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Effectiveness of Population-Based Interventions on Oral Health

Understanding Public Judgment on Science-Intensive Issues: San Diego Dialogues on Community Water Fluoridation

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Overview

The Effectiveness of Population-Based Interventions on Oral Health was a three year research project intended to provide advocates with a deeper understanding of San Diegans’ positions on fluoridation than can be obtained through opinion polls or focus groups and to improve their capability to effectively conduct a public learning process for fluoridation issues and other health issues that require public support, eg: tobacco and AIDS and immigrant health.

Between June 2005 and May 2007, Viewpoint Learning carried out six day-long ChoiceDialogues and 2 shorter “micro dialogues,” all conducted with randomly selected representative cross sections of San Diego residents. A total of 294 respondents participated in the dialogues, and each group included a wide range of socio-economic circumstance, ethnic backgrounds, and political leanings.

These dialogues were conducted with several purposes in mind:

  • To determine which considerations are most important in forming people’s views on fluoridation, and why their views may change.
  • To illuminate how citizens’ interactions with each other shape their decision about whether or not to fluoridate.
  • To determine how average citizens receive information, process it, form their attitudes on fluoridation and decide how they intend to vote on the issue.
  • To lay the groundwork for future efforts to engage the broader community and educate the public around the issue.
  • To develop insight into how the public reaches judgment on policy issues with a strong scientific component – which are becoming increasingly important both nationally and internationally.

Research Methodology

  • September 2003-September 2007
  • Funded by the Centers for Disease Control
  • ChoiceDialogues Conducted by Viewpoint Learning
  • Bayesian Analysis conducted by Dr. William J. Rudman

The centerpiece of the research is a sophisticated methodology intended to give the researchers, the California Fluoridation Task Force and the San Diego Fluoridation Coalition a much deeper understanding of San Diegans’ position on fluoridation than opinion polls or focus groups can provide. The ChoiceDialogue approach differs dramatically from the sort of focus group research that undergirds most public outreach and education campaigns. Too often, experts and advocates assume that the public simply needs more information, presented in the right way. In other words, if you give the public the facts, they will reach sound decisions (and these decisions will be the same ones that experts would make). If the public reaches “wrong” conclusions, the fault lies in the particular combination of facts. This model of opinion formation can result in countless dollars being spent on the search for an informational “magic bullet” that will transform public indifference or resistance into support.

In practice, however, when the public comes to grips with a difficult issue, information is only one component among the many they consider, and often not the most important. Instead, they draw on core values, deeply-held assumptions and life experience. And they do not reach conclusions in isolation, but by engaging in dialogue with family, coworkers, neighbors, and friends. This can be a long and difficult process – people must frequently make painful tradeoffs in which strongly held values come into conflict – and the public can take months or years to reach a conclusion.

The ChoiceDialogue methodology is designed to compress this process into a single day. In the course of the dialogue, participants confront these difficult tradeoffs, move past their initial top of mind response and work towards a more stable and well-considered judgment – a judgment that takes tradeoffs and consequences into account and meshes with core values. By engaging representative samples of the population in this way, ChoiceDialogues provide unique insight into how people’s views change as they learn, and can be used to identify areas of potential public support where leaders can successfully implement policies consonant with people’s core values. Participant responses are analyzed both quantitatively and qualitatively. All sessions are videotaped and transcribed, and participants complete before-and-after questionnaires designed to measure shifts in views over the course of the dialogue.

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