Health Behavior Change in the Dental Practice

Christoph A. Ramseier, Dr. med. dent., MAS is Assistant Professor of Periodontology at the School of Dental Medicine, University of Berne, Switzerland. Jean E. Suvan, DipDH, MSc, CRA, FHEA is Clinical Research Coordinator of the Periodontology Unit at UCL Eastman Dental Institute, UK.

Foreword Preface

List of Contributors

1. Introduction to Health Behavior Change for the Dental Practice

Health Care in the Twenty-first Century

The Opportunity in the Dental Setting

Adop tion and Integration of Health Behavior Change

The Role and Responsibility of the Dental Professional

Collaborative Care Toward Whole Health

References

2. The Challenge of Behavior Change

Introduction

Behavior Change: Some Key Concepts

The Patient’s Perspective

The Clinician’s Perspective

Understanding Health Behavior Change

Social Cognitive Theory and Self-Efficacy Theory

The Health Belief Model

Theory of Planned Behavior

The Transtheoretical Model of Behavior Change

Self-Determination Theory

Summary

References

3. Communication and Health Behavior Change Counselling

Introduction

The Relationship between the Clinician and the Patient

Styles of Communication

Directing

Following

Guiding

Key Skills for Communicating about Health Behavior Change

Question 1: Is the patient happy to talk with you about behavior change?

Question 2: How are you asking questions?

Question 3: How do you provide support?

Question 4: How do you convey understanding?

Question 5: How do you get information across?

Question 6: How do you bring it all together?

Summary

Acknowledgments

References

4. Motivational Interviewing (MI) and Its Basic Tools

Introduction

What Is Motivational Interviewing?

Research Evidence for MI

What Triggers Behavior Change?

Motivation and the Clinician-Patient Relationship

Definition of MI

“Spirit” of MI

Major Principles

Express Empathy

Develop Discrepancy

Roll with Resistance

Support Self-Efficacy

OARS: Basic Tools for Building Motivation to Change

Use Open-Ended Questions

Affirm Patients

Use Reflective Listening

Use Summaries

Elicit Change Talk

Evocative Questions

Decisional Balance or Pros and Cons Matrix

The Importance Ruler

Elaborating, Querying Extremes, and Looking Back and Forward

Exploring Goals and Values

Responding to Change Talk

Responding to Resistance

Enhancing Confidence

Strengthening Commitment

Negotiating a Plan for Change

Summary

References

5. Brief Interventions in Promoting Health Behavior Change

Introduction

Using a Patient-Centered Approach

Righting Reflex

Goals of Brief Interventions

Assessing Motives

Health History Form

Open-Ended Questions

Readiness Scales

Raising Awareness

Giving Information versus Raising Awareness

Conveying Understanding

Supporting Change

Encouraging Patient Problem Solving

Offering a Set of Strategies

Planning for the Change

Use of the Telephone for Brief Interventions

Use of Computers for Brief Interventions

Giving Brief Advice

When Brief Interventions Are Not Appropriate

Bringing It All Together

Summary

References

6. Implementation of Health Behavior Change Principles in Dental Practice

Introduction

Content of Change (the Objectives)

Context of Change (the Environment)

Process of Change (the Implementation Plan)

Micro-Environment: The Dental Visit

Easier than You Think

Patient Activation Fabric for the Dental Visit (Implementation Model)

“Your Patient Is Here,”

Single Behavior Patient Scenario

Multiple Behavior Patient Scenario

Macro-Environment: The Practice Setting

Importance of Support

Overcoming Potential Obstacles to Practice Implementation

Practical Guidance for Beginners (or Non-Beginners)

Summary

References

7. Health Behavior Change Education

Introduction

History of Medical and Dental Education

In Medicine

In Dentistry

In Dental Hygiene

Currents Trends in Dental Care and Education

The Need for Change in Dental Education

Public Health Goals and Responsibilities

New Educational Initiatives and Methods

Theoretical Education

Pathology and Epidemiology of Diseases

Behavior as a Determinant of Health and Disease

Practical Education

Students

Continuing Education

Clinicians

Assessment of Health Behavior Change Education

Faculty

Students

Clinicians

Summary

References

Index