SDM PH521 Behavioral-transcript (1) PDF

SPEAKER 0 All right. Good morning. So when I was talking to my dental school classmates last week after the lecture, they said, Matt, how'd it go? It's like, were you boring? Maybe. Were you strict and mean? Kind of. Are you going to do it again? I have to. So welcome back. I'm glad to see you all a...

SPEAKER 0 All right. Good morning. So when I was talking to my dental school classmates last week after the lecture, they said, Matt, how'd it go? It's like, were you boring? Maybe. Were you strict and mean? Kind of. Are you going to do it again? I have to. So welcome back. I'm glad to see you all again. But today we're going to focus a little bit differently on a couple things. But before we do I know that there is a there was a couple messages back and forth this week about posting in your discussion group and under the assignments tab. This week is practice. Next week is not. Right now if you did not post your reply posts, and there are 27 of you who did not post it under your assignments, I want you to do that during class today. Just sometimes people that are high fiving. I know that you are one of those people, so make sure you look at the grade center. At 10:00 today. I will not be as nice moving forward with next week. It just helps us keep organized. Now, for those of you who may have looked or utilized references on the internet to do your post. Blackboard has capabilities for me to know. What that means is if you copy and pasted which is plagiarism, right? And you put it into your post directly without citing it, right? Those of you who used quotations and citations, you are fine. Don't lose sleep. The software lets me know. Next week. If I see that again, I'll be having conversations, okay? Because there's a lot of different assignments that we'll be working on over the next few weeks that we shouldn't be copying word from word from websites. Right? I want to hear your thoughts. A lot of the things are very specific. And again, this is a message blanket across the whole class not targeted to a distinct individual. So make sure that doesn't happen next week. But to wrap up next week, last week we'll start with just a quick, quick clicker question. It should be on the screen. I'll drag it up higher. I want you to rank your top three so you can hit three different buttons. The order doesn't matter as much, but I want you to tell me, what are your top three? It's working because there's four of you. The first four were really quick. So last week we learned about these and we and you did a really fantastic job in the discussion boards. I want that to be a big takeaway message. A lot of you really cited your information. Great. I saw great resources, different studies, different ideas of what would be most effective. And that's exactly what my goal is of your work in the discussion group. Now, as we think about these terms and as we move forward and in some of the discussions and some of my replies to your posts, I might have mentioned that this week we'll talk more about theoretical models. And I want you to not to forget about these terms, because these are all things that should be underlying some of the ways that we communicate and the conversations that we have. We've got about 133. That's good. So we'll look carefully. And I think if I was scanning and as I was engaging in your discussion groups this week, self-efficacy was definitely a top one, right? That idea that I need to think I can do it right, I need to believe that I can make a change is really important. And I ask some of you, and I saw some of you talk about it in your discussion groups, right. How can we relate that and how can we include that in our message as we start talking with patients in a few months now, we see that a lot of you ranked external locus of control very low, and I think that makes sense. But by no reason or no definition was this to intended to be one factor is more than another? Does anyone have an idea why? Was there a right or wrong answer for this assignment? No. Right. Everything's related now for you. Your rank might be different than someone sitting next to you, right? And that's the exact purpose of this assignment last week, is to know that you need to get to know the individual that you're working with in order to determine what approach is going to be most effective for them. And today we'll start talking about what do you do once you got to know your person that you're working with a little bit more? And how can we use theory to help us drive that and move forward? So I mentioned last week and one thing I'm going to tie through many of the lectures. Not all this year is my first patient, Philip. And I saw him on the sixth floor of the dental school before. The clinics were really beautiful. And I brought him back. And back then there was no data collection rotation, so we had to take our own fmqs. We went down to the first floor shot, which is now, I think, where patients check in, and we took an FM. And let me tell you, this was a case that you would look at and say, what on earth? There was the periodontal condition was really, really poor. I was nervous when I was taking some of the paths that I would knock out some teeth because of the mobility. And I could tell as Philip sat in the chair, he was nervous. But if you remember, or if you think about when you're going to be a first year first patient in the clinic, right? You're a third year or a S2 student ready to see your first patient. You're like, let's do these procedures. I got to bring you here, do this, got to go here, do that, got to get this and make sure that I get my sign off. So I finish my session on time to get my points for GD 630. Right. And that mentality with Philip I knew wasn't going to work. He was nervous. Like many of us who have ever had a fish in our own mouth, he hated it. And you can imagine when teeth are mobile, right? And you're taking X-rays and you're asked to bite down. He himself was nervous. So I brought him back up to the sixth floor, and we started to look at his x rays and start the data collection process. And by all means, this was going to be a two part data collection for me. And I quickly learned that Philip hated the name Philip. He wanted to be called Phil. And I think the moment that he told me and then I asked him because I could tell he wasn't really looking at me when I was asking questions, what do you prefer to be called, or what would you like me to call you? He started to engage, and I want you to remember that as you meet your own patient. Is that how can we start building relationships even sooner than I did with my first patient? So just like I promised, that each week will kind of revisit a little bit about Phil and relate Phil to what we're learning that week. I will post learning objectives and they're here for you. I know that you have many exams coming up next week, and when you when it comes time for May and this exam, I want you to look at these objectives to know what you should prioritize when you're studying. So we started this conversation last week talking about behavior and why behavior is important. But now that we have an idea of different factors that can influence our behavior, we need to focus on behavior change. So I have another question for you. I'll pull it up. What percentage of New Year's resolutions fail? I was going to ask you what your