Personality traits and pre-treatment beliefs and cognitions predicting patient adherence to continuous positive airway pressure: A systematic review

Adherence to Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnoea (OSA) can be improved by behavioural interventions which modify patients' beliefs and cognitions about OSA, CPAP, and themselves. We have conducted the first systematic review of the literature on beliefs and cognitions held before starting treatment, and personality (which influences the former) that predict the decision to purchase or start CPAP, or CPAP adherence one month or more after CPAP initiation. A systematic search and screen of articles identified 21 eligible publications from an initial 1317. Quality assessment performed using an adapted Newcastle-Ottawa Scale demonstrated that 13 (62%) studies were poor quality and only seven (33%) were high quality. Eighteen factors, such as self-efficacy (confidence) in using CPAP and value placed on health predicted CPAP adherence; however, for only six (33%), utility as an intervention target is known, from calculation of individual predictive power. Studies did not use new behavioural frameworks effective at explaining adherence behaviours, nor did they interview patients to collect in-depth data on barriers and facilitators of CPAP use. Future studies cannot have these limitations if high quality evidence is to be generated for intervention development, which is currently sparse as highlighted by this review.

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study

INTRODUCTION

COVID-19 has impacted dentistry in unprecedented ways.

OBJECTIVE

The following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire.

BASIC RESEARCH DESIGN

An online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed.

RESULTS

The great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term.

CONCLUSIONS

Respondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes.

CLINICAL SIGNIFICANCE

COVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the 'new normal'. Assessing the results could be useful in informing support strategies moving forward.

Risk communication in the dental practice

The communication of risk in dental settings is a routine task that most clinicians are familiar with in their clinical encounters. However, work from medical settings has suggested that using this process in order to support health behaviour change in people may well be undermined by difficulties in understanding risk information, in presenting the information in a way that is clearly understood by the recipient and in the effects that such information may have for supporting further health behaviours by patients. This paper synthesises literature in the area that addresses these issues and explores approaches dental care professionals might consider when communicating risks in the dental surgery.

Defining patient-centred care in dentistry? A systematic review of the dental literature

Objective This paper presents the results of a systematic review, designed to explore how patient-centred care (PCC) is defined in the dental literature.Method An electronic search of MEDLINE (1946-2012), Embase (1980-2012) PsycINFO (1806-2012), the Cochrane Library and non-peer reviewed literature was conducted using a standardised search protocol. Definitions of patient centred care were identified and scored on two criteria to evaluate quality of definition and quality/type of evidence.Results Of the 28 papers included in the review the majority provided definitions of PCC synonymous with good quality general care (holistic, humanitarian). Only three mentioned the provision of information and the tools to facilitate informed choice. Less than a third of the papers included in this review were based on empirical evidence, and of those that were, only one was an RCT study.Conclusion The evidence suggests that the concept of PCC is neither clearly understood nor empirically and systematically assessed in dental settings. Whilst most authors seem to suggest that PCC is about delivering care that is humane, involving good communication and shared decision-making, there is no work assessing these concepts empirically or relating them to practical outcomes.

Oral Health Knowledge, Attitudes, and Perceptions of Pregnant Kuwaiti Women

Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women’s understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists’ purported incorrect beliefs about providing dental treatment to pregnant women and the women’s lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women.

Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.

Effectiveness of a web-based child protection training programme designed for dental practitioners in Saudi Arabia: a pre- and post-test study

AIM

Safeguarding children is an integral part of dental training and practice. The purpose of this research was to evaluate a web-based training program in child protection on dental practitioners' knowledge and practice in Saudi Arabia. In addition, participants' views of the course were also assessed.

METHOD

Pre-, immediately post-training, and one month post-training knowledge and self reported behaviour were assessed following completion of an online training course in child protection by 82 dental practitioners working in Saudi Arabia.

RESULTS

Eighty-two participants completed the whole training package and 62 completed the one month post-training survey. A significant increase in knowledge was found immediately after taking part in the child protection training program in comparison to baseline knowledge (P < 0.001). The course was highly rated by those who completed it. At one month following the training program, 21% have or intend to adopt a child protection policy in their practice, 29% identified a staff member to lead on child protection since completing the program, almost all participants have been aware of child abuse and neglect (CAN) signs in their daily practice and 27.4% have made a report of a suspected case of CAN in the last month since the training.

