FINAL V3 Action Research Project

Action Research Project

If I developed a simplified communication toolkit, would hygienists find it helpful to aid in

the communications on oral health? Would the profession welcome this?

Victoria Wilson RDH RDT

Abstract –

Introduction

There are a wide range of communication strategies that have been researched and

available to be used in the communication of oral health. However, an effective

simplified communication toolkit, combining and consolidating the existing

communications strategies, is not available for the communication of oral health.

The intent of the action research project, is to determine a preliminary simplified

communication toolkit to enhance the communication of oral health, that will aid in

facilitation of the change process, that could be welcomed by the profession.

Methodology

By developing a survey monkey that was circulated via email amongst practicing dental

hygienists in the UAE, UK, USA and Canada, it was possible to obtain data on the

profession’s opinion. On their feelings on the status of the oral health of their patients.

and if they would welcome a simplified communication toolkit intended for oral health.

Results

It is apparent that patients continue to return to the dental hygienist with persistently

poor oral hygiene. Clinicians become frustrated about this, and would be keen to

welcome a simplified communication toolkit intended for oral health into their existing

practice.

1

Conclusion

Dental hygienists would welcome a simplified communication toolkit focused on open

ended questions for oral health education. Further research is required to finalize a

comprehensive communication toolkit that could be amalgamated into daily practice.

Action Research Question


the communications on oral health? Would the profession welcome this?

Introduction - Research Background

Since an early age, I had a fascination for dentistry, a practical vocation, communicating

throughout the day, that makes a considerable contribution to peoples’ health and

wellbeing. I could picture myself within this profession, and have been working in the

field of dentistry for 13 years now. My career started in the UK and then moved to

Dubai, where I now live and work. In Dubai dental hygiene practice is not as common

as in the UK, where I have first hand experience. Patient’s compliance with oral

hygiene regimes have presented more of a challenge in the UAE than in the UK, along

with their attendance to regular appointments. Communication is a challenge as I treat

a multicultural society from varied economical backgrounds. Some patients have never

heard of a dental hygienist before, let alone seen one before. It is a challenge to reach

a high standard of oral health for these patients. Yet my commitment to deliver optimal

care that will lead to all my patients achieving optimal oral health never waivers. I

believe optimizing on my communication skills to be key, and this is where my field of

interest lies and has developed over the years. I have had a special interest in reading

articles and books on communication, and searching for tools that I could incorporate

2

into my daily practice. Despite using existing communication strategies, there is little

clarity on a model that I can turn to, and adapt on a daily basis and fit into the time

constraints of an appointment. On occasions I have felt swamped with options of

communications strategies, and pressured to choose the most appropriate strategy,

best suited to the patient in the limited appointment time available.

The curriculum for my diploma in dental hygiene and dental therapy had limited

modules on communication. I felt more equipped to simply show and instruct the

patient on the recommended oral hygiene technique, and using a model replicating a

tell show do approach.

I believe a clinician in a work environment with optimal success rates, will feel less

frustrated and face less stress with greater potential of fulfilment, compared to a

clinician in a work environment with more frustration, obstacles and resistance to

achieving optimal success rates (Hemsley B et al. 2012). On personal reflection of my

previous and current professional position, I have identified within myself and amongst

colleagues, a frustration surrounding resistance in achieving the intended oral health

goals, based on a lack of compliance from patients. Discussions have taken place in

dental hygiene meetings on topics such as long standing patients presenting with

persistent poor oral hygiene. It became apparent that the lack of understanding and

compliance was linked to a shortfall in the mode of communication delivery, especially

with dental hygienists based in the UAE. Hygienists would persistently re-demonstrate

what to carry out, and re-explain why the objectives of carrying out effective optimal oral

hygiene were beneficial in a similar way. It is for this exact reason I have identified the

3

need for re-evaluation of our communication approach. According to (House of Lords

Science and Technology Select Committee 2010 – 2012) “There is a lack of applied

research at a population level to support specific interventions to change the behavior of

large groups of people”.