resolutions were, but I think. You can keep that thought in your head. So the research pretty varying on this, right? Because in order for them to do research on what percentage of New Year's resolutions fail, they actually have to ask a bunch of people, right? And if you ever have a resolution, at least for me, I know that I'm going to fail. So when you know you're going to fail something, you probably don't share it with everybody, right? Let's see. All right. So 41% said 90%. And according to many sources. That's correct. New Year's resolutions fail for a majority of folks that set them. But why do we set them? And why do they fail? So New Year's resolutions fail for three common reasons, and I think that all of these reasons relate to the types of conversations we should be having with our patients, and the types of ways that we can interact with them. The first is that our New Year's resolutions are way too big. Has anyone ever said a really big resolution and not done it? Yeah, like those people who want to do like all the major marathons. I think those are kind of interesting people, right? Way too big. Maybe starting with A5K would work. The second is they don't know why. This is a really important factor when we think about talking to our patients and when we interact with our patients in the chair, right. We don't ask why, we don't know why it's important, and we don't include that perspective in what we're doing. And then lastly, sometimes people set New Year's resolutions because it's New Year's, right? And that doesn't always correlate to when and why they're ready to change. So a successful New Year's resolution needs to be a Smart goal, right? Something that's focused and achievable. Something that links to a why are we knowing why they're doing something or have a reason? And lastly, it's making sure you are ready to change. And sometimes those goals don't always relate to your timeline. So behavior change in general is something that we do all of the time, right? We do it all the time. Hopefully now we know how to post really effectively and discussion boards. So we don't send me a million emails, right? Especially emails that are flagged as high importance. They might be high important to you, but maybe not to me. Right. So this behavior change is happening, right? And we know that behavior change relates on one's motivation to make a change, just like we saw in the New Year's resolution stuff, right? We know that we have to be ready to change, and we need to have a why. That when you're ready is super important. When we think about our dental practice, when we think about how we engage with patients and how we present different information. Now. I think that this concept of being ambivalent is really important in this process of behavior change. Does anyone know what that means? Should I do it or not? Do it. We agree. You don't really know, right? I think that weighing pros and cons is something that we're going to see in some of the change models that we're going to present today. We want to think, should I do this or should I not? And careful contemplation is part of the process. Now when we think about behavior change in a dental practice, we can only do so much in the three hour appointments we have in the school, or in the much shorter appointments that you'll have in your eventual practice. Right? There's only so much time we can engage. And for those of you who have been in practice before, or for those of you who have seen on apex, when a dentist runs into a hygiene room to do an exam, how much time do they really have? Like sometimes. Not a lot. Right? So in order to make a behavior or to change a behavior in 2 or 3 minutes, you got to go in with a real clear mission and vision of what you're going to say. Or maybe you're just dropping little hints, right? Maybe you're just giving little pieces of information that can influence someone's behavior, or you make sure that the members of your team, your hygienist, your dental assistants, your front desk all know the types of things that we should be doing to drive and influence behavior, because behavior changes not just one person. Now at the school, it's going to be a little different because you're going to be the primary contact with your patients. So thinking about how and when and what we can recommend for our patients that link to their everyday life that's sustainable is going to be a big and important piece. So we think now that we know a little bit about behavior change, it's not easy. And it's not easy, particularly for the patients that we're going to treat. So research brings us to different areas or to different ideas of why behavior changes more challenging for some than others. The first is that behavior change by itself is a very complex idea, right? There's lots of factors. We started talking about those factors not only unique to a specific person, but today we'll revisit some of those factors that relate to the environment, to how their upbringing, to the social context. And I think it's important to know that when we get to the clinic, behavior change is not just hard for our patient. Sometimes it's hard for us to do or talk about. And that's why for the majority of the rest of this course, we're going to start practicing and applying theories of behavior change into a real clinical context. As we think about what we will say or what we will do when we see patients. Now everything on this screen says advice alone is not enough, right? So there's a difference between providing someone advice than there is to actually thinking about how behavior can change. And we'll talk a little bit about different approaches that folks use in order to influence someone's behavior. Now when we are giving advice, there is research that suggests one area is really important, and that's making sure that the conversational environment in which you're providing advice is really friendly and open to the patient. Right. So we shouldn't be making sure that as we give advice that we're all mighty, we're sitting on a throne and we're sharing exactly what we want them to do, but we should make sure that it's in a context in which they can relate. Now as we go through the fourth point looking at good communication. Communication is something that we're also practicing extensively in this course, right? We're practicing it and we're making sure that we practice our written in verbal communication. And a lot of the assignments are designed to practice those skills. But without good communication, we're unable to influence someone's behavior. Now, research suggests that empathy and being empathetic in your communication is actually the most important factor to help drive that change. And then lastly, we know that when we don't involve patients in the process, we don't include them in the decision making. The influence on behavior change will not be as great or significant. So thinking about empathy, right. And I think empathy is really important. I want you to think of it differently than how we're thinking of pity, how we're thinking of sympathy, and how we think of compassion. Right? Everyone has been a recipient of bad news before, right? Somewhere in your life you've heard something you didn't want to hear. And you might remember the way in which someone said that information affected the way that you took that information in and used it moving forward. If