the dental team to become involved in these
studies. The benefits of undertaking research are outlined, as well as barriers to becoming involved in such research. It is
argued that many of these barriers can be overcome by encouraging dental practitioners to collaborate with established
researchers in a variety of settings.

Recent initiatives in the NHS funding of research to list a few possible projects. As part of a proj-
RESEARCH IN PRIMARY have placed a greater emphasis on the involve- ect examining research priorities in primary
DENTAL CARE ment of healthcare professionals working in pri- dental care,3 the following areas were identified
mary care.1,2 Instead of research being confined as being important concerns in interviews with
1. Setting the scene to academic institutions and other specialist cen- GDPs:
2. Developing a research tres, healthcare professionals are being encour-
• Motivating patients to attend the practice,
question aged both to undertake research themselves and
both those who do not attend at all and those
to enter into discussions with research institu-
who are irregular attenders.
3. Designing your study tions to identify directions for future research. In
• The development and audit of protocols of
this way it is hoped that research will be relevant
4. Measures care.
to those working directly with patients.
• Reducing high rates of staff turnover (in par-
5. Devising a proposal, This is the first in a series of articles describ-
ticular nursing staff).
obtaining funding and ing why general dental practitioners (GDPs) and
• Examining the impact of information technol-
ethical considerations other members of the dental team working in
ogy in the dental setting (does it improve
primary care should take part in research, and
6. Data analysis patient confidence/satisfaction? Can it be used
how they might go about becoming involved.
for patient education?).
The series aims to provide practical advice for
7. Writing up your research • Reducing patient non-attendance at booked
GDPs as well as a basic introduction to research
appointments.
methods. In this article the authors will provide
an overview of the series as well as detailing the This list may include several topics relevant
1*Professor of Psychology as Applied to importance of research for the dental practition- to your practice, but it may also be that you can
Dentistry, Department of Dental Public er and their team. identify many more topics of greater importance
Health & Oral Health Services Research,
GKT Dental Institute, Caldecot Road,
to your practice.
London SE5 9RW; 2GDP, Staff Dental WHY SHOULD GDPS BECOME INVOLVED IN Research, in different forms, can help to
Service, Eastman Dental Hospital, 256, RESEARCH? address these topics, through:
Gray's Inn Road, London WC1X 8LD; The advantages for the GDP involved in
3Consultant Senior Lecturer in
1. Determining what kinds of questions should
Orthodontics, Department of Child Dental research are not immediately evident, however
be asked. What research is relevant to primary
Health, University of Bristol Dental School, such involvement may provide long-term ben-
Lower Maudlin St, Bristol BS1 2LY dental care?
efits. Participating in research will allow you,
*Correspondence to: Prof. J. T. Newton 2. Improving the quality and quantity of infor-
Email: [email protected] as a GDP, to ensure that you are providing the
mation upon which to base decisions about
best possible care for your patients and to
Refereed Paper your practice, by:
ensure the efficiency of your practice. If you
doi:10.1038/sj.bdj.4811238
© British Dental Journal 2004; 196:
take some time to think about research that • describing the needs of your patients
523–526 might improve your practice, you may be able • describing the outcomes of your care

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• providing information on the effectiveness undertake research.

