education and motivation of adult

PATIENT EDUCATION,MOTIVATION AND ORALHYGIENE INSTRUCTIONS

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طب مجتمع نظري / رابع اسنان كركوك
د.خوله
7/3/2018
300

The background to oral health education

The term Dental Health Education (DHE) has been gradually superseded in recent years by Oral Health Education (OHE), reflecting a wider concern than health only of the teeth.
Problems with oral health education
1. Previous inadequacies in OHE delivery have been attributed to two main faults.
2. The message which has been contained within the dental health advice has not always been correct and has at times been totally misleading.
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THE LEARNING PROCESS

Domains of learning
 In education it is accepted that there are three domains of learning
1. Cognitive domain: this relates to the acquisition of knowledge.
2. Skills domain: this is the learning of practical skills.
3. Affective domain: this involves the creation of attitudes and motivation.
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Behavioral change
The prevention and control of the two major dental diseases ,
inflammatory periodontal disease and dental caries, depend to a large
extent on a change in the behavior of the patient.

Changing behavior

.The following are the steps which must be followed to establish
behavioral changes
Factual education.
Practical demonstration.
Motivation.
Reinforcement.
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FACTUAL EDUCATION

Information is a necessary but not on its own sufficient condition for changing behavior.
The information supplied should be accurate and comprehensible to lay people.
Part of this information should include realistic goals that the patient can achieve.
For example, with some patients it would be preferable to concentrate only on the improvements achievable by brushing before progressing to inter dental cleansing.

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PRACTICAL TRAINING
1. The teaching of the physical skills involved in dental health includes disclosing, brushing, interdental cleansing and the cleaning of dentures and appliances.
2. Educator should use 'tell-show-do' approach.
3. The action should first be explained, then demonstrated to the patient, possibly at first on models, then in the mouth.
4. Finally, the patient should carry out the procedure with the instructor supervising, correcting and giving encouragement.
5. Do not overload the patient.
6. It is better to teach a little at a time.
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MOTIVATION

Refers to 'that which induces a person to act'.
----In dentistry, the term 'patient motivation' is often misused, implying that one can cause a third person to co-operate, comply or perform in some desired manner.
----- This would be a very useful ability, but unfortunately not possible.
---- Motivation must come from within an individual
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MOTIVATION

 The term "motivation" means conveying to the patient, through a series of words, gestures, and examples, the importance that self-performed oral hygiene has in the health of the oral cavity.
 In order to achieve this goal, dentists must possess:
- Technical skill
- Communication skill
Psychologic insight


 Dentist may have great technical skill, but will not succeed in their profession if they are unable to communicate with their patients in order to motivate them
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THE ESSENTIALS FORMOTIVATION

 In order to become motivated to alter a behavioral pattern an individual must be able to identify the following:

1. A problem exists which affects the individual personally

for example the existence of periodontal disease in the mouth.

2. The problem will have an unwanted personal outcome

such as the premature loss of teeth.

3. There is a practical solution such as adequate plaque control.

4. The problem is serious enough to justify the inconvenience of the solution.
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In relation to dental health education, people may be divided into three broad groups:

1- those who are already motivated,
2- those with latent motivation,
3 - those lacking the necessary motivation to change their behavior

Motivated : have their own drive and simply require guidance and reinforcement from time to time.
Latent motivation is possessed by a majority of patients.

This is indicated by studies which show that approximately 60% of patients attend a dentist at least every second year, usually for a preventive check-up.


This latent motivation requires a trigger to activate or release it.
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THE ESSENTIALS FOR MOTIVATION

Patients without the desired motivation are intractable problem.
 Various forms of threat or sanction may produce an improved short-term behavioral change, but no long-term alteration.
 However, even these patients may not be lost for ever, as research suggests that the priority of motives may change with time and circumstances, even in adults, and this will give rise to behavioral changes.
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REINFORCEMENT

The process of encouraging or establishing a belief or pattern of behavior.
Once the progression of the disease has been controlled, then most patients require a regular (possibly 3 monthly) maintenance programme of visits.
This can be coupled with reinforcement of the oral hygiene regimen.
The frequency of reinforcement will vary from person to person and will depend to a large extent on their attitudes and the type of problem present.
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THE LEARNING LADDER

 The learning ladder illustrates the six steps from learner unawareness to habit formation.
 When beginning to help a patient learn about oral health and what the individual's needs are, one must determine where the patient stands on the ladder and start from there.
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THE LEARNING LADDER

A. Unawareness
Many patients have little concept of the new information about dental and periodontal infections and how they are prevented or controlled.
B. Awareness
Patients may have a good knowledge of the scientific facts, but they do not apply the facts to personal action.
C. Self-interest
Realization of the application of facts/knowledge to the well -being of the individual is an initial motivation.
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D. Involvement

With awareness and application to self, the response to action is forthcoming when attitude is influenced.
E. Action
Testing new knowledge and beginning of change in behavior may lead to an increased awareness that a real health goal is possible to attain.
F. Habit
Self-satisfaction in the comfort and value of sound teeth and healthy periodontal tissue helps to make certain practices become part of daily routine Ultimate motivation is finally reached.
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CHANGE IN ATTITUDE TO DENTAL HEALTH

Periodontal health is important , teeth are deserve keeping for life.
 The patients must believe this; otherwise any change in habit as an immediate response will be short-lived.
 Several arguments may be employed and the experienced practitioner can tailor these to the patient's perceived needs.
 Adolescents and adults may respond to different arguments
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Impaired function