someone is empathetic, they understand they feel the way the person is or what you're what you're sharing to them, right? It's distinctly different than compassion. Compassion, right. Empathy is an emotion where compassion is more cognition. Compassion wants you to. Then you feel it so much you want to make the change for them. So as we think about the difference between the two. I think if we're really compassionate, that's where being a dentist some days can be really hard, right? Because not only do you understand the struggles your patient are going going through, but you want to make sure that you can relieve that suffering, right? That you can help them, that you're the solution. We're being empathetic, understands where they're coming from. They feel heard. But you, them, you yourselves are not the only solution. Maybe you're a part of the solution. Does that make sense? So I want you to think about in your conversations as we script different assignments this year, as we move forward in a lot of our work together, that now that we know empathy and exactly what empathy is, we want to make sure that as we're scripting, we're approaching it in an empathetic way that we hear that we understand and that we do that, and we're going to have some time in the next couple of classes to practice how we can ensure that what we're saying comes across, not just that you're giving advice alone, right, but that you're putting it in context and you're demonstrating empathy in that message. Now, the research also suggests this idea that a patient should be involved in the process. The idea of shared decision making is an idea that you're listening and engaging with your patient and including what's important and valuable to them. So you all write a chief complaint. When you do your notes, write you all will. You've learned about in other classes, right? What do you know about a chief complaint? It's the reason why the patients there, it should be written in the patient's own words. Right. So I can even tell you some of the things I write, but I write exactly what the patient says when they walk in. Right? And sometimes it's really funny when I get to know them. It gets even funnier in practice. But you want to know exactly what brought the patient in, right? And that's because to me, that should be a real main target of what you're going to do now in a lot of your courses and how you'll treat your patients comprehensively at the school. You're going to make an elaborate treatment plan, right? They'll either be this type or that type of patient. You need to make sure that you have everything kind of lined up. You'll have a sequence of events, and you'll be practicing that for the next two and a half years or a year and a little bit if you're in a student. Right. So I think that within that process, we should also be really mindful of what is driving the patient to come to your chair and how we can then communicate effectively to ensure the plan prioritizes why they're there. And if it can't prioritize, right, because we have plenty of patients that just want to fix their front teeth, right? We all have had that. They only want to do something up front. They don't care about anything else, and they don't see the importance of why we're recommending any type of posterior support. It's making sure that we reiterate and re-explain that in order to get to where they want to go. These are the steps that help us get there. A good long leg for a front. So we've got to be careful. Uh, so I want us to think for a second. Um, during this second, we will be showing the QR code on the side screens. It will be shown once today for a total of five minutes. If you don't get in. You have to tell me in those five minutes. Okay. Um, but I want us to turn and talk to our someone sitting near us and start thinking about how would you approach an empathetic, uh, conversation. So PC extended. All right. My timer's on. And after you scan, and I want you to talk about empathy to someone sitting next to you. I don't know why the volume is so loud, but. Okay, give me a second. Anna. Okay. Okay. Is Anna Anna? Yeah. I know who you are. You're fine. Did it work? Now that I refresh it? Oh, okay. Cool. Give me a second. Talk about empathy. Be empathetic to this process. That's good, right? Whoever laughed? Thank you. Tell me if it works. SPEAKER 1 Do you get it? SPEAKER 0 Didn't even get it to work. Someone did. I got a thumbs up. No, I got some thumbs up. Try again. The intent is not to be stressful. I'm going to leave. No one's walking in. We'll get it by the end of class. No one's walking out. That's really all I care about. Okay? I want to hear about empathy. What about empathy? Raise your hand if you did not sign in. There's a lot of talking if you didn't sign in. You have about two minutes to move to the front row for the remainder of class. Um, and I will take your names gladly. I know there's one student that I talked about talk to, but I heard some good conversations and one point that, you know, I didn't really think about is that when we think about empathy themselves, right? When we think about empathy ourselves, we also have to think about the context in which we work. Right. So there was an interesting conversation in the middle thinking about if I am a. Orthodontist pediatric dentist ended honest. The way I approach empathy is going to be different than if it's a patient that you're a general dentist in your in your practice that you see on a cadence of at least twice a year. Right. And sometimes that empathy is not directed directly to a patient. Right? Sometimes we have to think about how we can approach the concept of empathy with all of those who we interact with, including caregivers, parents and guardians, those who accompany people. So as we think about and in our next step with my conversation with Phil, he became a denture patient. And in that denture patient, really thinking about who's going to see his smile and how can we make sure that they also feel as if the smile is his when we're done? We'll talk more about that in a couple of weeks. SPEAKER 1 Doo doo doo doo. SPEAKER 0 We're just going to talk about empathy the whole class okay. So I think that there's also this notion of skills that you've been working on that are not clinical skills throughout the course of your time here. And some of them have been what we think of as interpersonal skills, how we communicate, how we talk, how we express and emote, all of the things that we're practicing in this class. Now, the beauty of working with all of this in this room is that we're all very different, but we all have a similar goal in mind. With that, I want you to think and acknowledge that our own person, our way of being, plays a key role into the way that we engage with our patients. And I want you to capitalize on you being you when you're the provider and your chair, not necessarily the provider. You. Had or the provider that you think you need to be, because there isn't a one size fits all approach to all of our patients and our patient interactions. And that makes sense, right? We know that we need to tailor our conversations. We know that we have to tailor our own interactions to everyone that we interact and communicate with. Right. So I want you to make sure that as you're doing this, as you're practicing, as you're thinking about the conversations that you're going to