Comparing a motivational and a self-regulatory intervention to adopt an oral self-care regimen: A two-sequential randomized crossover trial

Validation of an improved questionnaire assessing the social cognitive constructs of the Health Action Process Approach among parents regarding brushing their children's teeth

OBJECTIVE

The Health Action Process Approach (HAPA) describes social cognitive constructs related to behaviour change. A validated questionnaire is needed to measure these constructs in paediatric dentistry. The aim of this study was to improve an existing HAPA-based questionnaire for parents regarding brushing their children's teeth and to assess its validity and reliability in a population of parents of high caries risk children.

METHODS

Parents of high caries risk children of 3-10 years filled out the adjusted HAPA-based questionnaire. Mokken scale analysis, graded response model analyses, factor analyses and reliability analyses were performed according to the protocol of Dima. Discriminant validity was assessed by comparing the mean scores of the HAPA constructs between two groups of participants, based on different levels of caries experience, brushing frequency and education level of the mother.

RESULTS

The Mokken scale analysis and factor analyses indicated a multidimensional eight factor scale. The graded response model did not fit our data. The subscale action control could be identified as a two-factor subscale. Reliability indices from the Dima protocol varied, for instance Cronbach alpha ranged from 0.73 to 0.96. The constructs coping self-efficacy, action planning and action control discriminated between brushing frequencies.

CONCLUSIONS

The adjusted HAPA-based questionnaire is an improved, valid and reliable instrument that could be used to evaluate HAPA-based interventions to improve children's oral health.

Promoting influenza prevention for older adults using the Health Action Process Approach: A randomized controlled trial

Older adults are at greater risk of complications from seasonal influenza, and promoting uptake and adherence to preventive behaviors is key to attenuating this risk. The current study examined the efficacy of a theory-based telephone-delivered intervention to promote uptake and maintenance of influenza preventive behaviors in a sample of Hong Kong residents 65 years and older. The intervention adopted a three-group randomized controlled design (n = 312) with two intervention conditions, motivational and motivational + volitional, and a measurement-only control condition. The primary outcome variable was self-reported compliance with influenza preventive behaviors, including washing hands, avoiding touching eyes, nose, or mouth, and wearing face masks. Secondary outcomes were theory-based psychological variables. Influenza preventive behaviors in participants in the motivational + volitional intervention group were significantly improved 3 months post-intervention relative to those in the control condition. However, participants in the intervention group demonstrated no difference in behavior at 6 and 12 months post-intervention relative to the participants in the control group. Intervention effects were observed on the theory-based social support, action planning, and coping planning variables. Although short-term benefits of the intervention were observed, effects appeared to be short-lived and future research should investigate more intensive interventions that lead to greater behavioral maintenance.

Health action process approach in oral health behaviour: Target interventions, constructs and groups-A systematic review

OBJECTIVE

The aim of this study was to systematically map the Health Action Process Approach (HAPA)-based interventions in dentistry in relation to the type of intervention, the target groups and the constructs of the HAPA model that are used in the study and to assess the clinical relevance of the studies.

METHODS

A search in the databases of the National Library of Medicine (MEDLINE-PubMed), PsychINFO and Cochrane-CENTRAL was conducted. A quality assessment to estimate the risk of bias and a qualitative descriptive analysis were performed. The overall gathered evidence was graded.

RESULTS

Ten randomized controlled trials and three observational studies thus in total 13 studies were included. Flossing was the targeted behaviour in ten studies. The target groups consisted of students, adolescents and dental patients. Overall, all nine HAPA constructs were used, but only one study used all HAPA constructs. Six studies presented the used behavioural change techniques according to the BCT taxonomy. Based on the number of the used constructs, only two studies were classified as HAPA intervention studies. The most frequently used constructs were action control as an intervention and behaviour as an outcome measure. The overall evidence was graded with moderate certainty.

CONCLUSION

In the majority of the studies, the targeted intervention was flossing and the population consisted of students, adolescents and dental patients. All studies used only a selection of the HAPA constructs. Therefore, only a minority of the studies can be considered real HAPA intervention studies.

Top-down self-regulation processes as determinants of oral hygiene self-care behaviour: A systematic scoping review

Objectives

Understanding the psychological mechanisms that moderate oral hygiene self‐care behavior is anticipated to benefit efforts to change such behavior. Top‐down self‐regulatory (TSR) processes represent one group of relatively unexplored, yet potentially influential, moderating factors. This systematic scoping review aims to explore whether there is evidence that TSR processes moderate oral hygiene self‐care engagement within the current literature.

