Promotion or education: a content analysis of industry-authored oral health educational materials targeted at acute care nurses

OBJECTIVES: To assess the nature, quality and independence of scientific evidence provided in support of claims in industry-authored educational materials in oral health. DESIGN: A content analysis of educational materials authored by the four major multinational oral health product manufacturers. SETTING: Acute care settings. PARTICIPANTS: 68 documents focused on oral health or oral care, targeted at acute care clinicians and identified as ‘educational’ on companies’ international websites. MAIN OUTCOME MEASURES: Data were extracted in duplicate for three areas of focus: (a) products referenced in the documents, (b) product-related claims and (c) citations substantiating claims. We assessed claim–citation pairs to determine if information in the citation supported the claim. We analysed the inter-relationships among cited authors and companies using social network analysis. RESULTS: Documents ranged from training videos to posters to brochures to continuing education courses. The majority of educational materials explicitly mentioned a product (59/68, 87%), a branded product (35/68, 51%), and made a product-related claim (55/68, 81%). Among claims accompanied by a citation, citations did not support the majority (91/147, 62%) of claims, largely because citations were unrelated. References used to support claims most often represented lower levels of evidence: only 9% were systematic reviews (7/76) and 13% were randomised controlled trials (10/76). We found a network of 20 authors to account for 37% (n=77/206) of all references in claim–citation pairs; 60% (12/20) of the top 20 cited authors received financial support from one of the four sampled manufacturers. CONCLUSIONS: Resources to support clinicians’ ongoing education are scarce. However, caution should be exercised when relying on industry-authored materials to support continuing education for oral health. Evidence of sponsorship bias and reliance on key opinion leaders suggests that industry-authored educational materials have promotional intent and should be regulated as such.