be creating and drafting for some of your assignments, that they still feel like you. Because if I try to make you all be robots and say the exact same thing, there's going to be patients or people that we interact with that we won't be able to reach based on the research that suggests that we need to be flexible and approach each situation differently. Now, does that mean you can be your true self with everyone that walks in? Probably not right, but it means that you can highlight different elements of your own being that can influence the way in which we engage with others. And there's evidence to support that. That's really important. Now, as we think about counseling and consulting styles, we think about that when we're matching that style to the behavior style of our patient. We're actually going to be the most effective. So in order to do that, you need to get to know your patients really well. Now as you think about the providers that you want to become. Has anyone ever heard of any of the things here? The risk assessment? Those of you who might have worked. Yeah, I see some hands where you're determining your actual. Likelihood of how you lead a team, how you engage your own personal approach to different situations. There's also the Via character assessment. And I think in years past for the DMD students, we might have done this in apex year year. I think it was the year before. But we try to find your own personal strengths to be able to identify them. Now, I think it's important for you to know, although I'm not requiring you to know what your personal strengths are because I want you to capitalize them on your interactions with your patients this year as you move into clinic. If you're a person who is really creative, I think that can be a really important skill, not only in treatment planning, but in the way you approach an engaging conversation. Knowing where you're strong and where you're weak can be really helpful in identifying matches between you and your patient, and then seeing how can you be a chameleon? How can you then adapt your own personal style to what will work best with the patient? So when we think about approaches and we think about interacting with our patients and providing counseling and asking additional information, does the Fix-It approach work? You do this, I need you to fix it. Does that work? And sometimes it's really hard for us as dental students or practicing dentists or whoever, where we're going to go to realize that we're really good at fixing things. Right? You see a cavity. You fill it. You go to class, you study, right? We need to now think about more of the context and how we recommend these approaches. But thinking about a fixed approach and sharing it, that this is what we're going to do to fix your challenge, isn't going to be the approach that's most effective for our patients. Now, in that conversation, we already talked about shared decision making, but evidence suggests that it's the patient's task to make sure that they tell you and say how they're going to change their behavior. We can't tell a patient this is what you're going to do. Because if we do that, that's a fixit approach, right? We need to engage with them in dialog and find out in our role is to help the patient elicit or find out what are those arguments for change? What are they going to do? What are your specific priority areas? So we've talked a little bit about this last week, but we need to think about a patient's unique life context when we're thinking about and engaging with them and asking different questions and also emoting and expressing empathy. So thinking about those factors, much like we talked about last week, of those social determinants of health, what are the different challenges, barriers or concerns that fall into these different categories that we can hear, consider, and include in any of our recommendations and counseling and providing recommendations to our patients that step beyond the fixed approach. So in the discussion boards this week, I saw a lot of this in different ways. And some of you I might have commented on it right. There's this idea of fear appeals as and I put some examples on the screen. I asked a lot of you in the discussion board and I got some good responses. Our fear appeals super effective for everyone. Not really. Why not? Why not really. This doesn't make you not want to do meth. This doesn't make you want to make sure you're not smoking in front of your kids. Right. It only takes once, right? These messages are sometimes when we have condensed time, right? And we think back to maybe we're with our patients and we're running in to check our hygiene patients, and you have like two minutes to say something. We often, without knowing, put in a fear appeal. Do this or you're going to have to come see the periodontist, right? If you don't get this cavity fixed really soon, it could hurt. As we go through our assignments this year. I want to move past fear appeals because there is some research that suggests in certain situations, fear appeals can be really effective. They're super effective for you in this room, right? If I'm telling you you're going to lose a point for your grade, I'm going to get 100 emails and you're going to do what I ask, right? But I want you to step outside of that. And when you're engaging with behavior of the folks that you're going to be caring for as a provider. I don't really want to see a ton of language that suggests they have to do this or else, because to me, fear appeals relate to the fixed approach. They use scare tactics. They make you make a decision not based on what you want to do or your own unique life context, but rather because you're scared of the adverse outcome. So this also relates to stress. And I saw and I think we saw when we first started this presentation today, stress was one of those things that people either ranked first or they ranked last. Now some of you had some really interesting ideas about stress, I think. I think to Anthony's post that talked a little bit more about how stress is something that is important for us to realize when we're in the dental chair, because it's one thing as a provider. That we can control. Do you guys agree with that? I think of all the psychosocial factors we learned about last week. I can't control someone's. I can help motivate them to to prove they can do it. But I can't intrinsically affect their self-efficacy. I can't affect their internal locus of control. I can create and support and try to build it, but those things take a little bit more time. But right away in the first visit, you can work to reduce the stress of that environment. Does everyone agree? Now as a dental student about to see your first patient. What's your stress level like? Hundred, 100, 100, maybe 120, maybe even higher. So I think that it's really important for you to realize that that in this situation where you're caring for a patient, where you feel stress. The patients feeling stressed too. So you need to do everything you can do, possibly to make sure that your stress level is under control and managed, so that then you can start thinking of stress reduction protocols that you can put in place to ensure that you're carrying out the visit exactly the way that you want to, and making the patient as comfortable as possible. Now, the research is a little mixed on this, right? Because it's hard