I realized the problem I wanted to solve in my action research project would aid in

improving patients’ commitment to their dental hygiene appointments, assisting in

improving their oral health. Since patients frequently don’t maintain their dental hygiene

appointments and cancel last minute, my patients fail to become healthy and my values

are denied within the objectives of my clinical practice.

Incorporating my “values-in-practice” within my work is essential to maintain an honest

practice. “Values-in-practice” are outlined by (Aristotle 1953) as the, “foundations of

living and working”. I then searched deeper to identify my strengths, weaknesses,

opportunities and threats, using the SWOT analysis. I was able to identify that an

external weakness I was most bothered about was centered around the lack of effective

communication strategies that I could utilize with ease.

On reflection of my own practice I have adopted various communication strategies

within my daily practice to address the range of multicultural patients in the UAE

implementing OARS, which includes: Open questions, affirmations, reflective listening,

and summarizing.

Examples of open ended questions include:

Asking patients how they feel about their oral health?

4

Including evocative questions, affirmation, reflective listening, motivational interviewing.

Encouraging patients to elaborate, and looking forward to the future for what patients

imagine in 10 years. Giving patients choices.

Utilizing open ended questions that require more than a yes or no answer that have

proven to encourage patients to openly talk, such as:-

What do you want to get out of your appointment today?

There are a number of things we can talk about today, what would you like to talk

about?

How would you feel having a quick chat about?

Despite asking open ended questions, as a clinician, how is it possible to quantify my

patients answers of their feelings? I felt as a clinician I was failing to utilize the patients

open ended responses to the maximum potential. The patient’s responses to their

feelings on oral health are so different, so how can an open ended question, requesting

feelings, be practically utilized to a definitive result? In an appointment scenario, if a

clinician is repeating what a patient has said through reflective open dialogue, what else

is being achieved? It is making it clear that the patients feelings are heard and

understood, aiming to increase the patient confidence through making them feel heard,

instilling their confidence in you as a trusted clinician through showing empathy and

listening. However, I still don’t feel the answer is being used to the maximum potential.

Which leads to my next questions:

What else is being achieved towards their oral health through asking an open

ended question?

5

Am I as a clinician any closer to achieving the desired result of achieving better

oral health?

Am I as a clinician effectively enhancing oral health promotion?

In reflection, yes I am contributing to building a trusted relationship as an oral health

provider with the patient. Yet, am I able to motivate, and sustain transformational

learning? Or am I limited to just building a trusted relationship?

(Helman 2006) appropriately summarizes “The art of medicine is a literary art. It

requires of the practitioner the ability to listen in a particular way, to empathize and also

to imagine: to try to feel what it must be like to be that other person lying in the sickbed,

or sitting across the desk from you; to understand the storyteller, as well as the story”. I

perceive this to be the exact challenge, one can only really read between the lines of

our closest and dearest friends and family members.

In further preparation to begin my action research project, I began asking a range of

dental health professional colleagues within the UAE, “What percentage of your patients

are 100% orally healthy?”. Zero% of participants responded confirming 100% of their

patients were orally healthy. This supported my area of concern that we as dental

health professional still need to refine our approach in the promotion of oral health. (See

Appendix 1, Questionnaire included, Question 3 applicable for the purpose of this

research).

Then further evaluating the reasons for why patients are not 100% orally healthy in

6

group discussions amongst hygienists within Dubai in the UAE, lead to the consensus

that there are multiple reasons as to why patients are not 100% orally healthy. The

most significant reasons discussed ranged from, a lack of compliance with effective

sustainable oral hygiene, diet, and a lack of patient’s prioritization of their oral health.

This lead to my action research project’s further evolution. Why do patients not

prioritize the importance of their oral health? Why don’t patients follow the instructions

given them by the RDH for oral hygiene and maintenance visits? How could I impact

patient’s prioritization of oral health? What could I develop that could assist myself,

and other clinicians in impacting the patient’s prioritization of their oral health? I could

focus further on the delivery of oral hygiene instruction. I could focus further on

understanding my patients. I can continue to deliver the messages I have been

delivering until now, I can continue to search for communications strategies to

implement, or I can develop a communication toolkit intended to enhance oral health

status, that could be useful to myself and other clinicians utilizing enhanced

communication strategies. The communication toolkit could have the potential to aid in

patients’ attendance and compliance, to help improve their oral health. This would lead

to further fulfillment within my clinical practice. Leading to my final action research

question. If I developed a simplified communication toolkit, would hygienists find it

helpful to aid in the communication of oral health. Would this toolkit be welcomed by

the profession?

