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Behaviour change and behavioural models in oral health

Dr. Zahra Saied Moallemi

Khordad 1392

،ما هداد وا ﮫﺑ ﮫﮐ یددﻌﺗﻣ یﺎھ شزوﻣآ دوﺟو ﺎﺑ نﻣ رﺎﻣﯾﺑ ارﭼ ؟دﻧﮐ ﯽﻣﻧ هدﺎﻔﺗﺳا کاوﺳﻣ زا ﯽﻣ ار ندﯾﺷﮐ رﺎﮕﯾﺳ یﺎھررﺿ ﮫﮑﻧﯾا ﺎﺑ دارﻓا زا ﯽﺧرﺑ ارﭼ ؟دﻧﺷﮐ ﯽﻣ رﺎﮕﯾﺳ مھ زﺎﺑ ،دﻧﻧاد رﺿﻣ ﯽﺗﻣﻼﺳ یارﺑ دووﻓ تﺳﻓ ندروﺧ مﻧاد ﯽﻣ ﮫﮑﻧﯾا ﺎﺑ ارﭼ ؟مروﺧ ﯽﻣ ازﺗﯾﭘ ردﻘﻧﯾا ،دوﺷ ﯽﻣ ﯽﻗﺎﭼ ثﻋﺎﺑ و تﺳا K A B تﯾﺎﮭﻧ رد و تادﺎﻋ و شرﮕﻧ رﯾﯾﻐﺗ ﮫﺑ رﺟﻧﻣ ﯽھﺎﮔآ و شﻧاد دوﺷ ﯽﻣ رﺎﺗﻓر رﯾﯾﻐﺗ ﮫﺑ رﺟﻧﻣ . ﺎھ تﯾﻌﻗوﻣ و ﺎھ تﺻرﻓ زا یا هدﯾﭼﯾﭘ ﮫﻋوﻣﺟﻣ رد رﺎﺗﻓر ﺎﻣا ددرﮔ ﯽﻣ نﯾﯾﻌﺗ و ﮫﺗﻓرﮔ لﮑﺷ .

Behavioural theories and models

ﯽﻣ ﯽﻌﺳ و هدﺷ عادﺑا نﺎﺳﺎﻧﺷﻧاور طﺳوﺗ یرﺎﺗﻓر یﺎھ لدﻣ دﻧﻧﮐ ﺢﯾرﺷﺗ ار یرﺎﺗﻓر تارﯾﯾﻐﺗ دﻧﻧﮐ. یﺎھ هدﻧﻧﮐ نﯾﯾﻌﺗ مﮭﻣ شﻘﻧ و دراد دﯾﮐﺎﺗ درﻓ رﺑ ﺎﮭﻧآ رﺗﺷﯾﺑ تﺳا ﮫﺗﻓرﮔ هدﯾدﺎﻧ ار ﯽﻋﺎﻣﺗﺟا . لﻣاوﻋ رﮕﯾد ﯽﺧرﺑ تﺳا هداد رارﻗ رظﻧ دﻣ زﯾﻧ ار ﯽﻋﺎﻣﺗﺟا.

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Health behavioural models

provide useful methods to promote individual

behaviour and health

provide a framework for understanding the

process of behaviour change and the influence

f social circumstances of individuals upon

their behaviour.

(Yevlahova & Satur, 2009)

Stages for behavioural studies

A first stage of psychological research on

behaviour change (1920s):

classical conditioning (Pavlov, 1927)
sound of a high-speed hand-piece and dental pain
The second stage (1950s and 1960s):
focused on underlying cognitive information
Bandura’s theory: observational cognitive learning
The third stage of research (1970 so far):

– a specific social-cognitive approach to behaviour change

Health Belief Model (Becker, 1974),
Self-Efficacy (Bandura, 1977),
the Theory of Reasoned Action (Ajzen & Fishbein, 1980)

Health locus of control (HLOC)

تﺣﺗ هزادﻧا ﮫﭼ ﺎﺗ ﺎﮭﻧآ ﯽﺗﻣﻼﺳ ﮫﮑﻧﯾا ﮫﺑ دارﻓا دﺎﻘﺗﻋا نازﯾﻣ دوﺟوﺑ ﯽﺟرﺎﺧ لﻣاوﻋ رﺛا رد ﺎﯾ تﺳا ﺎﮭﻧآ دوﺧ رﺎﺗﻓر رﯾﺛﺎﺗ دﯾآ ﯽﻣ.