to exactly say in in situational context, fear, appeals and stress can actually be really helpful. So I don't want to say it's something you should never do because there's no should never would never. In the idea of behavioral science, right. We tailor our conversations the way we ask questions, the way we elicit more information, the way we are going to provide counseling to our patients needs. And if you know there's a patient where a fear appeal is the only thing that's going to work, that's what you're going to use, right? But I think when we think about our initial interactions, focusing on reducing the burden of stress is what's going to be most effective for you to start to have a meaningful conversation with your patient, to open up, and then to engage in some of the concepts we've already talked about. So as we think about. Not only what we're saying in communication, but our verbal or in our non-verbal interactions, how we stand if we're shaking as we're holding the probe, what do you think that's going to make them feel right as we do a full stereo chart? So it's ensuring that you're prepared. And that's a big piece of it. And that's why all of the assignments that we're doing in this class focus on the clinical application of behavioral science and afford you some area to practice. So when we get to the clinic, you'll feel more confident. Now, in order to do that, it's fundamental that we have an understanding of behavioral change from the perspective of a behavioral scientist. Now you're probably more familiar. And for the next series of slides, if you flipped ahead, you're probably thinking, oh, do I have to memorize all these models like the Krebs cycle? And the answer is no, right. But there are different approaches that different theologians have used, or people who are creating different models of care and have published on this to really help drive an idea. And that's what I want to think about as we think about behavior change and we think about theories, and we do that through the use of a theoretical framework, it's essentially a guide, right? It's a way to organize thoughts. And it's a way that individuals have described behavior change based on those different models. I think of it as a camera lens, right. If you select a theory, you should then be able to look at what you're looking at through the eyes of that particular theory and start dropping different things in different buckets and how it's influenced. What's more important about as we're thinking about behavioral science, as we're thinking about using these concepts, is that we start to identify where does this go, how does this influence someone's behaviors, and what factors appear to be most important in that individual's behavior change? So we're going to learn about five theories in this course. And the first four we're going to blow through pretty quickly right. And that's because as we talked about last week, the one we're going to focus on is the final trans theoretical model. But I want you to appreciate that there are other models out there that have similar ideas but are presented in slightly different ways. So we're going to walk through each of them. The first is social cognitive theory. So social cognitive theory is a theory of behavior change that has three components. It has the idea of cognitive factors, behavioral factors, and environmental factors. And believe it or not. Um bandura, who many of you referenced in selfefficacy this week in some of your posts, is the person who came up with this particular theory. Now, this theory suggests that what you know, the knowledge that you have influences how you practice what you do. And those folks who are around you in your environment and how you engage with the subject matter. Is what drives your ultimate behavior. So if you don't know anything and you don't get a chance to practice it, and you don't get to engage with it within your environment, right to assess what you know and then to then practice with others, your behavior is different. So I think of this theory as something that we're trying to do in this course. Right? We're trying to give you some knowledge. Right. And I know you already know a lot of things, but we're trying to baseline it. We're then trying to give you examples to practice what you know. And that's in your discussion forums. A lot of you learned a lot of information last week as you researched different articles, as you describe some of those different principles. And I have a strong feeling that's going to be really important as we move towards the the final exam. Because you already know these things because you determined it yourself. And then through the remainder of this course, especially the written assignments that will come next month, you're going to get to practice with someone else, and practicing with someone else within that context is really important to driving our behavior change. So bandura suggested that there are different factors that influence someone's behavior that can be lumped in three categories. So it's just a way of sorting different ideas, right? And that an individual themselves is a product of their environment and can influence their environment. Right. And we all influence our own environment because we're like, oh, I'm not doing that. I'm not going out there tonight. I'm not I'm not engaging with this group of or doing the next thing. And he was the first person to really think about how the environment can influence behavior. And that's what makes this particular theory stand out. Now moving to the next one. It's the health belief model. It looks more confusing, right? There's more boxes. There's more factors that can influence someone's overall behavior. But this one in particular, unlike social cognitive theory, relates directly to health and health behaviors. Right? Because your behavior about something else might be different than if it's about a health or something that affects your overall well-being, right? This model suggests that if you perceive a severity of a disease. And if there's a threat of that disease, we're more likely to change our actions and to have a healthy behavior. So I think that it's in this model. And what I want you to understand about this model is that it's specific for health, right? The way that we care for ourselves and the way we influence health behaviors of patients. But it's based on those two factors. One is how we perceived the threat, and another of how likely am I able to avoid or create an intervention or a treatment that would be successful in that threat to get a healthy outcome. And that kind of whole model talks a little bit more about how we can shape behavior around a specific health outcome. The third theory thinks about our planned behavior. This one is a more generic theory, again, that thinks that there's different factors that help us influence our behavior through the decision making process. Right. We know that our attitude, what we think we should do and what we have control over can influence our intention to act and ultimately our behavior. We all do this, right? It's just a fancy way of organizing our thoughts into how we make a decision in what we're going to do. So it thinks that the best predictor of behavior according to this model is one's intention, right? If you have good intention, you're able to influence your actual behavior because it's