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behavioural sciences & Patient motivation
This document summarizes behavioral science concepts related to patient motivation in dentistry. It discusses behavioral theories like classical conditioning, operant conditioning, and social learning theory. It then examines patient behaviors and motivations at different life stages - children, adolescents, adults, and geriatric patients. For each group, factors affecting their behavior are explored along with techniques for behavior management, communication, and motivation. These include psychological approaches like desensitization and modeling as well as pharmacological methods. The goal is to effectively perform treatment while instilling positive dental attitudes.
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Similar to behavioural sciences & Patient motivation
behavioural sciences & Patient motivation
- 1. BEHAVIOURAL SCIENCE & PATIENTMOTIVATION GUIDED BY : DR.PREETI DHAWAN(READER) DEPT. OF PREVENTIVE & PEDIATRIC DENTISTRY DR.RAVNEET ARORA(SENIOR LECTURER) DEPT OF ORAL MEDICINE & RADIOLOGY BY : ADITI SINGH (P.G I YEAR) DEPT.OF PREVENTIVE & PEDIATRIC DENTISTRY
- 2.
- 3. CONTENTS Introduction Behaviour theories The childpatient The adolescent patie nt The adult patient The geriatric patient God’s people Patient motivation Conclusion Bibliography
- 4. BEHAVIOR It is definedas any change observed in the functioning of an organism.
- 5. BEHAVIORAL SCIENCE It isthe science which deals with the observation of behavioral habits of man and lower animals in various physical and social environment.
- 6. Behavioral dentistry isan interdisciplinary science which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care delivery system.
- 7. BEHAVIOR DEVELOPMENT • Behaviordevelopment is dynamic process, which begins at birth and proceed in ascending order through a series of sequential stages. • The development of behavior initiates at childhood and persist forever.
- 8. BEHAVIORAL THEORIES • CLASSICALCONDITIONING • OPERANT CONDITIONING • SOCIAL LEARNING THEORY • HIERARCHY OF NEEDS
- 9. CLASSICAL CONDITIONING • PAVLOV(1927) •The conditioning is the relation between the conditioned stimulus and the unconditioned stimulus.
- 10. OPERANT CONDITIONING • SKINNER(1938) • Individual response is changed as a result of reinforcement or extinction of previous responses. • The consequence of behaviour itself acts as a stimulus and affects future behaviour.
- 11. SOCIAL LEARNING THEORY AlbertBandura, "Social learning theory approaches the explanation of human behavior in terms of a continuous reciprocal interaction between cognitive, behavioral, and environmental determinants" (Social Learning Theory, 1977).
- 13.
- 14. CLASSIFICATION OF CHILD’SBEHAVIOUR FRANKEL’S CLASSIFICATION (1962) RATING BEHAVIOUR Definitely negative Refuses treatment, negative behaviour associated with fear. Negative Reluctant to accept treatment, displays evidence of slight negativism. Positive Accepts treatment, but if the child has a bad experience during treatment, may become uncooperative. Definitely positive Unique behaviour, looks forward to and understands the importance of good preventive care.
- 15. FACTORS WHICH AFFECTCHILD’S BEHAVIOR IN DENTAL OFFICE
- 16. UNDER THE CONTROLOF THE DENTIST A) Dental Clinic B) Effect of dentist’s activity and attitudes C) Effect of dentist’s attire D) Presence or absence of parents in the operatory E) Presence of an older sibling
- 17. OUT OF CONTROLOF THE DENTIST Growth & Development Nutritional factors Past medical and dental experiences School environment Socio-economic status
- 18. UNDER THE CONTROLOF PARENTS 1) Home environment 2) Family development and peer influences 3) Maternal Behavior
- 19. BEHAVIOR MANAGEMENT Behavior management: is defined as the means by which the dental health team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude. (Wright 1975) Behavior shaping: is the procedure which slowly develops behavior by reinforcing a successive approximation of the desired behavior until the desired behavior comes into being.
- 20. THE CLASSIFICATION.. • Nonpharmacological (Psychological approach) • Pharmacological
- 21. Non-pharmacological methods 1. Communication 2. Behaviourshaping ( modification) a) Desensitization b) Modelling c) Contingency management 3.Behaviour management
- 22. COMMUNICATIVE MANAGEMENT TYPES OFCOMMUNICATION: a) Verbal communication is by speech b) Nonverbal (multisensory communication) c) Both using verbal and non-verbal
- 23. HOW TO COMMUNICATE? •Compliment him about his appearance. • Communication should be from a single source. USE OF EUPHEMISMS: • Euphemisms are substitute words,which can be used in the presence of children
- 24.
