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Table 3 Summary of themes, sub-themes and illustrative quotes

From: Dentists’ perceptions and usability testing toward the implementation of the ISAC, a comprehensive oral cancer intervention in dental practices: a qualitative study in Jazan region, Saudi Arabia

1-What are the first thoughts, feelings or impressions of dental interns while practicing ISAC?

Fleuren’s framework

Theme

Sub-theme

Example Quote

User level of determinants

Immediate feel (Affective attitude)

Regret

“I am regretting that I was not fair with patients”-DentalIntern4

Professional

“…it gives me the feeling that the doctor is professional and respectful.”-DentalIntern4

Organized

“I feel more organized”-DentalIntern6

Confidence

“It builds my confidence in myself.”-DentalIntern2

Awareness

“I feel I am highly aware of oral cancer screening more than before”-DentalIntern3

Recommendations

ISAC clinical protocol

“We need ISAC clinical protocol to ease following the steps”-DentalIntern3

Use the Arabic language

“It would be easier for us if the materials were in the Arabic Language”-DentalIntern1

Divide training per each intervention component

“It might be good if I have separate training on tobacco counseling and patient communication before actual implementation of ISAC.” – DentalIntern 6

2-What are the adopters, implementers and dental interns’ perceptions toward ISAC intervention?

Fleuren’s framework

Theme

Sub-theme

Example Quote

User level of determinants

knowledge

Aim of intervention

“…it is a comprehensive program aims to increase students’ awareness themselves aaa and the comprehensive goal is the early detection of oral cancer” – Adopter1

Model of intervention

“It rests on sound evidence-based methods, and it covers most of the deficient parts observed in dentist practice for example tobacco training and soft communication skills with patients.” – Adopter2

Cognitive attitude

Serves country needs

“…it targets the country need.” – Implementer2

Right project in right time

“It is the right project in the right time. We really need for such intervention”-Adopter1

Change beliefs

High ability to change

“…ISAC is going to help us from the perspective of early detection and from the perspective of the skills and abilities gained from ISAC” – Implementer1

Barriers

Gender

“…I don’t think all females would be satisfied that males examine them especially in the neck region and behind the neck.” – Adopter1

Language

“The second point that could be a problem is the language barrier and its less in Jazan region because most of patients are Arabic speakers and therefore patients can understand them, and they can understand patients.”-Adopter2

Dentist not from the region

“A point that could be present before, that the dentists were not from the same region, and they probably may not know the region needs and problems”-Adopter2

Facilitators

Gender concordance

“Among the points that should be highlighted is that usually dentists available in both gender and patients usually distributed based on gender. Most male patients go to male doctors and vice versa.”-Adopter2

Supportive JDSa environment

“The JDS environment is very supportive for such an intervention.”-Adopter2

Regional trainers

“I wish that you bring doctors who practice in the region, and they know how to deal with patients and problems in this region”-DentalIntern1

Standard form

“What I really like in the ISAC is that it tries to bring new form that we can easily follow it and if possible, I wish that you share it with ministry of health”-DentalIntern

Collaboration with Ministry of Health

“I suggest that after we finished the project that the ISAC team prepare special presentation for the program to the ministry of health so they will be in the same image.”-DentalIntern2

Motivation to use

Appealing

“The program is already appealing. We learned effective communication and smoking cessation counseling”-DentalIntern1

Certificates

“If dental interns will have certificates, they will be more excited for the program.”-Implementer2

Easy and clear

“Because it is easy to learn and to practice”-DentalIntern4

Build confidence

“One of the things that attracted me is that it has built my confidence on my ability to do the screening.”- DentalIntern2

Role model

“The fact that Dr. Jafer is the provider makes me excited and motivated for practicing ISAC.”-DentalIntern3

Impact of oral cancer

“I think the important thing is that they know the impact of oral cancer.”- Adopter1

Advertisement

“To be appealing, I think the university should make it visible to students especially the students and social media.”-DentalIntern1

Innovation level of determinants

ISAC development

Credible developers

“I believe that the developers are among the most qualified in the college and they know the region needs. They have diverse experiences; they have administration experiences, academic experiences, and clinical experiences, has work in academia and in ministry of health. They have good networking and experience in research and publications, and they are specialized in dental public health and exactly in disease prevention and creating intervention”-Adopter2

Engagement

“It rests on studies and involved students and different groups including us.”-Implementer1

Scientific approach

“I think the creation of the intervention follows clear scientific steps. Therefore, I believe this project was born to be successful.”-Adopter2

Clear process

“Everything was really clear… I felt I was guided step by step from the beginning”-Adopter1

Relative advantage

Targets dentists

“What I like in your intervention is that it targets oral healthcare providers themselves.”- Adopter1

Comprehensive

“Previous program didn’t ask if you use Shammah or not. I mean the education was superficial not in-depth like in the ISAC”- Implementer1

Raise the attention to oral cancer

“But we know that these conferences were the result of the ISAC founders’ efforts to the problem.”- Adopter2

Well-defined objectives

“I am not aware of any program that was like this or that targets oral cancer. This program is based on clear objectives and thorough assessments.”- Implementer2

Use relevant evidence

“The most thing that I like, and I feel it’s a new thing is that it is built on information that is relevant to our field and our community.”-DentalIntern1

Complexity

Different forms

“We don’t have a standard way that everyone can use in all the provinces of Jazan region.”- DentalIntern6

Easy to practice

“It’s easy to learn and practice”-DentalIntern2

Clinical time outside JDS

“We have limited time. We are practicing outside the college. So, we need to train on it many times to fit the clinical time.”- DentalIntern5

More training

“…we need more time for it. For example, patient education and communication, we need to practice them more”-DentalIntern5

Observability

Depends on measures

“It depends on the way of your measurements.”- Adopter1.

Very visible

“The result will be visible for everyone... I feel it will make a big change.”- Implementer1

Compatibility

Highly compatible with society norms and beliefs

“I see that it is 100% compatible because it arises from the community needs.” – Adopter2

Organizational level of determinants

Implementation environment

Supportive in JDS

“But outside the college, the supervising doctor tells me to check directly the patient chief complaint. So, I think I will practice ISAC if I have space for it. But if the doctor forces me, I don’t know what to do?”- DentalIntern4

Guidelines

Consistent with JDS guidelines

“…the college mission includes healthcare delivery, and this project optimizes the healthcare. So, I expect that it will support it to a large extent.” – Implementer2

Clinical time

Fit within existing time

“I think that because we are not organized in screening and in the steps that we should do it will take time. But I believe I can screen within the same clinical time that I usually have. I saw when the doctor performed it he was very organized and did not take long time”-DentalIntern1

Socio-political context

Dentist’s role in society

Important

“I see their role is important…Only the dentist knows the mouth very well. The advice that the dentist gives can increase patient knowledge and awareness about oral cancer. The dentist can screen very well for oral cancer and teach the patients on screening.”- Implementer1

  1. aJDS Jazan Dental School