Internal HLOC: impact of their own action on

health outcomes

External HLOC:
powerful others HLOC
chance HLOC

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Examples for periodontal disease

Internal HLOC:
my ability and skill to effectively remove plaque
Powerful others HLOC:
Dentists can help me: regular dental visit
Chance HLOC:
This is my chance that I have good gingival health

Health Belief Model (HBM)

دھد ﯽﻣ نﺎﺷﻧ یرﯾﮔ مﯾﻣﺻﺗ رد ار دﺎﻘﺗﻋا شﻘﻧ ﯽﺑوﺧﺑ لدﻣ نﯾا. ﯽﻣ رﺎﮑﺑ ﯽﺗﺷادﮭﺑ صﺎﺧ رﺎﺗﻓر ﮏﯾ ﯽﻧﯾﺑ شﯾﭘ یارﺑ لدﻣ نﯾا دور. ﮏﯾ ،دھد ﯽﻣ رﯾﯾﻐﺗ ار شرﺎﺗﻓر یدرﻓ ﯽﺗﻗو دﯾوﮔ ﯽﻣ لدﻣ نﯾا دوﺳ زﯾﻟﺎﻧا-دھد ﯽﻣ مﺎﺟﻧا ﮫﻧﯾزھ.

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HBM and ECC

mother should believe
that the child is susceptible to dental caries,
that primary teeth are important and dental

caries is a serious threat to them,

that dental caries can be prevented, and
the mother must be willing to limit the child’s

exposure to fermentable carbohydrates and

must assist the child in practicing good oral

hygiene

(Hollister & Anema, 2004)

Theory of Reasoned Action

This theory stresses the importance of attitudes

and intentions in changing behaviour.

subjective norm in this theory includes the role
f other people in behaviour.
A firmer intention to brush the teeth has been

related to a higher reported frequency of tooth brushing

(Tedesco et al., 1991; Syrjälä et al., 2002)

Stage of change model or Ttranstheoretical model (TTM)

A process of change behaviour
Smoking cessation

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New Century Model of Oral Health Promotion

patients’ behaviour is formed by cognitive, affective,

and behaviour factors interacting in a complex pattern with the time perspective and the patients’ situation. These authors argued that past behaviour is the best predictor of future behaviour. In addition, general health-related behaviour (such as diet and smoking) and dental health-connected behaviour (such as teeth grinding) should be considered as predictors of

behaviour. A life-span approach to oral health

promotion (time perspective) explains that oral health care practices must become a habitual part of a person’s life to be effective (Inglehart and Tedesco , 1995)

Levels of behavioural models

Behavioural change interventions are

targeted at three main tiers:

– individual, – interpersonal, and – community level (Linden & Roberts, 2004). Some models combine elements of the individual, interpersonal, and community levels. Individual level: knowledge, attitudes, belief

HBM, Stage of change model

Interpersonal level: the individual is influenced by close relationships with family, friends, and colleagues. How the person interacts with his or her immediate environment so that the desired behavioural change is achieved

the Social Learning Theory (SLT)

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Community level:
heart of public health approaches to

preventing and controlling disease

Community factors include norms or

standards of behaviour that all individuals are expected to follow within that community.

These norms include lifestyle behaviours as

well as the threats posed by environmental factors.

Diffusion of Innovations Theory: how new ideas,

products, and social practices spread within an

rganization, community, or society, or from one

society to another.

Combination of models is the best

No single theory or model is appropriate as a

guide in designing health interventions

combine various behavioural models under

the umbrella of an intervention is preferable.

models combine elements of the individual,
interpersonal, and community levels:
PRECEDE-PROCEED Model

(Green et al., 1980; Green & Kreuter, 1991)

PRECEDE-PROCEED Model (PPM)

A planning model that provides a structure for

the process of systematic development and evaluation of a behaviour-change intervention.

PRECEDE (Predisposing, Reinforcing, and

Enabling Constructs in Educational Diagnosis and Evaluation)

PROCEED (Policy, Regulatory, and

Organizational Constructs in Educational and Environmental Development)

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The ultimate goal of Health is to reach Quality of Life: PRECEDE-PROCEED MODEL

Quality of life Phase 1 Social assessment Health Phase 2 Epidemiological assessment Health education Policy regulation

rganization

Health Program*

Phase 5 Administrative & policy assessment Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Predisposing Reinforcing Enabling Phase 4 Educational & ecological assessment Behavior Environment Phase 3 Behavioral & environmental assessment

*New in 4th ed., Green & Kreuter, Health Promotion Planning.

Model from Saied-Moallemi Z. 2010

References

Essential Dental Public Health. Daly B, Watt R,

Batchelor P, and Treasure E. Oxford University Press, UK, 2003. chapters 10.

Saied Moallemi Z. Oral Health among Iranian