- 25. DESENSITISATION Tell show dotechnique (TSD): • Addleston 1959. • This is effective in children more than 3 years of age.
- 26. MODELLING • • Introduced by Bandura(1969) It developedfrom socio-learning principle procedure
- 27. CONTINGENCY MANAGEMENT • It isa method of modifying the behavior of children by presentation or withdrawal of reinforcers. These reinforcers can be : a) Positive reinforcer b) Negative reinforcer
- 28.
- 29. Aversive conditioning : •It is used for definitive negative behaviour child. • Two common methods used in the clinical practice are HOME and physical restraints:
- 30. HOME HOME (Hand overMouth exercise) Introduced by Evangeline Jordan 1920.
- 31. b) Physical restraints(Kelly 1976). - Active - Passive
- 32.
- 33. THE ADOLESCENT • Adolescents– young people between the ages of 10 and 19 years – are often thought of as a healthy group( WHO 2012)
- 34. THE MANAGEMENT.. Is insecureand unable to cope with many Be kind and understanding situations Have varied interest Determine what these are and encourage discussion on these issues.considerable rapport can be gained through discussion when handle properly Tend to reject adult authority Responsive to empathetic guidance. Be firm but kind; display authority in clinical matters,but do not be authoritarian Preoccupied with health matters in general and appearance in particular. Use these concerns as mechanism for motivating the type of behavior conducive to enhancing rapport and improving oral health
- 35. Often regress tochildlike behavior in clinic. this age group is particularly sensitive to being treated as a child. Be extremely careful not to cause the patient obvious embarrassment. Tend to worry about many circumstances; conditions in home, parent, school, social injustice, peer relationship Clinician should encourage conversation to develop a better rapport. Nutritional factors Clinician should motivate patient toward adequate nutritional intake and proper dietary practice from perspectives of obesity and oral health.
- 36.
- 38. DENTAL PATIENT’S FEARS •Fear from pain & treatment procedure • Fear from unknown • Fear from past dental history • Fear from the financial cost • Fear from treatment outcomes
- 39.
- 40. • WHO ISBETTER??? DURYODHAN ARJUN
- 42.
- 43. CHAIRSIDE TECHNIQUES FOR BEHAVIOURCHANGE • NON RELAXATION BASED TECHNIQUES COMMUNICATION LISTENING DISTRACTION • QUASI RELAXATION BASED TECHNIQUES GUIDED IMAGERY • RELAXATION BASED TECHNIQUES COGNITIVE COMPONENT SOMATIC COMPONENT
- 44. COMMUNICATION FOR HEALTH BEHAVIOURCHANGE • Patient Clinician Relationship “FIRST IMPRESSION IS THE LAST IMPRESSION”
- 45. VERBAL EXCHANGE Styles ofcommunication(Rollnick et al 2007): • 1.Directing(most common) • 2.Following • 3.Guiding (OARS)
- 46.
- 47. THE ART OFLISTENING “Apparently the act of attending carefully to another person is a difficult task for most people.” —Carl Rogers
- 48. HOW TO LISTEN •have a calm manner • say reassuring things • take seriously what the patient has to say • tell the patient what is to be done • encourage the patient to ask questions
- 49. “An inability tolisten will be judged harshly.” —Stanley Weiss
- 50. NON VERBAL EXHANGE •EYE CONTACT • FACIAL EXPRESSIONS
- 51. • VOCAL CHARACTERISTICS •BODY LANGUAGE
- 52.
- 53. QUASI RELAXATION TECHNIQUES HelenLindquist Bonny (1921 – May 25, 2010) Music therapist Kenneth Bruscia defined Guided Imagery and Music as “All forms of music-imaging in an expanded state of consciousness, including not only the specific individual and group forms that Bonny developed, but also all variations and modifications in those forms created by her followers."
- 55. TO SUM ITALL UP …
- 57.
- 59. What happensin the mouth is often a reflection of what happens in the body. Oral Health as been linked to diabetes, heart disease, stroke, and pneumonia. 5 9 Research also links Periodontal disease, a chronic inflammatory disease to cardiovascular disease, diabetes, Alzheimer's and other diseases (Journal of Periodontology Aug 2008 Supplemental Issue)
- 60. GERIATRIC PSYCHOLOGY (MM HOUSE) PHILOSOPHICAL: • well motivated • realizes his part in the success of the treatment. • Cooperative and adjustable. • They are rational, sensible, calm and composed even in difficult situations.
- 61. EXACTING (critical): • Methodicaland precise • He likes each step of the procedure explained in detail. • Proposes alternative treatment MANAGEMENT: Extra care, efforts and especially patience is required. The physician must listen to there demands but not give in, especially if they are unresonable.