focusing on the planned aspect, what you're doing before. It can be influenced by your own attitude towards a particular topic or situation. What we think other people should think about. What we should do in that situation, right. What others are doing. And I'm sure we do that all the time, and how we study for exams or how we engage with assignments. And lastly, what we can control is what we're doing, something that will help attribute to a positive outcome. The fourth theory is self-determination theory, again a theory that describes someone's behavior, but this time through the lens of how motivated are we to do something right? And motivation in this image is really the center of what's driving behavior change. If we're motivated, we will do a different behavior, right? It talks about our our autonomy, our competence, and our relatedness as we think about factors that influence what we end up doing that's driving our behavior and what we will be and how we will achieve that goal. So thinking about this particular theory, it's about how determined we are to get where we're going. Now, these first four theories, I want you to have a big picture understanding of how they're approaching it. But the next theory we're going to dive deeper into, and we're going to learn all of the different stages of this trans theoretical model of behavior change. Now this unlike the health belief model, this one doesn't have health at its forefront. But this was described originally through research that talks about smoking cessation. Right. And there are six different stages and we're going to walk through each of them. The first is pre contemplation right. In this stage. You don't even think about a change. Right. You don't even understand that there is some type of behavior that you might want to change. Because they don't consider anything that they're doing as negatively or positively affecting their behavior. And outcomes. At this stage, persons have no idea, right? That they are going to contemplate or think about it in the next phase. And this is how many of you might be about certain behaviors, right? Doesn't that bother me? I don't even think about that. Something that I should be doing. Like, should I be taking my multivitamins? Right. Like if you're not really thinking about it or engaging with it, these are things you're probably aware of, but you don't really have a stance to. But once you get to this, the contemplation phase, you start thinking about it. It doesn't mean you've made a choice. It means you make a pros and cons list. Have you guys all done that when you thought about your dental school locations and what you want to do, right? Maybe you've done that. You're starting to do that next year for residency applications and kind of where you want to go or how you want to spend the rest of your career. Contemplation phase. You're thinking about it, but you still don't have an idea. So you're like, oh, maybe I'll do AGD, maybe I'll go to practice, or maybe I'll go for ortho, right? So you're thinking you're collecting information and you're trying to discern and make a pros and cons list. This phase is where someone is starting to become more open to a change. Right? They're already thinking about it. They're engaging with the topic, and now we can then move them into actual behavior change. And that comes with the first phase of preparation. At this phase. Someone's done different things within their lives, and they're trying to think about how they can incorporate and make this change sustainable. Right. They have an intention to change. And this is the first time in that trans theoretical model of behavior change where someone's like, hey, I want to make a change to my behavior based on all the information that I've gathered, my pros and cons list, and what I want to do moving forward. But they're still thinking about how they're going to do it and how they're going to put it into action. And this is a really important stage when we think about our roles as dentists, right. Because a lot of people know that, hey, I should floss more, right? They're going to buy a water pick. They're going to get an electric toothbrush. Right. For some of them who contexts may afford those different options, but they might not know how they can put it into their routine or how they're going to be able to sustain that behavior to make a meaningful change. But once they figure that out, they move into action phase. And this is where we love patients to be right there, acting on those behavior changes. They are motivated and they start to feel successful. You guys have all changed the behavior. And then you're like, oh, I start to like and I know a lot of you wrote about this in your discussion boards. I didn't do well in the first exam, but then I studied really hard and I felt much better after the second one when I got a good grade. Right. We've all felt that way. That's where people are in action phase. They know they feel the change of that outcome. However, they're vulnerable. Without motivation or the ability to be sustained in that action, they can relapse. And that can happen really easily. So once action, they feel that initial excitement. They know what they have to do. You've got a good grade on that exam. Then it gets into maintenance phase. What can I do to sustain that level of action and what systems can I put in place? And as a dentist, you might think about how we can incorporate flossing as someone's routine, right? I can't tell you how many college students you think about incorporating flossing into their shower routine, right? Where they won't forget it. They can put it in their their travel caddy to the bathroom, and at least it's some way in which they're having an influence on their behavior. Right? And that doesn't work for everyone, but it's a recommendation that comes across pretty regularly for those who might think about how they can't can't maintain a particular action. But in this phase, the behavior is totally integrated into someone's lifestyle. You know exactly how many hours per lecture you need to spend to do well on an exam. But maintenance can have an end, right? And it can relapse. And at relapse, we know that we're no longer maintaining that behavior. And the cycle itself has to happen again. So that's why, as we look at this diagram of the trans theoretical model of behavior change, we're going to get some clinical scenarios where we start thinking about where does one fall in this cycle based on what they're explaining, and how am I going to change what I'm going to say? How I'm going to ask specific information, how I'm going to provide counseling in order to best meet them where they are in this process of behavior change. If they're at maintenance mode, how can we ask questions that encourage maintenance if they're at contemplation stage? What can we do to build their pros and cons list to help them make an action as they prepare for action? And these are things we want to talk about. Now these probing questions are just examples. I don't want to see word for word copying of some of the language in this question, or action in some of the assignments that you submit later this year or this semester. But I want you to think about how your questions will morph based on what stage you identify a person to be in, but the only way you're going to identify the stage in which someone is in any