Methods

CINAHL, The Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched up to April 2020 for articles that compared measures of TSR processes (such as self‐monitoring, inhibitory control, and task switching) to oral hygiene self‐care behavior, or tested interventions that aimed to change or support TSR processes.

Results

The search returned 6626 articles, with 25 included in the final sample. Weak evidence supported both the role of TSR processes as moderators of interdental cleaning and the value of interventions targeting self‐monitoring of interdental cleaning behavior. Overall, methodological limitations rendered the findings somewhat inconclusive, with an absence of objective assessments of TSR capacity, and little focus on TSR processes as moderators of intervention effects.

Conclusions

The inconclusive, but reasonably promising, findings point to the value of continuing to apply TSR processes within studies of oral hygiene behavior. Exploring why interdental cleaning appears more reliant on TSR processes than toothbrushing, employing objective neuropsychological assessment, and measuring TSR constructs within interventions targeting TSR processes, are encouraged. As a scoping review, the study hopes to generate interest and serve as a starting point for further investigation.

The effectiveness of the information-motivation-behavioral skills model-based intervention on preventive behaviors against respiratory infection among community-dwelling older adults

OBJECTIVE

To evaluate the effectiveness of an information-motivation-behavioral skills (IMB) model-based multi-component intervention on engagement and the quality of preventive behaviors against respiratory infections among community-dwelling older adults.

METHODS

This study was a controlled pretest-posttest study in which 91 community-dwelling older adults aged above 65 years were included. The intervention group (n = 42) received the six-week intervention theoretically based on the IMB model that comprised weekly group education and 5-10 min of tele-counseling per week.

RESULTS

The results showed that, after the intervention, the improvement in the level of knowledge, self-efficacy, self-reported engagement, and the quality of respiratory infection preventive behaviors was significantly greater in the intervention group compared to the control group. There was no significant difference between the two groups for the perceived threat of respiratory infection.

CONCLUSION

The IMB model-based intervention improved the engagement and quality of preventive behaviors by increasing the level of knowledge and self-efficacy in community-dwelling older adults.

PRACTICE IMPLICATIONS

The IMB model-based multi-component intervention can be an effective approach to improve preventive behaviors and will contribute to the preparation of communities for outbreaks of respiratory infections.

Toothbrushing and related factors among high school students in the Southeast of Iran: A cross-sectional study

INTRODUCTION

Dental caries is one of the most common problems in student, and tooth brushing at least twice a day is one of the preventive measures of dental caries. This study aimed to determine the frequency of daily brushing and its related factors among high school students in the southeast of Iran based on the Health Action Process Approach (HAPA).

METHODS

In this cross-sectional study, 2045 high school students of 13-15 years from urban areas of Zahedan in the southeast of Iran with multistage random sampling were selected. A self-administered questionnaire was used to assess demographic background, psychosocial constructs of the HAPA and daily brushing frequency. Binary logistic regression analysis was performed to determine predictors of daily brushing.

RESULTS

Only 18% of participants reported tooth brushing at least twice a day, which is the desired brushing behaviour. Multivariate regression showed that increased odds of daily brushing associated with gender (OR = 2.38, 95% CI 1.84-3.08), mother education (OR = 2.27, 95% CI 1.62-3.18), father job (OR = 2.24, 95% CI 1.20-4.19), task self-efficacy (OR = 1.24, 95% CI 1.08-1.42), action planning (OR = 1.10, 95% CI 1.02-1.19) and maintenance self-efficacy (OR = 1.20, 95% CI 1.13- 1.27).

CONCLUSION

The brushing behaviour of students needs to be taken seriously in Zahedan. Motivational and volitional constructs of the HAPA include task self-efficacy, action planning, and maintenance self-efficacy could be considered in intervention programmes targeting increase adolescent brushing.

Motivational Interviewing As an Adjunct to Periodontal Therapy-A Systematic Review

Aim: Periodontal therapy is highly dependent on a patient's long-term adherence with regard to oral hygiene, diet, and regular check-ups at the dentist. Motivational Interviewing (MI) is a client-centered, directive method for encouraging a patients' behavioral health change. The aim of this systematic review was to reveal the effects of MI as an adjunct to periodontal therapy.

Methods: Three databases (PubMed, Cochrane Library, and Web of Science) were reviewed for randomized controlled clinical trials. Articles were included when using MI as an adjunct to periodontal therapy and presenting clinical periodontal and oral hygiene related parameters. Two authors independently coded the relevant articles.