- 62. INDIFFERENT PATIENT Lacks motivation Usuallynot interested in treatment Tries to find faults in the treatment Tend not to cooperate or follow instruction MANAGEMENT: Difficult to manage An attempt is made to educate the patient and improve his interest
- 63. HYSTERICAL PATIENT • Easilyexcited • Highly apprehensive • Rarely cooperate with the treatment • Tend to have unfounded complaints and unrealistic expectation. MANAGEMENT: require lot of time and effort. Often medical consultation or professional help is required.
- 64. SKEPTICAL PATIENT • Hadbad result with previous treatment • Doubtful if their problem can be solved • psychological disturbance from some recent personal tragedy. MANAGEMENT Genuine kindness, care and sympathy should be offered. More time and attention to detail should be given. These patient can be made into excellent patient if handle properly.
- 65. M M HOUSEREVISITED
- 66. HEARTWELL THE REALIST…. Philosophical +Exacting type Follow instructions properly Maintain a good oral hygiene Seek dental care Take good diet
- 67. • THE RESENTERS… Indifferent+ Hysterical type Second childhood stage.. Will NOT listen to instructions properly Negligent in oral care Rarely seek dental care MANAGEMENT : Palliative treatment
- 68. • THE RESIGNED… Variableemotional & systemic status Passive submission MANAGEMENT : Definitive or palliative
- 69.
- 70. STATUS PREOPERATIVE MANAGEMENT ORAL SEDATION BEHAVIORAL 1. ANSWERINGPATIENT’S QUESTIONS 2. REASSURANCE PHARMACOLOGICAL EFFECTIVE LOCAL ANESTHESIA ORAL SEDATION BEHAVIOURAL INSTRUCTION TO PATIENT DESCRIPTION OF COMPLICATIONS PHARMACOLOGICAL POSTOPERATIVE 1. EFFECTIVE COMMUNICATION 2. MAKE THE PATIENT RELAX 3. EXPLAIN THE PROCEDURE PHARMACOLOGICAL OPERATIVE BEHAVIORAL ANALGESICS, ADJUNCTIVE MEDICATIONS Zwetchkenbaum S et al Prosthodontic considerations for older patient. The Dental clinics of North America 1997;41:817-46
- 71.
- 72. • “Before meetingthe mouth of the patient, we must meet the mind of the patient”- DeVan • The Golden Handshake.. • The Schizophrenic patient • Patient having Alzheimer’s disease
- 73. A WORD OFCAUTION… EXTREMELY STRESSED OUT PATIENTS SATISFIED WEARER OF OLD DENTURES GERIATRIC PATIENTS WHO DO NOT WANT DENTURES THE GERIATRIC PROSTHODONTIC PATIENT
- 74. • Prefer shortmorning appointments • Avoid exagerrated treatment options • Consider partial transitional denture , over dentures etc.
- 75.
- 76. • They formone of the more neglected population as far as oral health care is concerned • They need special considerations & strategies beyond those required for other people
- 77. THE HINDRANCES… • INFORMATIONOBSTACLE • PHYSICAL OBSTACLE • BEHAVIORAL OBSTACLE • ORGANIZATIONAL OBSTACLE
- 78.
- 79. MODIFIED ARMAMENTARIUM • MODIFIEDTOOTH BRUSH • TONGUE BLADE MOUTH PROP
- 80. BEHAVIOR SUPPORT • STRUCTURINGTHE ENVIRONMENT • INVOLVING THE INDIVIDUAL • EDUCATING THE CAREGIVER
- 81.
- 82. MOTIVATIONAL INTERVIEWING “ aclient- centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence ” (Rollnick and Miller 1995 )
- 83.
- 84. IN THE DENTALOPERATORY.. • AIM IS TO … (1) assess motives, (2) raise awareness, (3) support a change.
- 85. Modus operandi.. • Healthhistory form (objective) • Open ended questions
- 86. • Raise awareness Vs Givinginformation
- 87. Support a change •Encouraging patient problem solving • offering a set of strategies or options • planning steps for the change.
- 88. THE CHANGE TALK.. •ELLICIT – PROVIDE – ELLICIT • ROLL WITH RESISTANCE • A BRIEF INTERVENTION
- 89. OUTSIDE THE DENTALOFFICE • DENTAL HEALTH CAMPS 1. COMMUNITY LEVEL HEALTH PROGRAMMES 2.SCHOOL ORAL HEALTH PROGRAMMES 3.HEALTH AWARENESS CAMPAIGNS
- 90.
- 91.
- 92.
- 93.
- 94.
- 95.