of new techniques and materials in primary • A lack of available time for research.
care settings • A fear that research would generate paper-
• evaluating cost-effectiveness work.
• Lack of funding
Let us examine some of these in greater
detail. Consider for a moment the population in Let us examine each of these barriers in turn:
the area of your surgery. Some of those people
will be your patients, some will not. How many Incentives
potential patients are there in your area? How As mentioned above, the incentives to carry out
many are children, how many are elderly? What research are not immediately tangible. However,
kinds of treatments are they likely to need over research can form the basis for practice develop-
the next few years? From the results of the latest ment (including seeking funding for service
Adult Dental Health Survey4 we know that only development and evaluation). For example, the
around half the population regularly attend the development of personal dental services
dentist, and that among the group that do not schemes included a component of the evaluation
attend there is more untreated disease than of the impact of these new forms of service pro-
among those who do attend. What would make vision. Identifying the needs of your patients,
your surgery more attractive to those who cur- and potential patients, will allow you and your
rently are not attending (and what impact would practice staff to target your services most effec-
We hope to this have on your current patients)? Two of the tively and maximise your patient-base.
largest barriers to regular attendance that have There is a tradition amongst researchers of
encourage dental been identified are cost and fear.4,5 This leads us sharing their findings with other researchers
professionals to identify further questions about ways of over- through the publication of findings at confer-
working in primary coming these barriers. What systems of payment ences and in journals. The rewards of publica-
would your patients prefer? How could anxious tion are fairly intangible, although it is quite
care to ask questions patients be encouraged to attend the practice? exciting to see your name in print, and to gain
and seek the answers These are all research questions. The methods the recognition of colleagues.
using the skills they that might be used to identify the answers are Doing research as part of a postgraduate
varied and will be described in other articles in qualification is a good way to become involved
already possess this series. in research, and offers the reward of a qualifica-
In choosing materials and equipment to use tion, which may form part of specialist training.
in dental practice, GDPs will generally be guided Finally, the introduction of continuing pro-
by information from a variety of sources. How- fessional development (CPD) requirements pro-
ever, how applicable are sources of information to vides the opportunity to undertake research as
your own general dental practice? For example, part of this process. A large component of any
new impression materials may have fantastic research should include acquiring and reading
qualities in laboratory tests but are they more relevant literature. Through contact with aca-
effective than current materials for taking demic departments and departments of post-
impressions in your practice? Furthermore, are graduate dental education, research can form
any improvements sufficient to justify the part of your CPD.
increased costs?
A recurring theme in this series of articles will Research skills
be the asking of questions. Research at its most Most GDPs are involved in activities which
simple level is about asking questions and find- could be considered to constitute research, but
ing out the answers. We hope to encourage den- which are not traditionally labelled as such. For
tal professionals working in primary care to ask example, a GDP making a decision about pur-
questions and seek the answers using the skills chasing some new equipment will probably read
which they already possess, and to reinforce all the relevant literature about its effectiveness,
these through the articles in this series. and weigh up the costs against the likely bene-
fits. This is a research process. Research is about
WHAT ARE THE BARRIERS TO BECOMING asking questions, and using structured tech-
INVOLVED IN RESEARCH? niques to identify the answers. We hope to
Research by Blinkhorn et al.6 and Jowett et al.7 encourage dental professionals working in pri-
has identified the following barriers to under- mary care to ask questions and seek the answers
taking research in primary care: using the skills which they already possess, and
then reinforce these through the articles in
• Incentives. There is little incentive to under- this series.
take research in primary care. Such incentives
could be financial or related to prestige (for Supporting research
example, postgraduate qualifications). There are many researchers who are keen to col-
• A perception that GDPs lack research skills. laborate with and support those GDPs who wish
• The isolation of GDPs. Related to this, the GDPs to undertake some research. Usually such sup-
interviewed by Professor Blinkhorn and his port could be located within academic centres. If
team suggested that links to other GDPs and you work in an area close to such a centre this
links to the university sector would help them can be very useful. If, however, your practice is

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Table 1 Further and other information

INITIAL CONTACTS OTHER INFORMATION

Faculty of General Dental Practitioners (UK), The Department of Health

Royal College of Surgeons of England, 35-43, www.doh.gov.uk
Lincoln's Inn Fields, London WC2A 3PE
The huge research and development section of this
Contact the Research Officer on 0207 869 6752 or Email: website contains details of government policy and activity
[email protected] regarding research (including research governance).
www.rcseng.ac.uk/dental/fgdp/#research Information on the National Research and Development
Programme for Primary Dental Care can be found at:
Postgraduate Dental Deans www.doh.gov.uk/research/rd3/nhsrandd/timeltdprogs/pcd
A list of postgraduate dental deans and their contact ental/pcdental.htm
details can be obtained from:
www.copdend.org.uk/list/content1/htm The Department of Health supports several excellent
websites which provide a wealth of advice and
UK Federation of Primary Care Research Networks information for researchers:
A list of networks by region can be obtained from: Research funding — this site provides access to health
related research funding opportunities and details awards
www.ukf-pcrn.org from projects/programmes to travel awards.
www.rdinfo.org.uk

Research training — this site details post-qualification

courses and workshops relating to research skills.
www.rdlearning.org.uk

Research advice — RDDirect (0113 295 1122) is a telephone

advisory service and offers advice and help to NHS staff
who are undertaking or thinking about carrying out
research in the health related field. The website also
provides on-line help and links to useful websites.
www.rddirect.org.uk

Royal College of General Practitioners

The research section of this website has a lot of useful
contacts/links and information about research in
primary care.
www.rcgp.org.uk

