Bulletin of Dental Education

Teaching Dental Hygiene Students Effective Behavioral Changes Techniques

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In a fast-paced clinical atmosphere, dental hygienists only have a few minutes to counsel patients on good oral health behaviors. Studies show that approximately 30 to 60% of health information provided in the clinician/patient encounter is forgotten within an hour, and 50% of health recommendations are not followed. The University of Missouri-Kansas City (UMKC) has integrated a counseling technique into its dental hygiene curriculum that has evidence of positively effecting behavioral changes.

Motivational interview (MI), first described in the 1980s by Dr. William R. Miller, is a form of counseling that goes beyond the typical persuasion, education, or advice-giving used in a clinical setting. MI addresses a patient's ambivalence, which is described as the conflict between two courses of action that each have their own perceived benefits and costs. The oral health practitioner uses the counseling techniques of MI to assist the patient in expressing both sides and guides the patient to an acceptable resolution that triggers change. MI has been documented to positively affect behavior changes related to smoking, exercise, and medication adherence.

"The MI literature shows us how important practice is to learning MI. As such, faculty development was an integral component in allowing students to practice the MI strategies learned in class," says Kimberly S. Bray, Professor and Director of the UMKC Division of Dental Hygiene. The integration of MI into dental hygiene preventive counseling, tobacco cessation, care plan presentations, and nutritional counseling courses was made in fall 2009 at UMKC. The implementation model is illustrated in the chart.

"I think we are just beginning to see the students' interactions with patients change as a result of practicing an MI approach," says Prof. Bray. She notes that "a clear shift was observed, indicating greater recognition on the part of the students of the challenges associated with motivating patients. In other words, they naively came into the program with a preconceived notation that patient motivation was ‘not difficult' and ‘likely to succeed' to recognizing that it takes practice and skill as a counselor to achieve favorable results."

Bray attributes the successful integration of MI into the UMKC dental hygiene curriculum to interprofessional collaboration with the UMKC Department of Health Psychology and the teamwork of Dr. Delwyn Catley, Associate Professor and Co-Director of Clinical Training in the UMKC Department of Psychology; Dr. Karen B. Williams, Coordinator of the Clinical Research Center at the School of Dentistry; and Prof. Marsha A. Voelker, Assistant Professor and Course Director for Oral Health Education at the School of Dentistry.

Prof. Bray and Drs. Catley and Williams presented the Faculty Development Workshop Bringing Prevention to Life in Dental Education: Portraits of Sustainable Behavior Change Through Motivational Interviewing at the 2010 ADEA Annual Session & Exhibition.

Additional Resources
Treating tobacco use and dependence: 2008 update. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service; 2008 May.

Evaluation of a Comprehensive Tobacco Cessation Curriculum for Dental Hygiene Programs. Journal of Dental Education. 2010 74: 472-479.

The effects of teaching dental students brief motivational interviewing for smoking-cessation counseling: a pilot study. Journal of Dental Education. 2003 67: 439-447.

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