- 97. REFERENCES • Ralphe EMcDonald ,Avery R D, Dean J A ;Dentistry for the child and Adolescent;8Ed Mosby;2004 • Mostofsky I D, Fortune Farida; Behavioral Dentistry;2Ed;Wiley BlackWell;2012 • Glanz K, Rimer B, Vishwanath K;Health Behavior & Health Education Theory, Research & Practice;4Ed;Jossey-Bass;2008 • Ramseier C, Suvan J;Health Behavioral Change in Dental Practice; 1Ed;Wiley-Blackwell;2010 • Tandon ShobhaTextbook of Pedodntics;2Ed Paras Medical;2009 • Ernest R. Hilgard ;Introduction to psychology; 6Ed;Mosby • Charles M heartwell ;Syllabus of complete dentures • Module 4. Behaviour Modification ;UNESCO ;February 2000
- 98. • Diana MGardnier;Psychosocial behaviour pattern for adolescence- dental clinics of north america; vol-50 (17-32) • David Kohllo;Child & adolescence psychology ; journal of clinical psychology ; vol 13; (47-53) • Ripa & Barenier;Management of dental behavior in children • Busschots G Milzman B Dental patients with neurologic & psychiatric concerns. The Dental Clinics of North America.1999;43:471-83 • Laxman Rao Polsani,AjayKumar G,Githanjali M, Anjana Raut;Geriatric Psychology & Prosthodontic Patient;IJOPRD,AprilJune 2011;1(1):1-5 • Thomas A. Cavalieri, DO;Managing pain in Geriatric Patient; J Am Osteopath Assoc. 2007;107(suppl 4):ES10-ES16 • Gamer S,Tuch R,Garcia L T;M. M. House mental classification revisited: Intersection of particular patient types and particular dentist’s needs; J Prosthet Dent 2003;89:297-302.
- 99. • Freeman R;Strategiesfor motivating the noncompliant patient;British Dental Journal; Vol 187(6)1999-307 • Anne E, Halvari M,Halvari H, Bjørnebekk G, Deci L E; Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance; Motiv Emot;2010(34):15–33 • Anne E, Halvari M,Halvari H, Bjørnebekk G, Deci L E;Motivation for Dental Home Care:Testing a SelfDetermination Theory Mode; Journal of Applied Social Psychology,:2012;42(1)1–39.
Editor's Notes
- #2 Custom animation effects: faded zoom entrance and exit(Basic)To reproduce the picture effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click Picture. In the Insert Picture dialog box, select a picture, and then click Insert.On the slide, select the picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 5.5” and the Width box is set to 6.5”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes.Select the picture. Under Picture Tools, on the Format tab, in the PictureStyles group, click PictureShape, and then under Rectangles click RoundedRectangle (second option from the left).On the picture, drag the yellow diamond adjustment handle toward the corner to decrease the rounding on the corners of the rectangle. Under Picture Tools, on the Format tab, in the PictureStyles group, click PictureEffects,point to Shadow, and then under Outer click OffsetCenter (second row, second option from the left).To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation.On the slide, select the picture. In the CustomAnimation task pane, click Add Effect, point to Entrance, and then click MoreEffects. In the Add Entrance Effect dialog box, under Subtle, click Faded Zoom, and then click OK. Under Modify: Faded Zoom, in the Start list, select With Previous.Under Modify: Faded Zoom, in the Speed list, select Medium.Also in the Custom Animation task pane, click Add Effect, point to Exit, and then click MoreEffects. In the Add Exit Effect dialog box, under Subtle, click Faded Zoom, and then click OK. Under Modify: Faded Zoom, in the Start list, select On Click.Under Modify: Faded Zoom, in the Speed list, select Medium.To duplicate the animated picture effects on this slide, do the following:Select the first picture. On the Home tab, in the Clipboard group, click the arrow under Paste, and then click Duplicate.Select the second picture. Under Picture Tools, on the Format tab, in the Adjust group, click Change Picture. In the Insert Picture dialog box, select a picture, and then click Insert.Select the second picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 5.5” and the Width box is set to 6.5”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes.Select the second picture. On the Home tab, in the Clipboard group, click the arrow under Paste, and then click Duplicate.Select the third picture. Under Picture Tools, on the Format tab, in the Adjust group, click Change Picture. In the Insert Picture dialog box, select a picture, and then click Insert.Select the third picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 5.5” and the Width box is set to 6.5”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes.Press and hold CTRL, and then select all three pictures. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Middle.Click Align Center. In the Custom Animation task pane, select the sixth animation effect (faded zoom exit effect for the third picture). Click the arrow to the right of the effect, and then click Remove.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 50% (second row, second option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).