The intention of the simplified toolkit would be to aid clinicians in enhancing their

communication, to assist in increasing patient’s prioritization on oral health importance.

7

The toolkit would focus ultimately on enhancing communication strategies utilized by

clinicians. In the long run, this toolkit could have the potential to impact oral health

status of patients through their increased prioritization of their oral health.

It is important to recognize there are specific individual challenges surrounding the

change process, dynamic for each person that remain unique to that individual.

Through much reading of research and publications, there is a generic complexity in

attempting to understand the change process. By applying a process of elimination it

may be possible to arrive closer to a tool kit that may aid in the facilitation of behavior

change. It is important to remember that this toolkit will have limitations. It is

undeniably subjective to the researcher’s interpretation of accessible content.

In further preparation to begin my action research project, I asked existing regular

attending patients, what makes them want to maintain their maintenance hygiene

appointments? This allowed me to identify elements to consider, that are likely to

influence new patients. The answers I received ranged from family connections, the

concerns of loosing teeth, starting to feel better, professionalism, dedication,

enthusiasm on my behalf, passion for my work, and because their mouth feels better.

An important point to consider is that people face difficulties when it comes to complying

with treatment recommendations and they do have to be ready to change. Frequently a

patient is not ready to change when the practitioner attempts to intervene. We need to

be able to “assess the patient’s readiness to adhere, provide advice on how to do it, and

8

follow up on the patient’s progress at every contact”. “Adherence to long-term therapy

for chronic illnesses in developed countries averages 50%. In developing countries, the

rates are even lower” (WHO 2003).

Another point to consider is every person has the potential to change. It is important

throughout the process to be realistic; avoid loosing sight of the process of individual

change, as it will only occur when the person is ready to change. Conventional modes

of giving advice to bring forth change, common to dental hygiene practice, and in my

personal education, have been known to make a person feel pressured to accept a

certain view or attitude, disabling their freedom to make a choice, resulting in the exact

opposite from the intended being achieved. The psychological theory of reactance

supports this. (Brehm 1966 and 1981).

There appears to be a current weakness in the depth and clarity of our existing

communication strategies, how can this be improved whilst optimizing on the available

appointment time.

Methodology

Phase 1

Twenty patient were asked a single open ended question during their regular dental hygiene

appointments:

On a scale of 1-10 how important is your oral health to you?

9

Subjects included new and existing hygiene patients within my practice in the UAE. They were

from multiple cultural backgrounds and varied in age from 15 to 56. The results were then

documented by hand writing in a book.

Since I was only starting to explore further communication strategies to include within

my general hygiene practice, I did not include a consent form for patients to sign at this

early stage, as I did not intend to use my data from these patients for my action

research project. In support of not having obtained consent I have not divulged any

personal information on these patients.

Phase 2

I developed some questions in figure 1, in a survey monkey, to identify how hygienists felt

about the current oral health of their patients, the actual status of the patients oral health, and if

hygienists would be open to using a simplified communication tool kit if one was available.

Figure 1

10

On identifying the ease of asking the style of question stated in phase 1, and collating the

answers, I began to see the potential value of open ended questions, that gave patients the

opportunity to score how they felt.

To develop the questions intended for the simplified communication toolkit section of the

survey, I began by reviewing the book “Health Behavior Change in the Dental Practice”

in great depth. Being reflective on the relevance of certain behavior change models,

and being conscious of the limited extent of my bachelors. I chose to focus on

12

developing 4 questions that required an answer that was a scored numbered. Based on

the style of question featured in phase 1, outlined in figure 2.

