understanding patient motivation i aquafresh science academy

8/14/2019 Understanding Patient Motivation I Aquafresh Science Academy

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PRACTICE INFORMATION RESOURCE

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As more knowledge about practitioner-patient communication is uncovered,the answers to these questions havebecome clearer. In this rst articlereviewing patient motivation, we discussvarious barriers that prevent patientsrom ollowing advice and explain whyconcordance where a patient isempowered to take ownership o theirhealth and treatment in partnership withthe healthcare practitioner is a moreeective approach than compliance.

The traditional approach to motivatingpatients to change behaviour is otentermed the compliance model andinvolves the oral hygiene proessionalexplaining the health acts o thesituation, and prescribing an oralhygiene or treatment regimen usinglogical arguments ocusing on long-termbenet. Compliance in a healthcaresetting makes two assumptions: . the

practitioner knows best; and 2. patientswill ollow instructions regardless o theirown belies or wishes.

So why do some patients apparentlyignore what seem to be simpleinstructions, despite the act that youradvice will benet their oral healthor directly impact on the success o atreatment plan? The concept o non-compliance is not new and is one thathealthcare proessionals have consistently

struggled with. First documented as arback as 200 BC, Hippocrates is creditedwith saying: Be alert to the aults o

Why dONT PATIENTS

Dispensing advice to patients

about their oral health routine

is part of your everyday role.

But do you sometimes feel your

words are falling on deaf ears?

Do patients claim that they

are following your advice but

their gingival condition or tooth

decay tells you otherwise?

always follow advice?

UNDERSTANDING PATIENT MOTIVATION I

sm nt ntn

There has been much written aboutcommunication between health proessionalsand patients as well as patients adherenceto advice. Some o the terminology used isoutlined here.

Compliance:A measure o the extentto which patients ollow prescriptiveinstructions. It makes two assumptions:1. the practitioner knows best; and2. patients will ollow instructions regardlesso their own belies or wishes.

Concordance: A therapeutic alliance betweenhealth proessional and patient, in which theyshare decisions and negotiation takes placebetween equals. The patients knowledgeand belies are valued and he/she is seenas a partner.

Persuasion:The process o guidingpeople towards the adoption o an idea,attitude or action using your social orproessional infuence.

Motivation: The reason(s) that someone(including yoursel) engages in a particularcourse o action. The level o motivation can

be measured by what they choose to do, theintensity o activity, their perormance andhow well they sustain the activity.

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patients who lie about their taking omedicines prescribed and when things gowrong, reuse to acknowledge their ault.Today the issue o non-compliance hasbecome a major concern in medicine.Research suggests that around 50% o

patients with chronic disease do not taketheir medication correctly (RPSGB, 997)even i this puts their lives at risk.

One challenge is that some patients areunable to appreciate the long-term benetso taking their medication as they do notperceive any change in their health on adaily basis. This same issue aces dentalpractitioners. For example, patients ollowinga prescribed oral hygiene programme areexpected to input ongoing repetitive eortor a hoped-or, long-term benet.

dgu nntIn recent years it has become acceptedthat a dierent approach to thetraditional compliance model isneeded and there have been somekey learnings rom the eld o medicine.For example, early research on physician-patient communication and decision-making about prescription medicationindicated that doctors underestimatethe degree to which they instruct, while

overestimating the extent to which theyconsult patients and elicit their views(Makoul, 995).

With this in mind, a number oprogrammes have been initiated byhealthcare organisations, patient supportgroups and pharmaceutical companies,like GlaxoSmithKline, that provide

resources to improve patient and providereducation. These address the barriersto compliance and aim to improvepatient outcomes by taking an approachbased around concordance and patientempowerment. Inormation resourceshave been designed to empower thepatient with knowledge and support thedialogue between the patient and theirhealthcare provider.

dnttr guIn dentistry, several studies have shownthat a disconnect between patient andpractitioner can exist or several reasons.These have a number o implications andhighlight that, as with medicine, there isa similar need to oster concordance andempowerment in order to improvepatient outcomes.

In discussing novel bioeedback models tomotivate patients with periodontal disease,

Chapple and Hill indicate that althoughmaintaining a thorough home careroutine directly impacts on the success

The fact that patients think their brushing

habits are better than they are clearly has

implications for practitioners wishing to

change their patients behaviour.

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o a treatment plan, patients oten ail(Chapple, 2008).

Similarly, a study by McCracken and histeam at Newcastle University illustratedthis urther; although up to one-third o

gum disease patients correctly ollowedadvice to brush their teeth or 2 minutestwice a day, more than hal thoughtthey had done so when they had not

(Newcastle Universitys School o DentalSciences, 2005). The act that patientsthink their brushing habits are betterthan they are clearly has implicationsor practitioners wishing to change theirpatients behaviour.