quite distant from a dental school, it might be Funding

possible to develop support mechanisms Ensuring adequate funding for research projects
through email and the internet. Later in this arti- is a prerequisite for successful research. Fund-
cle we discuss ways of becoming more involved ing can be obtained from dental bodies, manu-
in research, and how to use support networks to facturers, the Department of Health's Research
assist you in undertaking research. and Development programme and other sources.
First-time researchers should consider collabo-
Time and paperwork rating with established, successful researchers There are
These are two important considerations for any when applying for funding. many resources and
GDP, particularly since both are listed as com- contacts available
mon sources of stress.8 The key to undertaking HOW CAN GDPS GET INVOLVED IN RESEARCH?
successful research is, as far as possible, to There are several routes which GDPs can take to
for general dental
ensure that the collection of information does become involved in research. These are not nec- practitioners
not interfere with day-to-day practice. There is, essarily mutually exclusive: interested in
however, an enormous amount of information
routinely collected for other purposes that might
• Contact the research officer at the Faculty of becoming involved
General Dental Practitioners (UK) in research, these will
be used for research. The challenge then is to
• Join a primary care research network
identify resources for collating and analysing
• Establish links to a university department be explored later in
the existing information. Alternatively, if new
• Undertake postgraduate studies this series
information is to be collected, this should be
• Read this series of articles
done as efficiently as possible. This requires
careful consideration of the information which The Faculty of General Dental Practitioners
is necessary (a common mistake is to collect too (FGDP) (UK) is keen to promote research in gen-
much information which is unwieldy and ineffi- eral dental practice and has appointed regional
cient), and consideration of data input options. research co-ordinators to promote and co-ordi-
Academic departments will be able to advise you nate research locally. The FGDP(UK) also main-
on automated data input devices. tains a database of GDPs who are interested in

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undertaking research, and lists of academics, will be encouraged to decide on whether their
statisticians and experienced researchers who study is qualitative or quantitative in nature. On
may be able to support GDP researchers. They the basis of that decision, readers will be given
can also supply a series of research leaflets to further information about designing their study.
assist GDPs in research and there is an annual The use of evidence-based research methods is
research scholarship award for a single research promoted.
project in primary dental care.
Throughout the UK, there are primary care Measures
research networks which provide advice on This article will provide an overview of measures
research methodology and sources of funding, which can be used within research, including
act as a source of advice on potential collabora- standardised evidence-based tools developed by
tive research opportunities, network with other researchers and guidelines for designing
national research bodies and provide a focus for new measures, in particular questionnaires.
the dissemination of research results. Some pri-
mary care research networks also provide fund- Writing the proposal, funding and ethical
ing for research projects. considerations
Several university departments also have set This paper will outline how to produce a
up networks of GDPs to support research in pri- research proposal, suggest ways of obtaining
mary care. Contact your local dental postgradu- funding for your project and detail ethical and
ate dean for further details. research governance responsibilities.
Postgraduate studies typically include a
research component, which is supervised by an Data analysis
experienced researcher who is familiar with both This will include simple analysis of both qualita-
research methods and previous studies in the tive and quantitative data.
area. This is a good way of both becoming
involved in research and acquiring a further Report writing and submitting your research
qualification which will benefit your practice for publication
and your patients. The final paper in this series will encourage you
to write up your research for scientific publica-
In order to generate research findings of tion. Emphasis will be placed upon; identifying
the highest quality and to fulfil the legal and writing for your audience; identifying and
requirements of research governance,9 it is complying with requirements of journals.
recommended that GDPs are supported by
1. Medical Research Council. Primary Health Care [Topic
experienced researchers and/or academic Review]. London: MRC, 1997.
departments at all stages of the research 2. Department of Health. Research & Development in Primary
process. Care [National Working Group Report]. London: HMSO, 1997.
3. Newton J T, Gibbons D E, Kavanagh D, Zoitopoulos L. Primary
Care Research Priorities - Dentistry [Report to NHS Executive].
There are six further articles in this series. London, 2000.
These are outlined below: 4. Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, Pine
C, Pitts N, Treasure E, White D. Adult Dental Health Survey:
Oral Health in the United Kingdom 1998. London: The
Developing a research question Stationery Office, 2000.
This article will look at ways of devising and 5. Finch H, Keegan J, Ward K, Sen B S. Barriers to the receipt of
revising a research question, commencing with dental care: A qualitative study. London: Social & Community
Planning Research Unit, 1988.
an initial idea and focussing this into a testable 6. Blinkhorn A S, Clarkson J E, Craven R, Holloway P J,
research question. The skills that this article will Worthington H V. An evaluation of a training programme in
develop include literature searching and critical primary care research for general dental practitioners. Br
analysis of literature. Dent J 2000; 188: 333-336.
7. Jowett S M, Macloed J, Wilson S, Hobbs F D R. Research in
primary care: extent of involvement and perceived
Designing your study determinants among practitioners from one English region.
This article will compare and contrast two dif- Br J Gen Prac 2000; 50: 387-389.
8. Gibbons D E, Newton J T. Stress solutions for the Overstretched.
ferent approaches to data collection, the quanti- London: Macmillan, 1998.
tative and the qualitative. Considering the 9. Department of Health. Research Governance Framework for
research question described previously, readers Health and Social Care. London: HMSO, 2001.

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