Question 1

On a scale of 1-10 how open are you to wanting to enhance your oral

health? (score1 not very open, 10 very open)

I have already identified readiness for change is an important consideration, and people can

be at different stages. This question intends to identify a patients’ readiness to engage and

participate in their oral health. (Rollick et al 1999)

Question 2

On a scale of 1-10 how much do you want your mouth to remain to be optimally

clean and healthy? (score 1 not very much, 10 very much).

This is leaving the patient the freedom and ownership over what they want, leaving the

clinician the opportunity to interpret the score.

(Brehm 1966; Brehm and Brehm 1981)

Question 3

• On a scale of 1-10 do you see many benefits, if your mouth was maintained to

be optimally clean and healthy? (score 1 not many, score 10 many).

Motivational Interviewing (MI) has proven to be efficient in behavioral change (Burke et

al. 2003, 2004; Hettema et al. 2005; Rubak et al. 2005). By incorporating a motivational

interviewing style into the questions, would allow the clinician to identify the patient’s

awareness of the benefits of oral health. Allowing the clinician to better gage the

patient’s extent of oral health awareness.

13

Question 4

• On a scale of 1-10, how strongly do you feel about returning for your dental

hygiene appointment? (score 1 not bothered, 10 feel strongly).

Ambivalence “Most people will experience a certain amount of ambivalence through the

process of change” (Rollick et al. 2007; Ryan and Deci 2000).

I did not include the below question in my survey monkey however it would be possible to

consider using this in the future –

If your score is closer to 10 can you explain why?

Question 6 & 7 in figure 2, were finally included in the survey monkey to understand if the

questions in question 5 could be of value to the hygienists.

Figure 2

14

I emailed the survey monkey to 18 dental hygienists based in the UAE, US, UK, and Canada

to complete. The criteria of subjects included in the survey process were practicing dental

hygienists of varying years of working experience.

On circulating the survey I was then notified by survey monkey when the survey had been

completed and reviewed the data.

16

I did not include consent forms as the survey was shared amongst colleague dental

hygienists, and a consent form is not required for this purpose.

I then requested a few hygienists implemented question 5, and reported back to me on

the below questions.

Was it easy, and time efficient to ask these questions?

Did you find the patients reflected more on their oral health, when asked these

questions? If yes, why do you think they did?

Do you think these questions could help patients engage more, in the long term

of maintaining optimal oral health?

Where patients happy to answer these questions?

Did you document these answers in their notes, or would it be easy to in the

future?

Would you find it helpful to use these questions, or style of questions again?

Would you find it helpful re-document the answer at appointment intervals to

monitor the patients’ perception on their oral health?

Would you use these questions again?

Would you be interested in using this style of question more to support oral

health promotion?

What were your overall thoughts in incorporating these questions into your

practice? (i.e. what could be the benefits, and why, what could be the limitations

and why?)

17

Results

Phase 1 Results

Based on the question -

On a scale of 1-10 how important is your oral health to you?

The results are featured in figure 3.

Figure 3

Patient 1

Patient 2

Patient 3

Patient 4

Patient 5

Patient 6

Patient 7

Patient 8

Patient 9

Patient 10

Patient 11

Patient 12

Patient 13

Patient 14

Patient 15

Patient 16

Patient 17

Patient 18

Patient 19

Patient 20

0

2

4

6

8

10

12

Oral Health Importance Scale 1- 10

Patients

The answer for all 20 patients from figure 3 scored 10.

This question seemed to be a striking question to ask, that was simple and easy to incorporate

into a hygiene appointment. It enabled patients to reflect on themselves internally, and how

they really feel about oral health. By doing this surprisingly every patient’s response was that

their oral health was very important to them. Surprisingly these results would however differ

from my early research that clinicians do not consider their patients are orally healthy. This

18

would indicate a variable between how important patients may view their oral health when

asked within a clinical setting, compared to what they continue to do at home to care for their

oral health. If patients view their oral health as being important when asked in a clinical

setting, what more can we do to enhance this belief into effective behavioral change,

reminding patients of their own personal thoughts on how important their own oral health is.

This question could also indicate to a clinician how likely the patient may adhere to long term

therapy (WHO 2003).