Results: The search yielded 496 articles. After analysis and exclusion, a total of five papers could be included. The quality of the articles ranged between 72–88%. The two independent raters showed a high inter-rater reliability (Cohens-Kappa = 0.89). In two studies MI showed a significant positive effect on bleeding on probing and plaque values. One study showed improvement of self-efficacy in interdental cleaning. Two studies showed no influence of MI on periodontal parameters of the patients.

Conclusion: The use of MI as an adjunct to periodontal therapy might have a positive influence on clinical periodontal parameters (plaque values, gingival, and periodontal inflammation) and psychological factors related to oral hygiene (self-efficacy). Due to the low body of evidence further studies are needed. Future studies should include fidelity measures of the applied MI, a high number of counselors, several MI sessions, and long-term study follow-up to show potential effects.

Combining self-management cues with incentives to promote interdental cleaning among Indian periodontal disease outpatients

Background

Periodontal disease is a significant public health issue worldwide. Motivational techniques in combination with financial incentives are shown to lead to effective behavior change. The current study sought to examine whether a brief oral health promotion program (self-management cues that were based on self-efficacy and self-regulatory skills) in combination with an incentive (free dental treatment) would make a difference in the adoption of regular dental flossing in a population of Indian periodontal disease outpatients.

Methods

One hundred and twelve participants (n = 55 oral health promotion intervention group; n = 57 control group) were assigned to the intervention (self-management cues + incentive) or control groups, and follow-up assessments were performed three weeks later. Flossing frequency, behavioral intentions, and perceived self-efficacy served as dependent variables. Data were analyzed with mixed models, ANCOVAs, and path analyses.

Results

The intervention yielded effects on flossing frequency (p < 0.01) and flossing intentions (p < 0.01) at follow-up. Women developed stronger intentions than men. Moreover, by path analysis a sequential mediation chain was found that demonstrated an indirect effect of the intervention on flossing via self-efficacy and intentions: the intervention predicted changes in self-efficacy which, in turn, were associated with changes in intentions, predicting flossing frequency at follow up, while controlling for baseline behavior, gender, and age.

Conclusions

Combining incentives with minimal self-management cues has been found effective in improving interdental cleaning intentions and habits in periodontal disease patients, and the facilitating role of dental self-efficacy has been demonstrated.

Self-efficacy, planning and action control in an oral self-care intervention

To evaluate a theory-guided intervention on oral self-care and examine the possible mechanisms among self-regulatory factors, two brief intervention arms were compared, an information-based education treatment and a self-regulation treatment focusing on planning and action control. Young adults (N = 284; aged 18-29 years) were assessed at baseline and 1 month later. The self-regulation intervention improved levels of oral self-care, dental planning and action control. Moreover, a moderated mediation model with planning as the mediator between experimental conditions and dental outcome, and self-efficacy as well as action control as moderators elucidated the mechanism of change. More self-efficacious participants in the self-regulation condition benefitted in terms of more planning, and those who monitored their actions yielded higher levels of oral hygiene. Dental self-efficacy, dental planning and action control are involved in the improvement of oral self-care. Their joint consideration may contribute to a better understanding of health behavior change.

Evaluating brief motivational and self-regulatory hand hygiene interventions: a cross-over longitudinal design

BACKGROUND

Frequent handwashing can prevent infections, but non-compliance to hand hygiene is pervasive. Few theory- and evidence-based interventions to improve regular handwashing are available. Therefore, two intervention modules, a motivational and a self-regulatory one, were designed and evaluated.

METHODS

In a longitudinal study, 205 young adults, aged 18 to 26 years, were randomized into two intervention groups. The Mot-SelfR group received first a motivational intervention (Mot; risk perception and outcome expectancies) followed by a self-regulatory intervention (SelfR; perceived self-efficacy and planning) 17 days later. The SelfR-Mot group received the same two intervention modules in the opposite order. Follow-up data were assessed 17 and 34 days after the baseline.

RESULTS

Both intervention sequences led to an increase in handwashing frequency, intention, self-efficacy, and planning. Also, overall gains were found for the self-regulatory module (increased planning and self-efficacy levels) and the motivational module (intention). Within groups, the self-regulatory module appeared to be more effective than the motivational module, independent of sequence.

CONCLUSIONS

Self-regulatory interventions can help individuals to exhibit more handwashing. Sequencing may be important as a motivation module (Mot) first helps to set the goal and a self-regulatory module (SelfR) then helps to translate this goal into actual behavior, but further research is needed to evaluate mechanisms.