Another study observed that whilepatients brushing and fossing abilityincreased dramatically over weeksollowing two sessions o oral hygiene

instructions, with benets on plaqueremoval, adherence reduced as soon asinstruction and supervision came to anend (Stewart, 989). This highlights howimportant it is or the practitioner toprovide patients with the appropriate helpand support to enable them to changetheir behaviour over the longer term.

Prtnrhp pprhThese studies highlight some o the issues

aced by practitioners and oer useulinsights into how patient dialogue andmotivation can be improved. Current

attitudes in relation to this are centred onbuilding a true partnership with patientsthat involves approaching all treatmentdecisions in an attitude o concordancerather than compliance. This means thatDo as I tell you should give way to Lets

discuss your treatment options and agreewhats best or you.

It is clear that a number o actors impactupon a patients willingness and abilityto engage in a productive dialogue andtake ownership o a prescribed homecare routine or treatment plan. Theseinclude the severity o the condition,the time necessary to complete thetreatment, how complicated the plan isand the immediate benets provided bythe treatment. For example, in terms operiodontitis, patients need considerablemotivation to engage in what is aconsiderable daily commitment andre-motivation on a regular basis is key orlonger-term success (Chapple, 2008).

Other elements that come into playcentre on the patients themselves, suchas personality type and this is discussedurther in the article What makes your

patient tick. Socio-economic background,age and belie structure as well as therelationship that exists between patient

How many psychologists does it take to

change a light bulb? Only one but the

light bulb must want to change.



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and practitioner also play a role. Theapproach taken to patient education isan important actor indeed Blinkhornsuggested that all too oten patienteducation is unplanned, haphazard,

not relevant to a particular patient anddicult to understand (Blinkhorn, 99).How much has this situation changed?

Puttng up brrrWhen combined together, it is clear thatthere are a number o actors that thedentist or hygienist must navigate aroundin order to eectively counsel their patientand motivate them to act in an eectiveand sustained way. But what stopspatients rom ollowing advice?

Communication ailure is common andgetting your message across can be blockedin many ways. This may stem rom a seriousbreakdown in communication to just asimple misunderstanding. Your patientmay be under stress, may have misheardor simply may not be listening. The result isthat the patient leaves the surgery with noclear idea o what action to take.

Alternatively, your patient might lackmotivation and have little intention ochanging their behaviour. I they are tocarry out your instructions, they need to

understand the benets, be aware o thedisadvantages and be clear about whatis in it or them your patient has to

want to ollow your advice! For example,a teenager may see gum disease andtooth loss as a distant possibility andmay thereore lack motivation to alterhis/her behaviour.

Physical reasons are also an importantbarrier to be aware o. A young patientmay dislike the taste o their toothpaste,while an older person with dexterityproblems may nd it dicult to hold atoothbrush or may struggle with fossing.Consequently, the patient may simplyabandon the practical elements o theirhome care routine.

So why might concordance be a moreeective approach than compliance?

Simply conveying inormation andincreasing knowledge does notnecessarily lead to a change in behaviournor does it engage a patients views andconcerns. Patient concordance involvesconsulting your patients and elicitingtheir views, based on partnership. Bydoing so, your patients would eel thattheir voices are heard and that theirbelies, needs or concerns are considered.Ultimately, the patient should believe

that the decision to ollow a particularcourse o action is theirs.

O course it will require patience andengagement on the part o the provider,which in itsel may require a dierentapproach to patient communication.

Motivation is what gets you started.

Habit is what keeps you going.Jim Ryun, World record holding athlete and US politician



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Blinkhorn AS. Factors aecting the compliance o patients with preventive dental regimens. Int Dent J 1993; 43: 294298.

Chapple ILC, Hill K. Getting the message across to periodontitis patients: the role o personalised bioeedback. Int Dent J 2008:58; 294306.

Makoul G, Arntson P, Schoeld T. Health promotion in primary care: physician-patient communication and decision making aboutprescription medications. Soc Sci Med1995; 41: 12411254.

Newcastle University (2005). Two-thirds o patients brush o their dentists advice, study suggests. Available at:www.sciencedaily.com/releases/2005/05/050513103319.htm. Date accessed: June 2009.

RPSGB and MSD (1997). From compliance to concordance. Achieving shared goals in medicine taking. London.

Stewart JE, Wole GR. The retention o newly-acquired brushing and fossing skills.J Clin Periodontol 1989; 16: 331332.

furthr nrmtnFor urther inormation about various approaches that may be helpul or managingbehavioural change, reer to Infuencing behavioural change: strategies or success.Three urther articles on eective communication to help get your message across andtwo slide decks on patient motivation and communication are also provided within the

Patient ocus section.


understanding patient motivation i aquafresh science academy

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