theoretical model of behavior change, but specifically the trans theoretical model of behavior change, is by getting to know them and where they're at, right? And some of these questions would work really well for some of you, and other questions wouldn't work well, right? So it's also tailoring that specific message to who you're interacting with. So if someone doesn't even realize that a behavior could be worth changing, and we determine that they're in what we think of as the pre contemplation stage of this model, what can we say or do, or what do you think it would be worthwhile for them to even think about making a change, right. Often when we hear that someone totally doesn't know that a behavior is negatively affecting their overall health, we say, well, we jump right to questions that focus on either real contemplation why are you not doing this? What factors are getting in the way? Instead of slowing down and saying, what do you eat? What would you want to know? Or what would you want to think about? That even makes you think this is something that you'd want to change. And asking that question can open the doors to new questions that can very easily move someone from a phase where they're not even thinking about a change to now, when they're curious about what are those pros and cons? If you say, and this is where concepts like health literacy, like social determinants of health really come into play in our conversations with patients. Because if you say if you focus too hard or too high of a literacy level for the patients that you're treating like and you're asking questions, what are the pros and cons of this gum procedure, right. We might not even have enough information from a patient's perspective for them to even be in any phase other than pre contemplation, because they don't even understand the factors that you're talking about. So as we craft questions, as we think about our interactions, as we script those interactions based on our assignments that are coming in the future, what can we do or what can we say to identify where someone is in this model of the trans theoretical model of behavior change? But how can we tailor questions to help them move further along? Right. Because ultimately we love all of our patients to be in maintenance mode, right? And I say that quite often to a lot of my patients when they come into the chair and they're doing everything I ask them to do. When I can tell that they're brushing very effectively two times a day where there's evidence that they're flossing really well, they're using a fluoride mouth rinse at night, they're wearing their their night guard. Right. I say right to them. Things look great. You're in maintenance mode. We're here just to make sure that we check on you and make sure that we're doing everything we can to keep you as healthy as possible and right on track. And that's really where we target all of our patients. But let's face it, those of you as you enter clinic, you're hoping for patients that aren't in maintenance mode, right? You want a patient that's going to have a million procedures, right? You want to have a very small roster of people who have very significant needs. So you can do all your graduation requirements, right. Again, I challenge you to step outside of that as we start forming relationships with patients to remember the humanistic approach that we're going to include and think about and focus more on moving people forward, rather than what we're going to do mentally for them is going to actually make the biggest impact in the type of provider you'll come in your future practice. So I know I promised you that every class or for most classes, I'm going to give you a question that will be very similar to a test question. Right. So I'll give you a second to read this. Give me a little thumbs up if you're good. Oh, I see some thumbs up. Thank you. Okay. Hold on, I didn't. Okay. 137. Hey, 80%, that's mastery. That's pretty good. Okay. So I think I can go back here, right? Yeah. So going back to the story, why did we choose contemplation? Thank you. She knows about the problem, but she hasn't done anything about it yet. We agree. Yeah, she knows this is something. Now, how many patients do you think they're in this category? A lot, right. You might have told them. And you're like. So you can't force anyone as much as you really can. My personal belief is if you see a cavity on an x ray, you can't drag them to your appointment next time and make them do it, can you? If you wish. Right? I. I'm not strong enough to do that, so I won't say I wish to do that. But. We can't do that as providers, right? We can never force someone to do something. We can only give them the knowledge and skills necessary and the information necessary to make a choice to do their own pros and cons list, to actually take action, to prepare, to take action, and then to do action to then maintain that action. Right. Now, in this story, this patient, you're 100% right, knows that there is a problem, but hasn't done action. Why do you think someone might not have done this? Why has she not went? SPEAKER 1 Anyway. SPEAKER 0 She's waiting for the pain to go away. Money. These are good factors. Time. Yeah. She wants to stay with her dentist. Interesting point. Fear. What is she afraid of? Pain. What are they going to do it with? Like if you go to a TMD specialist. Diagnostic testing. Okay. Fear of the unknown. Has anyone ever seen it or been wired shut? So in my class, one of my classmates had total like a BSO, right? Bilateral. All the stuff you learn in oral surgery that I would never do in my life because I'm not interested. And he was wired shut for an extensive amount of time. Fear could be real, right? I think I'm afraid of that after watching him get so skinny. But I was a little jealous. And his name's. His last name is lower, so I probably he wasn't my patient so I can share it. And we were right next to each other in alphabetical order. Right. So the SLC was quite an interesting place. Fear can be a main factor that influences someone behavior, but all of the things that you're sharing are things that we've talked about already in this class, right? It's that if you don't know or think about why someone might not take action or move out of pre contemplation phase, it's because you don't have conversations with the patient and you don't know what makes them tick, what drives them, what makes them come back to you in your office, what they value with their care. Right. So I think that this the idea here is how can we take a scenario, right? How can we take a clinical scenario? How can we take an interaction, determine where they are and help move them to the next, the next criteria? Right. So now that we know that this particular patient knows there's a problem but hasn't taken it. What are some things we could say to them? Or what's the most appropriate types of questions to say to them? Are you afraid? Is that a good question? Probably not. What would you say? What's. What's what? What's stopping you? How did you feel if someone says what's stopping you to a behavior? Raise your hand if that would work for you. I actually think it would work for me. What's stopping me? Because maybe I'm not realizing what's stopping me. How many people would that question not fly well? It's okay. Some people in the room, right? Because what's stopping you has what type of