Podcast
Questions and Answers
What is the recommended daily limit of free sugar for individuals aged 11 years and older according to the NHS?
What is the recommended daily limit of free sugar for individuals aged 11 years and older according to the NHS?
What is the primary benefit of adapting toothbrushing technique to patient needs?
What is the primary benefit of adapting toothbrushing technique to patient needs?
What is advised regarding smoking in relation to oral health?
What is advised regarding smoking in relation to oral health?
What is the percentage of the UK population aged 18 years and older that smokes, according to the ONS 2019?
What is the percentage of the UK population aged 18 years and older that smokes, according to the ONS 2019?
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What is a recommended dietary guideline to promote oral health?
What is a recommended dietary guideline to promote oral health?
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What is the correct way to use fluoride toothpaste for optimal effectiveness?
What is the correct way to use fluoride toothpaste for optimal effectiveness?
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According to the DBOH Toolkit, how should sugar intake be managed?
According to the DBOH Toolkit, how should sugar intake be managed?
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What proportion of individuals in the UK are reported to have excellent oral health?
What proportion of individuals in the UK are reported to have excellent oral health?
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Which component of the OARS framework involves encouraging patients through positive reinforcement?
Which component of the OARS framework involves encouraging patients through positive reinforcement?
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What is the primary goal of active listening in the context of patient-professional communication?
What is the primary goal of active listening in the context of patient-professional communication?
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Which question type is preferred when trying to elicit detailed responses from patients?
Which question type is preferred when trying to elicit detailed responses from patients?
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In the context of effective communication, what role do non-verbal cues play?
In the context of effective communication, what role do non-verbal cues play?
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Which of the following best describes the purpose of reflecting in the OARS framework?
Which of the following best describes the purpose of reflecting in the OARS framework?
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What does the 'P' in the COM-B model primarily refer to?
What does the 'P' in the COM-B model primarily refer to?
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Which psychological factor is directly linked to habitual behavior in the COM-B model?
Which psychological factor is directly linked to habitual behavior in the COM-B model?
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In the context of Bella's case, what may influence her decision to not floss her teeth?
In the context of Bella's case, what may influence her decision to not floss her teeth?
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What role do social norms play in the COM-B model?
What role do social norms play in the COM-B model?
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What common belief does Bella hold about flossing?
What common belief does Bella hold about flossing?
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What is a potential barrier for an individual attempting to improve their oral health as per the COM-B model?
What is a potential barrier for an individual attempting to improve their oral health as per the COM-B model?
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What aspect of the patient-clinician relationship is indicated in Bella's scenario?
What aspect of the patient-clinician relationship is indicated in Bella's scenario?
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According to the COM-B model, which factor involves conscious evaluation before performing a behavior?
According to the COM-B model, which factor involves conscious evaluation before performing a behavior?
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What aspect of Bella's case showcases the impact of the social environment in the COM-B model?
What aspect of Bella's case showcases the impact of the social environment in the COM-B model?
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What assumption can be made about Bella’s oral health based on her situation?
What assumption can be made about Bella’s oral health based on her situation?
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How does socio-economic status influence behaviors in the COM-B model?
How does socio-economic status influence behaviors in the COM-B model?
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Based on the guidelines presented, what should clinicians do for patient-specific treatment?
Based on the guidelines presented, what should clinicians do for patient-specific treatment?
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In the context of the case scenarios, which aspect is emphasized for motivational interviewing?
In the context of the case scenarios, which aspect is emphasized for motivational interviewing?
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What is the primary concern that Bella expresses about flossing?
What is the primary concern that Bella expresses about flossing?
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Which factor is critical when assessing when to use different motivational interviewing approaches?
Which factor is critical when assessing when to use different motivational interviewing approaches?
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What is the first step when assisting a patient to change their behavior?
What is the first step when assisting a patient to change their behavior?
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What should be done if multiple behaviors need to be changed?
What should be done if multiple behaviors need to be changed?
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Why is it important to listen for cues from the patient?
Why is it important to listen for cues from the patient?
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What role do SMART goals play in patient support?
What role do SMART goals play in patient support?
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What does rolling with resistance involve?
What does rolling with resistance involve?
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What factor should not influence Bella's perceptions of flossing, based on her belief system?
What factor should not influence Bella's perceptions of flossing, based on her belief system?
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What are behavior change techniques (BCT's) primarily based on?
What are behavior change techniques (BCT's) primarily based on?
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Which model is mentioned for supporting behavior change?
Which model is mentioned for supporting behavior change?
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What type of goals should be set to help support patient behavior change?
What type of goals should be set to help support patient behavior change?
