psychological+factors+and++ oralhealthpracceiadh.org/wp-content/uploads/2013/10/schuz_b_tue... ·...
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Psychological Factors and Oral Health Prac4ce
Benjamin Schuez School of Psychology, University of Tasmania
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1. Intro -‐ Why Psychology? 2. What determines individual health
behaviour? 3. What determines health professionals’ and
caregiver behaviour? 4. Some Conclusions
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“...daily flossing is highly recommended.” (ADA)
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Why Psychology?
• All paJent acJviJes are behaviour: – Brush teeth regularly – Apply fluoride gel on a weekly basis – Floss – Make appointment with denJst / hygienist – Follow specific diet – ...
• Psychology as science of human behaviour can help understanding paJent engagement (or non-‐engagement)
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Why Psychology?
• Oral health also depends on others’ behaviour – Adherence to treatment guidelines is individual behaviour
– Adherence to recommendaJons for best oral health pracJce is individual behaviour
• Psychological models of behaviour can be applied to understand and modify oral health professionals’ behaviour
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Efficacy / Effec4veness: Behaviour
Efficacy Effec4veness
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What determines individual health behaviour?
• Rewards / Operant condiJoning • Common-‐sense model of health and illness • MoJvaJon and acJon components of changing behaviour
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Rewards and behaviour
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Operant Condi4oning
Add posi4ve s4mulus: Posi4ve Reinforcement
Remove nega4ve s4mulus: Nega4ve Reinforcement
Add nega4ve s4muls: Posi4ve Punishment
Remove Posi4ve s4mulus: Nega4ve Punishment
Increase Behavior
Decrease Behavior
Add Remove
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Condi4oning: S4mulus value maPers
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Reward schemes: Tokens
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Reward schemes: Tokens
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Self-‐rewards and concrete tokens
• Self-‐rewards: Arrange a contract with yourself
• Works well with interdental hygiene (O’Neill et al., 1987)
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Reward Effects
• Group 1: BASS demonstraJon, floss demonstraJon
• Group 2: AddiJonal plaque coloring with feedback
• Group 3: AddiJonal praise from denJst
• Group 4: AddiJonal list of tasks to Jck off
FMPS: Full Mouth Plaque Score Weinstein et al., 1996; J Clin
Periodontol
FMPS
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Reward schemes
• Very effecJve in general (on the mean level) • Operant condiJoning is the best-‐evidenced theory in psychology
• Require reinforcing insJtuJon / person • On societal level: IncenJves based on policy decisions (naJonal or insurance-‐based)
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Common-‐sense model
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Common-‐sense model
• IdenJty – Symptoms and labels • Causes • DuraJon – Timeline • Consequences • Controllability
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• IdenJfy symptoms and label them
Iden4ty – Symptoms and labels
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Causes
• Plaque, biofilm – stuff on teeth
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Time-‐line: Acute or chronic?
• PeriodonJJs and caries are chronic diseases • Progression depends on compliance
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Control beliefs
• Belief that own behaviour can control the course of illness – Causes – Course – Consequences
• Belief in one’s ability to correctly perform behaviour
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Improving control beliefs
• DemonstraJon and supervision of oral hygiene behaviours
• Learn correct performance, increase control beliefs
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Effects of common sense (Philippot et al., 2005, J Clin Periodontol)
0
0.5
1
1.5
2
2.5
Baseline Control Baseline IntervenJon
1 mo. Control 1 mo. IntervenJon
Global
Lingual
Buccal
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© Dominik Herrmann, 2008
Mo4va4on and ac4on
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Mo4va4on-‐Behaviour-‐Gap
Mo4va4on Behaviour
GAP
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Mo4va4on and behaviour
• Even moJvated paJents perform below recommendaJons
• Lack of specific strategies and techniques for transferring moJvaJon into acJon (voliJon)
• Address moJvaJon and voliJon differenJally
McCaul, Glasgow & O‘Neill, 1992, Heal Psy
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Planning
• Strategic planning cogniJvely links situaJonal cues to intended acJon
• AutomaJc triggering of acJon in target situaJon
• Simple and concrete plans comprise of an exact definiJon of the situaJon
• WHEN? • WHERE? • HOW?
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Evidence: Effects of Planning on Flossing (SniehoPa, Araújo-‐Soares & Dombrowski, 2007, J Dent Res)
Times flossin
g / w
eek
**p < .01; *p < .05
**
*
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Evidence: Effects of Planning on Flossing (Schüz, Wiedemann, Mallach & Scholz, J Clin Periodontol 2009)
Times flossin
g / w
eek
**p < .01; *p < .05
* *
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Evidence: Effects of Planning on Flossing (Schüz, Wiedemann, Mallach & Scholz, J Clin Periodontol 2009)
0
1
2
3
4
5
6
Baseline 2 weeks 8 weeks
Control unmoJvated Planning unmoJvated Control moJvated Planning moJvated
Times flossin
g / w
eek
**p < .01; *p < .05
**
*
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Self-‐monitoring and behaviour change
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Dental Diary
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Self-‐monitoring effects (Schüz, SniehoPa & Schwarzer, 2007; Heal Educ Res)
6
8
10
12
14
16
not mo4vated mo4vated
did not use diary
used diary
Flossed in 14 da
ys
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Comprehensive interven4ons (Clarkson et al., 2009; J Dent Res)
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Comprehensive interven4ons (Clarkson et al., 2009; J Dent Res)
0
20
40
60
80
100 Control IntervenJon
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What determines health professionals’ behaviour?
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What determines professionals’ behaviour?
• Rewards • Common-‐sense informaJon • MoJvaJon and acJon components of changing behaviour
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Rewards: Fees for service
• Fees for services are effecJve incenJves to change professional behaviour
Clarkson, J. E., et al. (2008). Changing clinicians’ behavior: A randomized controlled trial of fees
and educaJon. J Dent Res, 87, 640-‐4.
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Planning and den4st behaviour (Bonej et al., 2003, Br Dent J) IntervenJon prompJng plans for alternaJves to 3rd molar extracJon
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Common-‐sense and training
• Longitudinal study in 56 nursing homes in Berlin, Germany (total of 120 caregivers took part in the study, longitudinal data from 85)
• Mean number of residents = 32.7 (31.8) • 1 intervenJon session with trained dental assistants per nursing home
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Interven4on
• General oral hygiene informaJon based on causes, courses and consequences of oral diseases
• Special focus on needs of care recipients • Focus on care recipients’ capabiliJes for oral hygiene with targeted instrucJons and brushing demonstraJons
• Supervision of caregivers’ oral health rouJnes with feedback
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Effects on behaviour
75
80
85
90
95
100
105
110
Pre-‐test 3 months post-‐test
Mean brushing Jme
Pfeilschiner, M. (2007). It’s up to the caregiver [Dipl.-‐Psych.] Freie Universitaet Berlin
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Effects on behaviour
0
10
20
30
40
50
60
70
No technique Any technique RotaJon Bass
Brushing technique
Pfeilschiner, M. (2007). It’s up to the caregiver [Dipl.-‐Psych.] Freie Universitaet Berlin
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Predictors of brushing
Pfeilschiner, M. (2007). It’s up to the caregiver [Dipl.-‐Psych.] Freie Universitaet Berlin
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Conclusions
• Behavioural science can help understanding and modifying individual oral health care beahviour
• Principles from behavioural science can be used to modify health professionals’ behaviour: – Rewards – Plans – Vulnerability, Self-‐efficacy, intenJon
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