4. Behaviour Change

Question 1

What behaviours interest dentists?

Answer 1

• cleaning teeth
• diet
• smoking
• general health
• self-management

Question 2

What is the assumed model of communication?

Answer 2

• accurate info about the risk/impact of behaviour and benefit of change
• understanding
• appropriate behaviour change

Question 3

Behaviour change messages in dentistry

Answer 3

• limit sugar intake and restrict it to mealtimes if possible. Too much sugar causes tooth decay and other health problems
• brush your teeth twice a day for 2 minutes with fluoride toothpaste

Question 4

Self Efficacy Theory - Bandura

Answer 4

• a change in behaviour is predicted by confidence a person has that they can carry out behaviour
• so experience of doing it, observation of others carrying out behaviour, persuasion and feeling good/calm after behaviour leads to self-efficacy judgement then the behaviour or performance

Question 5

Theory of Planned Behaviour - Ajzen

Answer 5

• people have behavioural and control beliefs which interact with each other and normative beliefs
• this affects attitude, subjective norms and perceived behaviour control
• changes intention and the behaviour

Question 6

Behaviour change requires …

Answer 6

• intention to change
• importance and confidence
• ability to translate this intention to new behaviours
• knowledge of what to do, plan how to do it
• tailored to individuals needs

Question 7

What is the intention-behaviour gap?

Answer 7

• phases of behaviour change
• motivational phase - leads to intention
• volitional phase - leads to initiation and maintenance of new behaviour
• this last phase affected by maintenance self-efficacy, action planning and action control (self-monitoring)

Question 8

Implementation Intention Theory - Gollwitzer

Answer 8

• likelihood of a person performing behaviour is increased by making explicit action plan about where and when the behaviour will happen
• action plans function as cues that remind a person to perform behaviour

Question 9

Explain a MAP for behaviour change

Answer 9

• motivation, action and prompt
• careful communication is essential for individual, patient-centred conversations about each element
• made by Dixon, Diane and Marie Johnston

Question 10

Role of motivation in behaviour change

Answer 10

• how important it is to the person to change
• if a number of changes are to be made, which would they prioritise?
• do benefits of continuing behaviour outweigh the benefits?

Question 11

Tips from Motivational Interviewing - Rollnick

Answer 11

• practice guiding rather than directing style
• develop strategies to elicit patient’s own motivation to change
• refine listening skills and respond to encouraging change talk from patient

Question 12

Stages of Change Model or Transtheoretical Model of Change

Answer 12

• Prochaska and DiClemente in field of addictions
• different interventions for people at different cycle points
• pre-contemplation, contemplation, planning, action, maintenance (this is where relapse can happen and cycle begins again)

Question 13

Questions which must be asked at the action stage of Stages of Change model?

Answer 13

• does person feel confident and ready?
• what precise steps will need to be taken? is it better to do it all at once or in small steps?
• do they need to develop new skills to help make change?
• are there barriers to change? (affordable, fit with routine, social circumstance)

Question 14

Patients should set … goals, which are …

Answer 14

SMART
- specific, measurable, achievable, relevant, timed

Question 15

Explain prompts for behaviour change

Answer 15

• reminder to carry out behaviour
• planned in advance when and where
• physical reminders like sticky dots or elastic bands
• linked to other activities like meals or washing hands
• electronic reminders
• can be sorted at appointments

Question 16

Use of motivational interviewing in oral health

Answer 16

• systematic review in 2014
• 16 studies found using it
• in 7, assessing impact of MI on periodontal health, 5 reported improvement in MI group compared to control. remaining 2 had no diff
• in 4 studies assessing impact of MI on development of oral cavities, young children reported significant improvement. Improvements in severity of cavities and toothbrushing

Question 17

The best evidence suggests how should dentists influence oral health?

Answer 17

• chair side oral hygeine about method and timing of toothbrushing
• provide or reccomend use of powered toothbrush with rotation oscillation action
• provide instruction on use of toothbrush

Question 18

What 2 psychological theories is brief intervention based on?