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Study Notes
Behaviour Change
- Foundation in Clinical Skills and Practice, Year 1 course
- Presented by Jacky Hart and Preena Shah
- Delivered at Eastman Dental Hospital, LSBU Education Centre
GDC Learning Outcomes
- 1.1.1, 1.1.11, 1.7.1, 1.10.1, 1.10.2, 1.10.3, 1.11.1
- 2.3, 3.1, 3.2, 4.1, 6.1, 6.2, 6.3, 11.1
Intended Learning Outcomes
- Describe behaviour change and its relevance to oral and general health
- Familiarise with evidence-based guidelines for oral health behaviours
- Identify factors influencing behaviour using the COM-B model
- Discuss how patient-centred conversations support oral health behaviours in dental hygiene and therapy practice
Assessment
- Formative: Active engagement throughout sessions and peer feedback
- Summative: E-assessment and OSCE
- Future: Effective behaviour change improves patient health outcomes
Links to Prior Learning
- History Taking: Dental, social, and diet
- Delivering Better Oral Health Toolkit: Evidence-based guidance for behaviours
- Communication: Verbal, non-verbal, and clinical conversations
Outline for the Session
- Theory: Definitions, context, evidence for oral health-related behaviours and their evidence; Influences on behaviour (COM-B model); Behaviour change in action, linking to communication
- Practical: Case studies discussions in teams
Definitions
- Behaviour: What we do in response to internal or external factors
- Health Behaviour: What we do that impacts our health, positively or negatively
- Behaviour Change: Doing something that changes the way a person does something
Why is this Important?
- Behaviours impact health and well-being, increasing risk of or protecting from long-term conditions, including oral diseases
- Oral health professionals are crucial in supporting patients to adopt positive behaviours through patient-centred conversations
Evidence-Based Guidance
- NICE Oral Health promotion in general dental practice (NG30) and Behaviour change: Individual approaches (PH49)
- How to adopt a patient-centred approach?
- Interventions for the individual targeting general health
- Scottish Dental Clinical Effectiveness Programme (SDCEP)
Oral health-related behaviours quiz
- Mentimeter recap and test knowledge
- Relating behaviours to oral health and the guidance for them
Oral Health in the UK
- 75% of adults are clean twice a day
- 66% of adults exhibit visible plaque
- 1 in 10 adults have excellent oral health (ADHS 2009)
- Data in the form of a graph showing percentages of excellent oral health by age group (ADHS 2009)
Toothbrushing Advice
- Clean all tooth surfaces and the gumline
- Use powered or manual toothbrushes
- Adapt technique to patient needs
- Benefits: reduces risk of dental caries and periodontal disease
Dietary Guidance
- Reduce frequency and quantity of sugar
- Eat a balanced diet with lots of vegetables and fruit
- Daily free sugar recommendations from the NHS (30g/day for 11+ years, 24g/day for 6-10 years, and 19g/day for 4-6 years) or no more than 5% of total calorie intake
Dietary Intake of Free Sugars
- Graph showing percentages of total calorie intake of free sugars for different age groups and genders (NDNS 2016/17)
- Recommended level of free sugars is 5% or less of total calorie intake
Fluoride Exposure
- Fluoride toothpaste (1450ppm; less for under 6 years old)
- Spit don't rinse
- 76% use fluoride toothpaste
Smoking Advice
- Recommendation is not to smoke
- Encourage smoking cessation
- 14% population smokes in UK (aged 18+ years)
- Additional sessions on Smoking Cessation to come
Alcohol Advice
- Not to exceed 14 units per week
Attendance
- Recommendations based on risk: 3-24 months as per NICE guidance for Dental Checks and intervals between oral health reviews (CG19)
- Figure 6.1.1 showing Dental attendance by age (ADHS 2009)
Building Foundations for Optimal Treatment Outcomes (BSP)
- Treatment plan, explaining disease, risk factors and treatment alternatives, risks and benefits
- Importance of Oral Hygiene improvement; Risk factor reduction
- Individual advice, including interdental cleaning, toothpaste, and mouthwash, +/adjunctive efficacious toothpaste
- Professional Mechanical Plaque Removal (PMPR), including supra and subgingival scaling
- Consider recall periods, smoking cessation, and diabetes control
Impact of Oral Health-Related Behaviours
- Venn diagram with overlapping circles for oral health, systemic health, and behaviours
Motivation
- What motivates individuals to do tasks ?