 No appliance can function as efficiently as the natural and healthy dentition

 Full dentures may be an extremely poor substitute for the patient's own teeth.
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ATTITUDE TO DENTAL HEALTH

Personal hygiene.
 These days most people are concerned about personal cleanliness and yet there may be a marked contrast between the patient's general appearance and the state of his mouth.
 This usually represents a lack of awareness of oral hygiene and when the true state of affairs is demonstrated the individual who is truly concerned about personal hygiene will be ready to change his habits.
 The patient is given a hand-mirror to witness the examination of the mouth, and deposits of plaque and calculus can be pointed out.
 The use of a disclosing agent is valuable.
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Social handicap

 Periodontal disease produces halitosis, inflamed gingiva and eventually tooth loss due to mobility
 The idea of possessing offensive breath or an ugly smile is often sufficient incentive for patients to improve their home care.

General health

 The fact that periodontal disease can have an adverse effect on general health should be explained to the patient.
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ESTABLISHMENT OF COMMUNICATION : RAPPORT
 The first task of the practitioner is to establish rapport with the patient, which then makes possible further development of communication, learning, and motivation.
 Despite their importance, history taking, clinical examination, and diagnosis must all wait because, according to Meares 1957, while they may all occur concurrently with rapport, rapport must come first.
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RAPPORT….

 Rapport is an emotional state in which logical, intellectual, or verbal
factors may play only a small role.

 Expressions, gestures, and other nonverbal communication, however small,

may assume symbolic value to the patient as the initial meeting with the
doctor takes place
.
 On the surface the patient may be reciting his symptoms and concerns, but
underneath this veneer he is assessing the competence and trustworthiness
of the doctor.

 Meanwhile the doctor should be establishing the emotional relationship

with the patient that we know as rapport.

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METHODS OF PATIENTEDUCATION
Cinotti and Grieder advocate methods that may prove to be effective and more efficient.
 These are conditioning and insight learning
.
Conditioning
 The dental patient is conditioned by past experiences to expect pain and discomfort before he visits the dental office.
 In our society, the dentist is often portrayed in cartoon and lay articles as a threatening of the mouth who is to be feared
.
 It has been stated by many that the most feared figure in our society is the psychiatrist and that the dentist is possibly a close second
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HEALTH BELIEF MODEL

Based on the concept that one's beliefs direct behavior; model is used to explain and predict health behaviors and acceptance of health recommendations; emphasis is placed on perceived world of individual, which may differ from objective reality
Components
1. Susceptibility-individuals must believe that they are susceptible to a particular disease or condition

2. Severity-individuals must believe that if they get the particular disease or condition, the consequences will be serious

3. Asymptomatic nature of disease-individuals must believe that the disease may be present without their full awareness

4. Behavior change will be beneficial-individuals must believe that there are effective means of preventing or controlling the potential or existing problem and that action on their part will produce positive results


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FACTORS THAT INFLUENCEPATIENT MOTIVATION

 OUR YOUTH - ORIENTED SOCIETY
 OUR DESIRE TO BE PHYSICALLY ATTRACTIVE
 SUPERSTITIONS AND FOLKLORE
 SELF-DISCIPLINE (control)
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OUR YOUTH - ORIENTEDSOCIETY.

 Our society is a youth oriented one and those things that enable us to prolong our youth and retain our youthful appearance are much desired and valued.
 Teeth are the most important physical facial feature that, if lost almost single handedly give the impression of the onset of old age.
 Old age has been pictures for centuries as a period of toothlessness with a collapse of vertical dimension in the face, subsequent characteristic changes in speech and facial form, and an increase in wrinkling.
 Therefore from the aesthetic standpoint teeth are important, not purely for a superficial attractiveness, but also from more deep-seated fear of aging.
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OUR DESIRE TO BEPHYSICALLY ATTRACTIVE

 Teeth are a major factor in preserving a pleasant facial expression that helps us retain our attractiveness to the opposite sex.
 Attractiveness in men and women is aided immeasurably by the presence of teeth —hopefully natural teeth.
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SUPERSTITIONS AND FOLKLORE
 Many times facts regarding teeth and the pathology associated with them are warped slightly incorrect to the extent of preventing patients from receiving proper advice on retaining their teeth and preventing dental disease.
 Practitioners have repeatedly heard about the "soft" teeth or the familial susceptibility to decay or pyorrhea.
 Folklore also contributes its share of distortion to the truth.
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SUPERSTITIONS ANDFOLKLORE….

 Tonge (1965) indicates that this report is no doubt due to the fact that teeth are the most lasting parts of our bodies, as demonstrated by skeletal remains from all parts of the world.
 In present-day life some evidence of' our respect for teeth still remains.
 We still use eruption of teeth as a measure of maturity in the child.
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SELF-DISCIPLINE

 Both caries and periodontal disease are by nature chronic and thereby slowly progressive.
 The practice of preventive measures to prevent future disease and discomfort requires considerable self-control by the patient.
 Age. Another factor that may be a barrier to successful motivation is the fact that most periodontal patients are adults.
 Adults are more difficult to change from their habits of neglect because their previously held concepts must be overcome before learning can take place.
 On the other hand an adult can learn from another's experience and can accept long-range goals better than a younger patient can.
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