{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:19:20Z","timestamp":1787894360001,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The WHO Global Strategy and Action Plan on Oral Health 2023\u20132030 encourages innovative approaches such as shifting tasks from dentists to Mid\u2010level Dental Providers (MLDPs), who work independently to improve access to and equity in oral health. This study aimed to examine stakeholders' perspectives on the challenges and opportunities associated with introducing MLDPs in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive approach was adopted. Guided by the Consolidated Framework for Implementation Research (CFIR), semi\u2010structured interviews were conducted with 10 stakeholders selected through an informant\u2010based sampling strategy. Interviews were transcribed verbatim and analysed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Stakeholders widely acknowledged the need for MLDPs but disagreed on their scope. Some supported limiting their role to preventive services, while others argued for including essential clinical tasks. Participants recognised that Iran has a legal basis for introducing MLDPs, though some criticized its \u201ccareer transition\u201d pathway which allowed dental therapists entry into dental programmes. Rural communities and primary health care facilities perceived as receptive to dental therapists, though infrastructure gaps persist. Implementation was considered as dependent on ministry and non\u2010ministry actors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings highlight both opportunities and challenges associated with introducing MLDPs in Iran. The introduction of MLDPs is hindered by professional protectionism and power dynamics that prioritise dentists' interests over public needs, as well as infrastructural weaknesses. Overcoming these barriers will require redistributing decision\u2010making power. This can be advanced through participatory research approaches and public engagement to promote the inclusion of community voices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70109","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:24:16Z","timestamp":1786620256000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Introducing Mid\u2010Level Dental Providers in Iran: Challenges and Opportunities"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5938-0077","authenticated-orcid":false,"given":"Homa","family":"Fathi","sequence":"first","affiliation":[{"name":"McGill Faculty of Dental Medicine and Oral Health Sciences  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9301-844X","authenticated-orcid":false,"given":"Tayebe","family":"Rojhanian","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry Hormozgan University of Medical Sciences  Bandar Abbas Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9531-0102","authenticated-orcid":false,"given":"Ali","family":"Kazemian","sequence":"additional","affiliation":[{"name":"Department of Community Oral Health, School of Dentistry Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1169-5392","authenticated-orcid":false,"given":"Ian","family":"Litchfield","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3056-3704","authenticated-orcid":false,"given":"Vahid","family":"Ravaghi","sequence":"additional","affiliation":[{"name":"Dentistry, School of Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Global Strategy and Action Plan on Oral Health 2023\u20132030","author":"World Health Organisation","year":"2024"},{"key":"e_1_2_11_3_1","volume-title":"Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030","author":"World Health Organisation","year":"2022"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001608"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2019.07.010"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-020-01148-w"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph10051882"},{"issue":"2","key":"e_1_2_11_8_1","first-page":"72","article-title":"Dentist to Population Ratio and Geographic Distribution of Dentists in Iran in 2019","volume":"10","author":"Afsahi M.","year":"2021","journal-title":"Journal of Oral Health and Oral Epidemiology"},{"issue":"1","key":"e_1_2_11_9_1","first-page":"1","article-title":"Rethinking Dental Care in Iran","volume":"11","author":"Ravaghi V.","year":"2022","journal-title":"Journal of Oral Health and Oral Epidemiology"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-022-01245-0"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05396-y"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-8-87"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2014.31"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-124"},{"key":"e_1_2_11_16_1","volume-title":"Qualitative Research & Evaluation Methods: Integrating Theory and Practice","author":"Patton M. Q.","year":"2015"},{"key":"e_1_2_11_17_1","volume-title":"MAXQDA 2022 [Computer Software]","author":"Software V.","year":"2021"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744987117741667"},{"key":"e_1_2_11_19_1","volume-title":"Task Shifting: Rational Redistribution of Tasks Among Health Workforce Teams: Global Recommendations and Guidelines","author":"World Health Organization","year":"2008"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19137640"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-024-02246-8"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1922\/CDH_IADR22Kearns06"},{"key":"e_1_2_11_23_1","volume-title":"WHO Guideline on Health Workforce Development, Attraction, Recruitment and Retention in Rural and Remote Areas","year":"2021"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/idj.12563"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0020872820967431"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-017-0631-x"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00177"},{"key":"e_1_2_11_28_1","first-page":"11","article-title":"Australian Dentists' Knowledge, Opinions and Acceptability of Oral Health Therapists and Their Scope of Practice","volume":"1","author":"Cree M. E.","year":"2015","journal-title":"Australian and New Zealand Journal of Dental and Oral Health Therapy"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-016-0437-z"}],"container-title":["Community Dentistry and Oral Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70109","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cdoe.70109","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:38:54Z","timestamp":1787891934000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cdoe.70109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":28,"alternative-id":["10.1111\/cdoe.70109"],"URL":"https:\/\/doi.org\/10.1111\/cdoe.70109","archive":["Portico"],"relation":{},"ISSN":["0301-5661","1600-0528"],"issn-type":[{"value":"0301-5661","type":"print"},{"value":"1600-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2025-10-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cdoe.70109"}}