- Intrinsic and extrinsic motivation
Habits
- Behaviours take 66 days to form into habits
COM-B Model
- For effective behaviour change, interventions should be underpinned by evidence-based theories, relevant to the behaviours to be changed
- The COM-B model is well-recognised in health as key
COM-B Model - Example Application
- Example of eating chocolate illustrating the capability, motivation, and opportunity
COM-B Model applied to Oral Health
- Applying the COM-B model to Oral Health - Capability (Physical skills/dexterity, Psychological capacity to do), Motivation (Habitual, Believes it's beneficial), Opportunity (Social norms/culturally accepted, Able to afford/source tb)
Psychology of Clinical Practice - Case Scenario 1 - Bella
- Case scenario involving a patient (Bella) with a history of dental visits; oral hygiene; bleeding gums; and stopping flossing, and the use of the COM-B model to guide her behaviour modification
- Applying the COM-B model
COM-B Model applied to Case Scenario 1 - Bella
- Applying the COM-B model; Capability (Able to floss but is technique damaging?), Motivation (Emotional reaction to bleeding, Beliefs about consequences), and Opportunity (Not a social norm, Able to afford/source floss)
COM – B + Bella case study
- Exploring Bella's motivation around flossing and the questions you might ask
- Modification and different approaches to address the behaviour
Consider
- The benefits and consequences of behaviour should reflect the values of the patient
Behaviour change in-action
- What can dental professionals do for behaviour change?
Cycle to address behaviour change
- Raise the issue; build motivation; Support patient on next steps; Assess readiness
Raise the issue and build motivation
- Elicit information from patients
- Provide specific information related to patient needs, oral and general health, relating it to patient values
Assess readiness to change
- Discuss the advantages and disadvantages of making changes
- Listen to cues about their desires, ability, and reasons
- If there are multiple behaviours, select one to address
- Address patient resistance
- Review readiness at each visit
Support patients to take the next step
- Demonstrating techniques, Planning, SMART goals, Identifying barriers, Coping mechanisms for relapse, Encouragement, Rewards, and Signposting or referring
Behaviour change techniques (BCTs)
- Numerous BCTs available
- Thinking about how these behaviours are carried out
- Research focusing on communication skills between patient and professional
Essentially
- Patient-professional relationship, Communication skills, Psychology, History taking skills, and Behaviour Management
Communication Skills
- Patient-centered approach, Trust, Respect, Active listening, No judgment, Empathetic, Non-verbal cues, Open questions, Rapport, and Relevant
OARS Framework
- Open questions, Affirmations, Reflections, and Summaries
Question Style
- Open vs Closed questions
Affirmations
- Positive reinforcement for desired behaviour change
Reflective Listening
- Summarising patient's concerns and feelings
- Paraphrasing to show understanding
Summaries
- Summarising patient's information to check if correct
- Identifying anything missed
SCDEP OH TIPPS video
- SCDEP Oral Hygiene TIPPS video
SCDEP OH Video BINGO + examples
- Bingo cards relating to the various techniques in behaviour change
COM-B Model & SCDEP OH video
- Applying the COM-B model to behaviour change techniques and SCDEP OH video concepts
Determining the need and desire for change
- Gathering patient history, oral health education, and continuous review
Summary so far
- Behaviour change and the evidence; Oral health-related behaviours; Positive and negative influences on health; COM-B model; Behaviour change in-action; Raise the issue; Assess patient readiness; Support patients; OARS model; Case scenarios
References
- References included for evidence and different resources used
Learning resources and evidence base
- NICE Guidelines, Oral Health promotion in General Dental Practice(NG30); NICE Guideline: Behaviour change: Individual approaches (PH49); Delivering better oral health: an evidence-based toolkit for prevention; and, Scottish Dental Clinical Effectiveness Programme (SDCEP)
- Relevant web addresses or URLs
Further Learning
- Health Education England e-learning modules on behaviour change
- Article on behaviour change in oral health
Time for application
- Case scenarios
Case scenario 1 - Bella
- Case scenario to demonstrate understanding of the COM-B model for patients, specifically for flossing
- Patient beliefs, clinician advice, relationship description, assumptions, patient behaviour modifications, and suggestions
Case Scenario 2&3: Smoking Cessation Advice
- Case scenarios for addressing smoking cessation with patients
Case Scenario 4: Bob's Story
- Narrative about a patient with advanced stages of oral cancer receiving smoking and alcohol use
Case Scenario 4 - Bob's Story Questions
- Questions about the ethics of treatment and balancing patient wishes with evidence-based treatment
Discussion in groups
- Discussion points in group settings; Information to increase knowledge about interdental brushing; Demonstrations of toothbrushing; Tackling smoking cessation; and, Addressing fluoride use
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Description
Test your knowledge on oral health recommendations based on NHS guidelines and current statistics. This quiz covers topics such as sugar intake, smoking effects, fluoride use, and effective communication strategies in patient care. Perfect for dental professionals and students alike!
