Deeper Insights into the Science of Behaviour Change
Behavior change is a coordinated set of activities designed to change specified behavior patterns.
Often times, interventions are ineffective if they aren’t designed using behavior change principles. Ineffective intervention bombards patients with all relevant information and expects favorable outcomes. However, effective intervention finds ways to make
information actionable, help users build skills, competencies, and knowledge.
Behavior change starts with asking key questions:
What do you want to help change?
Are you trying to create a positive behavior?
Are you trying to break a bad habit?
What are the barriers to desired behaviors?
Behavior change techniques from a literature review were converted into simple tools that could be deployed in a system and used easily by a hygienist to increase patient self-management.
I. Uncover the Motivation of Your Patient
The Science Inside:
Autonomous motivation has been associated with improved oral care behaviors. One of the core tenets of autonomous motivation is patient perceiving the behavior as part of their personal goals and values. Identifying and connecting desired oral health behaviors with a patient’s personal goals around their oral health may be an opportunity to build autonomous motivation and support self-care behaviors.
How It’s Used:
Ask patients about specific goals they may have for their oral hygiene and oral health. Help patients understand how your clinical recommendations may support them in their desired goal.
II. Provide Feedback
The Science Inside:
Feedback is information about patient behavior that helps him/her to understand when they are making progress, how that progress impacts their ability to reach their goals around oral health and builds a sense of competence. Feedback that helps individuals understand how, when and why they are doing something well, can impact their belief about their ability to make change which is also a component of self-efficacy. Feelings of competence and self-efficacy have been associated with improved oral self-care behaviors.
How It’s Used:
Provide feedback about what people are doing or have an opportunity to improve with the use of positive and encouraging tone. Connect feedback to clinical and patient goals and provide information about progress towards those goals where possible.
III. Establish Habits and Overcome Barriers
The Science Inside:
Habits are thought to be the automaticity of behavior. Habits are thought to be a form of automaticity that is related to a context cue and a response. Doing a behavior at a specific time and with a specific context cue may support habit formation. Understanding and possibly creating the context cues for both proactive as well as barriers to self-care behaviors may contribute to building oral health self-care routines and habits. Additionally, this may support improved goal setting and action planning and ultimately improved oral care self-behaviors.
How It’s Used:
Discuss the current routines of oral care self-care behaviors, addition of behaviors into existing routines, potential ways to overcome barrier with strategies and provision of choice. Encourage the patient to write down when and where they will perform the desired behavior over the next 4 weeks and keep track of how they are doing.
IV. Connect the Conversation
The Science Inside:
Patients may struggle to maintain motivation for oral care behaviors because they don’t connect the importance of oral health to themselves or things that are important to them. Building/supporting autonomous motivation has been shown to be associated with improved oral health self-care behaviors and downstream oral health outcomes.
How It’s Used:
Apply what you learned in the “what matters to me” tool and frame clinical guidance around patient goals and patient reasons for why the goals are important. Keep in mind that each patient is different. Acknowledge his/her unique oral care goals and connect your recommendations to the goals that matter to them. Communicate with genuine understanding.
V. Provide Choice
The Science Inside:
A fully-compliant oral care routine may mean significant changes to a patient’s lifestyle, making it difficult to successfully adopt and leading to patients feeling overwhelmed rather than engaged and willing to make change. One important element of supporting motivation for sustained change is providing individuals with expert guided volitional choice about the behaviors that are being recommended. The provision of volitional choice (as part of supporting autonomous motivation) has been shown to be associated with increased behavior change including oral self-care behaviors.
How It’s Used:
Collaboratively discuss the options that patients have to implement the oral self-care recommendations that are being made. Assure that you consider these choices as you develop recommendations as well as discuss how these choices are important in planning for success (see goal setting). Rather than giving up, encourage the patient to take small, progressive improvements to help drive optimal behaviors. Help your patient to understand the many choices available to improve oral health that can be part of the goals they collaboratively set.
VI. Use Friendly Terms
The Science Inside:
Patients need to understand the information that is being provided. Each patient has a different level of health literacy. It is therefore important to provide information in the most simplified language to assure understanding.
How It’s Used
Throughout the exam, describe what you see in terms that are easy to understand. Confirm understanding and ask if they have any questions about the information you are providing. Connect recommendations to what you saw during the exam.
VII. Set Realistic Goals
The Science Inside:
Setting goals and planning for how to attain them has been associated with improved oral self-care behaviors1-3. Setting goals that are structured to support successful implementation of recommendations when the patient leaves the office includes several specific steps. Helping patients to be specific, take on what they believe they can do, plan for how they will take action and ways they will overcome barriers or challenges and collaborate with them about the choices they may have is all part of the process.
How It’s Used:
Talking with patients about areas where they may need to improve based on what you are seeing during the dental visit can prompt discussion about goals. Asking patients about which area they want to focus on, the technique they feel most comfortable doing or learning and trying are all part of the process. Setting incremental goals may also help increase chances for success by not overwhelming the patient. Collaborate with your patient and help them set realistic goals based on and their personal and clinical needs.
VIII. Show Don’t Tell
The Science Inside:
Patients perceived ability to perform the behaviors they are being asked to perform has been associated with oral self-care behaviors. Supporting patients in building the necessary skills through modeling and practicing the behavior while being expert guided is one technique that may help improve competence.
How It’s Used:
Expert guided modeling and patient driven behavioral practice can be encouraged through demonstrating the behavior, allowing the patient to practice the behavior and providing the patient with corrective and positive feedback along the way. Asking if patients feel confident that they will be able to perform the behavior at home and understanding why they may not be, can lead to further discussions about whether the recommended behavior is the best fit for the patient. Plans to overcome barriers through actions and potentially providing other options through choice may support a patient sense of ability to perform the necessary recommendations.
IX. Build on Success
The Science Inside:
Providing a mechanism to track progress against a goal and to praise/reward the person for effort is thought to be a component of building competence and supporting self-efficacy. Establishing and collaborating on achievable tasks, planning for how to implement and providing positive feedback are all important.
How It’s Used:
Support the patient in self-monitoring behaviors to implement outside of an office visit, and track progress across office visits over time. Provide feedback on progress.