Understanding decision making for the use of atraumatic restorative approach based on non-clinical factors by Indian pedodontists - a conjoint analysis.

Background: Atraumatic Restorative Treatment (ART) approach is considered as one of the minimally invasive interventions. The success of restoration depends on various clinical factors like material, patient and operator factor. Conjoint analysis is a technique for measuring individual’s preference structures via systematical variations of products attributes in an experimental design. Aim: Assess Pedodontists’ perception of non-clinical factors and investigate influence of child’s age, level of cooperation and vulnerability status on their decisions to perform Atraumatic Restorative Approach (ART) approach using hypothetical patient scenario’s and conjoint design. Materials and methods: A cross-sectional exploratory survey using a web-based questionnaire was performed among Pedodontists registered as life members under Indian Association of Pedodontic and Preventive Dentistry. Self-designed structured scenario-based questionnaire was prepared and validated. Three non-clinical factors Age of child, Cooperation level and Vulnerability status were considered. Using orthogonal design, SPSS software nine profiles were created randomly along with two holdouts. Final study proforma consisted of three sections with description of eleven clinical scenarios. It was administered to participants using Google forms. Using SPSS conjoint software relative utilities for each factor on decision for using ART was estimated. Results: Four hundred and thirty-two pedodontists had completed the survey (35.9%). Pedodontists considered vulnerability status of the child as the most important factor for their decision to use ART treatment. For the vulnerability status, the factor vulnerable had the greatest utility (-0.364) compared to non-vulnerable factor (0.364). For cooperation level, factor uncooperative had greater utility (-0.343), as compared to moderately cooperative (0.066) and uncooperative (0.277). For the age factor, the age of 4 years had the greatest utility (-0.175) compared with age 6 (-0.013) and age 12 (0.19). Conclusion: The most preferred scenario by pedodontists to consider ART as treatment of choice was child belonging to vulnerable section, being very young and uncooperative.