Behaviour Change Lecture Notes PDF

Behaviour Change Jacky Hart Preena Shah Foundation in Clinical Skills and Practice, Year 1 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 Intended Learning Outcomes By the end of the sessions students will be able to: Describe what is meant by...

Behaviour Change Jacky Hart Preena Shah Foundation in Clinical Skills and Practice, Year 1 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 Intended Learning Outcomes By the end of the sessions students will be able to: Describe what is meant by behaviour change and its relevance to oral and general health Familiarise with the evidence-based guidelines for oral health-related behaviour change Identify factors that influence behaviour in line with the COM-B model Discuss how patient-centred conversations can support oral health-related behaviour change in dental hygiene and therapy practice Assessment Formative Active engagement throughout today’s sessions and peer feedback Summative E-assessment OSCE Future Effective behaviour change can improve health outcomes for our patients Links to prior learning dental History taking social diet Delivering Evidence Based Better Oral Health Toolkit Guidance for behaviours verbal Communicatio non-verbal n clinical conversations Outline for the session Theory Practical Definitions, context, evidence Case studies discussions – in Oral health-related behaviours we teams have opportunity to change and their evidence Influences on behaviour, psychological theory (COM-B) Behaviour change in action, link to communication Definitions what we do in Behaviour response to internal or external factors Health what we do that can impact on Behaviour our health, +/- Behaviour doing something that changes the change way a person does something Why is this important? Behaviours impact on our health and well-being by increasing our risk of, or protecting us from long-term conditions and illness including oral diseases. Oral health care professionals are strategically placed to support patients to adopt positive health behaviours using patient centered conversations – it is our duty!  Evidence-based guidance Oral Health promotion in general dental practice (NG30) How to adopt a patient centred approach? Behaviour change: Individual approaches (PH49) Chapter 3 Behaviour Change Interventions for the individual targeting general health NHS Long Term Plan Prevention and Treatment of Periodontal Disease in Primary Care Oral health-related behaviours quiz Mentimeter recap and test your knowledge: What behaviours are related to oral health? What is the guidance for these? Oral health in the UK 75% clean 2/day 66% visible plaque 9 in 10 1 in 10 need support excellent oral health ADHS 2009 Toothbrushing advice Powered OR manual toothbrush Clean all tooth Clean the Adapt technique to patient needs. surfaces gumline Benefits: Reduces the risk of dental caries Reduces the risk of periodontal Last thing at One other time night during the day disease Dietary guidance According to the DBOH Toolkit: 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 of free sugar 11years + 24g/day 6-10yrs 19g/day 4-6yrs OR no more than 5% of total calorie intake This Photo by Unknown Author is licensed under CC BY-SA Dietary intake of free sugars NDNS 2016/17 Fluoride Exposure Fluoride toothpaste 1450ppm Spit don’t rinse 76% use fluoride toothpaste (less for under 6yrs) Smoking advice Recommendation is not to smoke Encourage smoking cessation Around 14% population smoke in the UK aged 18yrs+ (ONS 2019). More to come in Smoking Cessation sessions Alcohol advice Not to exceed 14 units/week This Photo by Unknown Author is licensed under CC BY-SA-NC Refer to alcohol lectures in FCSP Attendance Recommendations based on risk: 3-24 months as per NICE guidance – Dental Checks: Intervals between oral health reviews CG19 ADHS 2009 Impact of oral health-related behaviours Oral health Systemic Behaviours health What makes us do what we do? What influences our behaviour? Own experiences of influences on behaviour… The wider determinants of health – influences on behaviour This is NOT exhaustive…can you think of any others? What factors can we/individuals controls? Motivation What motivates you to do things? Intrinsic (internal) and extrinsic (external) Habits Aim for behaviours to become habits It takes 66 days to build a habit on average What does this mean for our patients? COM-B Model For effective behaviour change to take place, interventions should be underpinned by an evidence-based theory. There are several theories relevant to behaviours and changing them. The COM-B model is well- (Michie et al 2011) recognised in health as key. COM-B Model Physical Psychological Automatic processes Reflective processes Social environment Physical environment (Michie et al 2011)  COM-B Model – example application Physical: Physically able to eat chocolate. Psychological: Knows how to eat chocolate. Eating chocolate Automatic: Likes the taste of chocolate makes you feel good. Reflective: deciding on and Justifying the need to eat chocolate Social environment: Able to buy chocolate, Socially acceptable, affordable Physical environment: available in the cupboard, staff room (Michie et al 2011) COM-B Model applied to oral health Physical skill/dexterity Psychological capacity to do Toothbrushing Habitual Believes it is beneficial Social norm/culturally accepted Able to afford/source a tb (Adapted from Michie et al 2011) Psychology of clinical practice - Case scenario 1 - Bella Bella attends the dental clinic for a routine visit. When asked how often she cleans her teeth, she responds that she is brushing every day but does not floss anymore. She mentions that since she tried flossing, her gums had started bleeding so she stopped flossing them and the bleeding stopped. The clinician responds that daily flossing is recommended to prevent gum disease and decay so she should start doing it again. Apply the COM-B model to this scenario.  COM-B Model applied to Case Scenario 1 - Bella 1. Which are should we target? Why? Able to floss but is technique damaging? 2. How will you do this? Examples? Knowledge of how to floss Bella’s Flossing Emotional reaction to bleeding prevents flossing Beliefs about consequences Not a social norm Able to afford/source floss (Adapted from Michie et al 2011)