CONCLUSION

The web-based training program in child protection was appraised positively and was effective in increasing knowledge and changing attitudes towards safeguarding children.

Are clinical decisions in endodontics influenced by the patient's fee-paying status?

OBJECTIVE

We explored whether the fee status of a UK patient influences clinical decision-making in endodontics.

SUBJECTS AND METHODS

In a randomised-controlled vignette study describing either an 'NHS-funded', 'Privately-funded' or undisclosed fee-status patient, we examined the importance vocational trainer dentists placed on a series of factors normally considered when deciding whether to offer patients endodontic treatment as opposed to extracting the tooth. N = 119 experienced (M years post qualification = 20.01) dentists participated.

MAIN OUTCOME MEASURES

Having read a vignette describing a hypothetical patient who could potentially be treated either endodontically or through an extraction, dentists rated a series of factors they would normally consider (for example, poor oral hygiene, the rest of their mouth is unfilled and caries-free), before recommending either endodontic treatment or an extraction.

RESULTS

The patient's funding status had no influence on these dentists' clinical decision-making when considering endodontic treatment as an option (p >0.05) with the exception of a single item relating to infrequent attendance where the NHS patient was more likely than the 'undisclosed-fee' patient, to be offered extractions (F (2, 116) 3.43, p <0.04).

CONCLUSIONS

We have found no strong evidence to suggest that the fee-status of a patient influences clinical decision-making in endodontic treatment by experienced dentists.

Knowledge, attitudes, and experience of dentists living in Saudi Arabia toward child abuse and neglect

AIM

To analyze the experience and knowledge of dental practitioners in Saudi Arabia regarding the identification of child abuse and neglect (CAN), to identify barriers that prevent the reporting of suspected cases of child maltreatment by dental practitioners, and to assess the need for training dentists in child protection.

METHODS

A self-administered, web-based questionnaire was emailed to all of the members of the Saudi Dental Society (n = 7352) in 2012.

RESULTS

The respondents (n = 122) demonstrated good knowledge of the forms and indicators of CAN. Moreover, a large proportion (59%) had experienced a case of child abuse or neglect in their practice over the previous five years. However, only about 10% of these respondents made a report. Fear of family reprisal, lack of certainty about the diagnosis of child maltreatment, and uncertainty about case management were critical barriers to the reporting of the suspected child maltreatment. In addition, only 20.9% of the respondents reported having knowledge of a child protection policy in their workplace.

CONCLUSIONS

Based on the results of this survey, it appears that the level of knowledge among the respondents regarding the forms and indicators of CAN is good. However, a large proportion of respondents did not take action regarding suspected cases of CAN in their practice over the past five years. Therefore, additional resources and training are needed to support the identification and management of cases of child maltreatment by dental practitioners.

Motivation to study dental professions in one London Dental Institute

INTRODUCTION

While past research has explored dental students' motivation to study, there is limited understanding in the reasons behind career choice for hygienists/therapists and dental nurses. The aim of this study was to investigate simultaneously the views of students of dentistry, hygiene/therapy and dental nursing in King's College London and explore similarities or differences in career choice.

METHODS

All first-year students were invited to the questionnaire survey, exploring motivation to study using a 23-item instrument. Data were analysed using SPSS v18; statistical analysis included one-way analyses of variance and factor analysis.

RESULTS

The overall response rate to the study was 75% (n = 209). Ten out of 23 factors were considered important by more than 80% of respondents, with 'job security' (93.8%), 'desire to work with people' (88%) and 'degree leading to recognised job' (87.5%) being top three. Analysis suggested that 52% of the total variation in motivating influences was explained by four factors: 'features of the job' (26%), 'education/skills' (11%), 'public service' (8%) and 'careers-advising' (7%); at group level 'features of the job' were significantly more important for the direct entrants to dentistry (P = 0.001).

DISCUSSION

The findings suggest that across groups students were motivated to study by common influences reflecting altruistic, but also pragmatic and realistic motives, while 'features of the job' were more important for the direct entrants to dentistry.