connotation to it. Negative. And if we have a negative connotation in the way that we ask questions, what might that do to the patient? It might close them down, right? It might make it so that they're actually less likely to share any information or share. Or think about or move to the next phase. Because if they're in pre contemplation, the next phase is. Is what? And when they're in preparation phase, they have. Decided to do something right. Now they're thinking about how they're going to do it and how they're going to sustain it, right. So I think we need to ask questions that focus on how can we prepare you? How can we think about getting you ready to make a change? So what I want us to do is I want you to take a second, and I want you to first respond to a clicker question where you can type up some of the ways that you would start a response to this patient. And there's no right or wrong answer, because that question, the way that you said it, what's stopping you, I think would be like, oh, what is stopping me? So there's no but I want you to think about a way that you would approach it. And once you've submitted, like the first start of that sentence, you don't have to send the whole sentence. I want you to talk to someone near you about what you wrote and justify why you wrote it, and what type of person you think that would be most effective for. I'm not spying, but I'm thinking. So you're thinking a lot about what you're going around. You're like. Yeah. It's like, why is this so exhausting? You know, 8 a.m. is a real thing on a Friday for anyone, so. I want to take a second just to look at what some of you wrote. Right. Because there's really not. I think there's a really wrong answer. Right. There's a really wrong thing you could say, but what's wrong with you? I think. SPEAKER 1 You're right. Um. SPEAKER 0 So my mind gone again, or is he telling me something's wrong? Um. I think that there's a really wrong thing we could say, right? We could make a patient feel bad. And if we make a patient feel bad, how do you think that's going to affect their behavior? But there's a lot of things that we could say that aren't necessarily wrong, but there's a best approach and I want to take a look. So there's one thing on this screen that really stands out to me. And in some of the conversations I had throughout the room. What do you think is the one that really stands out? I heard it, but I want to hear it louder. How can I help you more? So I think when we think about phases of behavior change, I want you to think more about why you're asking questions as you ask them. And in some of the conversations that I had, many individuals wrote something like, what are your concerns? What do you want to know? Right. Tell me what's going to help you. Why do we want to know that information? Because when we have that information, we can then tailor our approach. When we tailor our approach, it's to their specific needs. I want you to think about as you're crafting questions and as you're thinking about motivating someone, you put that part first. What can I do? Or what information can I bring to you? How can I help you? How can I facilitate something for you? Right. Because that's a lot of the reason why some of you are asking these questions. It's not just to know what your concerns are, but it's to think about a solution oriented approach in the way that we're asking questions so that we can then influence behavior on and identify what you want, what the patient wants you to do. Right. What do they want to know? If you ask it that way, they might say, well, I don't understand this, and that's part of it. That could happen. Or that office doesn't have the hours that work for my schedule with picking up my kid from school. So is there another place that we can go to? These are the types of pieces of information that are going to then move someone from a pre contemplation phase. To preparation, to action and to maintenance. So there are a lot of really good questions, but as soon as I saw that, I felt really good about kind of what we're doing. Were you guys laughing at something? Was there something inappropriate? Um. So. Which one do you guys laugh about? What's what. Now. So. I put this up because. I know, I think that that was a specific joke to a specific person. But regardless, I'm glad you're using the clicker questions as a way to have fun. But I want you to think critically about why we're practicing this to. Because I think if we were all to walk around the clinic today, as I see patients on the, you know, fourth, fifth and sixth floor, there going to be some questions that are really effective and some that really need some work. And I think that it's okay to understand that you might not be perfect at crafting these questions. And that's why, through the rest of this course, I want you to start thinking about how we can set. Prompts how we can set. Reminders for us to then think about these things as we actually engage with the patient, because no one's going to be over you assessing if that question was totally appropriate or not, but you're going to be able to pick up how that question and response works based on your patient's interactions and their motives. So a couple of things before we wrap up today. Number one. The take home message is. Overall, the discussion boards were really great last week. I was very pleased. I saw a lot of great interaction. The one thing I want you to do towards the end of the week, even if you're an early reply poster, which I'm okay with, is look at how those dialogs evolved, because I think there were some questions that will remain unanswered. If you've done your two reply posts and never look at it again, that could actually influence and start to change your thought process about the way that we're going to approach some of the assignments moving forward. For those of you I told you at the beginning of class that I want you have until 10:00 to make sure that everything is posted, both in your discussion board and in the assignments tab. The assignments tab does have a deadline associated with it this week. I'm flexible. Okay. You have till 10:00. All of you've done it for the most part and I'm pretty confident you all have. But I know for sure some of you did not post it in the assignments tab. Maybe even some of the folks that were having fun and laughing today. Then make sure that you have in your calendar. I know you have a busy week when Discussion Board two is due and when the responses are due. And then the one thing you can't see because of this session ID is next week is more of a workshop format. So we're going to start thinking about crafting and applying those questions. So as we think about maybe Tiffany's question from last week, how are we going to start engaging with our partner next week in class is where we're going to start the process of thinking about our written assignment number one. So I want you to use the next course of this week. If you haven't introduced yourself to who you're going to be working with, to find your specific partner and to sit with them, do I need you to sit all as Group eight together? No. Do you have to hold hands? No, but I want you close. Okay. So that you can then think about and how you craft questions. So we can have a discussion so you can take action towards completion of those assignments. Sound good. All right. Have a good week.