Answer 18

• self-efficacy theory
• implementation intention theory

Question 19

NICE guidelines for behaviour change

Answer 19

• having considered commonly used models of health behaviour, the PDG concluded evidence did not support one model
• training should focus on generic competencies and skills rather than specific models
• practitioners should design valid/reliable interventions and programmes that take accoutn of social, environmental, economic context of behaviours
• identify and use clear and appropriate outcome measures to assess changes in behaviour
• employ a range of behaviour change methods and approaches, according to best available evidence

Question 20

Explain using an implentation plan

Answer 20

• university students given dental floss and advised of recommendation to floss for 5 minutes daily
• filled in online questionnaires
• one group asked to make plan for when they were going to floss. took around a minute
• planning group reported more flossing and used more floss than control group

Question 21

Explain COM-B model

Answer 21

• psychological models provide a structured theoretical framework
• behaviour affects capability, motivation, opportunity and vice versa
• we use this framework to assess potential needs of individuals or communities
• plan interventions designed to address needs
• evaluate and learn from results of intervention

Question 22

Phase 1 of designing intervention

Answer 22

• define problem in behavioural terms
• what behaviours need to change to resolve problem - by who? where?
• define one or two target behaviours (things that are easy to change, large impact if changed behaviours)
• specify target behaviour in as much detail as possible (who needs to do it? what, when, how often etc?)
• identify what needs to change (in environment, attitude, skills)

Question 23

What’s the behaviour change wheel?

Answer 23

• capability - ability to enact the behaviour (psychological and physical)
• motivation (reflective and automatic)
• opportunity (physical and social environment)

Question 24

Example of a behaviour wheel for…
Encouraging parents of young children to support toothbrushing at home

Answer 24

• capability psychological - might not have skills to maintain routine when busy and physical - might not have co-ordination
• motivation reflective - might not think it’s important and automatic - might trigger stress
• opportunity physical and social env - family may not agree it’s imp to brush teeth

Question 25

Phase 2 of designing an intervention

Answer 25

• identify intervention functions e.g education, persuasion, restriction, training, coercion
• identify policy categories - what policies would support delivery of intervention
• consider full range of intervention functions

Question 26

Phase 3 of designing an intervention

Answer 26

• identify exactly what you are going to do
• how to do it
• psychological theory behind it
• how you’ll evaluate it to see if intervention is successful

Question 27

How would phase 1,2,3 of an intervention look for improving exercise in obese adults ?

Answer 27

• they think they can’t do it - self efficacy and implementation intention
• they are worried they look stupid - subjective norm theory of planned behaviour
• use training (ps provided structured exercise plan tailored to level of fitness) or environmental restructuring (closed gym sessions arranged for ps with obesity)
• modelling (link to above theories) - ps have access to video clips of people similar to them completing structured exercise and ps have access to community forum to share experiences and ideas with similar people

Question 28

How to evaluate behaviour change?

Answer 28

• what info do you need?
• how do you know the change was as a result of the intervention?
• need to comment on what could have been better

Question 29

Compare arguing for change and having a conversation

Answer 29

• arguing can trigger patient to voice other side of argument, most will have heard it before and can feel unproductive to both patient and clinician
• conversing gives opinions both sides, behaviour more likely to be influenced by what they say than clinician and impact of reflecting ambivalence (roll with resistance)

Question 30

Explain simple reflection

Answer 30

• repeat back what the person has said
• can be a direct repetition of the last few words accompanied by appropriate nonverbal signs
• slight rewording
• demonstrates you are listening and hearing what they say

Question 31

Explain summary reflection

Answer 31

• paraphrases last few sentences the person has said
• gives opportunity for them to agree and see you’ve paid attention or to correct things you haven’t fully understood

Question 32

How can scaling questions work?

Answer 32

• on a scale of 0 to 10
• how important is the change
• why did you choose this number
• what would increase your chance to a higher number
• what can we do to make it more likely

Question 33

Explain ‘rolling with resistance’

Answer 33

• uses person centred skills for good active listening (reflections, clarifications, summaries)
• based on observation that people have usually rehearsed both sides of an argument (will respond with the one they aren’t given)
• doesn’t try to persuade or direct patients
• acknowledges change may not be a priority right now
• maintains a sense that professional is listening but maintains a good relationship for further future conversation