Barriers and opportunities of empowerment as applied in diabetes settings: a focus on health care professionals' experiences

This exploratory study examines the opportunities and barriers health care professionals (HCPs) working with diabetes patients face when they try to implement the rhetoric of patient empowerment in practice. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and general practitioner (GP) clinics in South-East England, was interviewed through in-depth semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed thematically. The analysis showed that empowerment was seen as beneficial for patients and HCPs. Time and resources could be moved from successfully empowered patients and focussed on more complex patients, this was termed 'selective empowerment'. The main barriers to empowerment were identified as a lack of resources, time and HCPs trained in empowerment techniques. Empowerment is a popular concept in theory, and presents HCPs with several opportunities but also important barriers in its practical, clinical implementation day-to-day.

Health care professionals' understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

This exploratory study examines what Health Care Professionals (HCPs) working with diabetes patients, understand by the term 'empowerment', their attitudes towards it and whether they believe they practise in ways consistent with empowerment principles. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and General Practitioner (GP) clinics in South-East England, was interviewed. In-depth semi-structured interviews established attitudes towards and use of empowerment in day-to-day practice. Interviews were recorded, transcribed verbatim and analysed thematically. There was no clear specific understanding of what empowerment is and what it involves, although there was broad reporting of factors around education and informed choices. Disagreement was evident about the level of freedom patients should have in making choices - from leading them to the 'right' choice to an acceptance that they may have the right to choose not to be empowered. No consensus emerged on what is successful empowerment and how it is measured. The resistance of some patients to the process of empowerment in its original definition of active partnership in care, was seen as problematic by HCPs. Although empowerment is a popular concept in theory, its practical, clinical implementation day to day, can be problematic.

Personality profile of students entering dentistry, hygiene/therapy and dental nursing at one London dental institute

INTRODUCTION

King's College London Dental Institute (KCLDI) is the largest school in the UK, training dental professionals: Dentists, Hygienists/Therapists and Dental Nurses. Although previous work has examined dental students, there is a dearth of studies on the personality profile of students of hygiene/therapy and dental nursing.

OBJECTIVE

To investigate the personality profile of students studying dentistry, hygiene/therapy and dental nursing at KCLDI, by programme, sex and ethnicity.

METHODS AND MATERIALS

All entrants into dentistry, hygiene/therapy and dental nursing at KCLDI were invited to participate in the study. A self report questionnaire including the brief version of the Five-Factor Model and personal details was administered to the 218 recruited students in groups and under supervised conditions.

RESULTS

  One-way ANOVA on data from 148 questionnaires revealed significant differences; the medical graduate entrants to dentistry appeared to have a more extraverted profile than hygiene/therapy entrants (P<0.04). The graduate entrants to dentistry were more open to experiences than the direct entrants (P<0.03) and the dental nursing trainees (P<0.03). The medical graduate entrants also appeared more open to experiences than the dental nursing trainees; the latter also appeared to have a more sensitive profile compared to the medical entry students (P<0.03). No differences were found between groups in agreeableness and conscientiousness.

CONCLUSIONS

The findings suggest the presence of personality differences between entrants to dentistry, hygiene/therapy and dental nursing. The implications of these findings are discussed.

Assessment of the transtheoretical model as used by dietitians in promoting physical activity in people with type 2 diabetes

BACKGROUND

The transtheoretical model of change (TTM) is an approach to behaviour change, which has been successful in increasing physical activity levels. This study examined the application of a TTM approach to increase physical activity in people with type 2 diabetes by a specialist dietitian.

METHODS

Forty participants were recruited to either an exercise consultation interview (ECI) or a control group. All participants received a physical activity leaflet and those in the ECI group also received a one-to-one interview with a dietitian a week after their routine appointment. Both self-reported physical activity levels and stage of change were measured at baseline and after 6 weeks.

RESULTS

Thirty-four participants (17 in each group) completed the study. Both groups showed an increase in physical activity levels. However, there was a significant difference in change of physical activity levels in the ECI group alone [F(1,32)=15.99;P<or=0.01]. In the ECI group, eight participants increased their stage of change compared with just one in the control group. There was a highly significant difference between the ECI and control group for success rates of stage progression (P=0.007).

CONCLUSIONS

A specialist dietitian with motivational interviewing and behavioural change training can successfully deliver a TTM intervention to people with diabetes that results in an increase in physical activity and stage of change. Dietitians with behavioural change skills may wish to include this approach within their practice.