By requesting the patient to personally reflect on the importance of their oral

health, evaluating their reflection and translating this into a number, the patient

and the clinician are able to quantify the feelings and score the feelings. This could

lead to less risk of misinterpretation of patient’s feelings. The clinician is able to

reflect on the number, restating the number supporting that the clinician is listening and

reflecting back on what the patient has expressed clearly in a shorter amount of time. The

number can be documented in the clinical notes and reflected on, and recorded for

comparisons from one appointment to the next. A shorter amount of time is needed to extract

valuable information that can ultimately be utilized with ease, from one clinician to the next.

I initially asked this question in the appointment time, however it could be appropriate to ask

this question in the waiting room, or prior to an appointment, via whatsapp, text, Facebook,

email, phone call, before the appointment and then at the end of the appointment, and a few

days later. These are areas for further research.

19

Other questions requiring a scored answer could evolve from phase 2 question, not loosing

sight that this toolkit is deemed to ensure the results are used to their maximum potential to

have an optimal impact on oral health.

Aside from asking the questions outlined in figure 2, it is important to remember creating a

good rapport is key, according to (Najavits et al. 2000) this “correlates with the patient behavior

change outcomes”.

Throughout the whole consultation creating an environment of understanding and respect is

very important, and remembering to use appropriate non verbal body language such as smiling

to welcome the patient and listening to the patient for the patients’ autonomy is necessary. All

the numbers scored would allow an opportunity of reflection and to expand upon the score in

conversation. This would lead to the patient feeling understood and giving the patient an

opportunity to clarify what they mean, drawing personal meaning from the questions. “The

more information is evaluated and applied by the recipient of it, the more likely it is that such

information will be taken on board” (Wilding and Valentine 1997). Always making the patient

feel understood adding to their existing knowledge and summaries the findings of the

questionnaire.

Phase 2 Results

Figure 4

20

Nearly 80% or clinicians in figure 4 appear to be frustrated that their patients frequently return

with reformation of plaque, indicating there is still room for improvement in the delivery of oral

health promotion. The frustration could be impacting overall work and happiness within the

work environment, and potentially overall productivity. Any negativity is not conducive to

optimization, and requires a solution to overcome it, certainly supporting the need to further

develop strategies.

21

Figure 5

Scattered results in figure 5 support my initial background research for my action

research project featured in appendix 1 that 0% of dental professionals believe their

patients achieve perfect oral health. Indicating there is a need for further developments

22

within the dental profession to obtain improved oral health statuses amongst patients.

Figure 6

100% of the hygienists included in the survey, support the view that if a simplified

communication toolkit was available to use in the communication of oral health they

would be very open to use it. This indicates hygienists are not aware of a simplified

communication toolkit available specifically intended for the communication of oral

health, or that could be adapted for the use of communication of oral health. These

answers would also support the need for further research in this area, leading to further

23

publications, courses and qualifications in support of the findings. The results could

also indicate a need for the re-evaluation of existing dental hygiene curriculums to

incorporate a more comprehensive module on communication into the syllabus, this

syllabus could also include the study of psychology.

Figure 7

100% of the hygienists included in figure 7, support the belief that they are frequently

repeating themselves, following a similar structure from one appointment to the next. If

patients were achieving optimum oral health, clinicians were not frustrated, and

24

clinicians were not very open to a communication toolkit the answer to this question

may not be so significant. Since this is not the case I can identify that we need to

review the current format of appointments.

Figure 8

25

Scattered results indicating that hygienists would be open to use the questions proposed in the

methodology on their patients, shows an open willingness to explore new strategies and

changing their existing practice to incorporate these questions into their appointments. Since I

wanted to develop a simplified survey that would be easy for clinicians to complete, I did not

include the supporting evidence of the basis of these questions in the survey. The strength of

these results is based on little background information and hygienists are still open to use

these questions. These results may vary if the supporting evidence behind these questions

was presented. The work of (Bandura 1977) indicates “self-efficacy beliefs reflect an internal

awareness that one is able to perform a specific task. Without an internal belief that one is

able to make a change, change is unlikely to happen”. The questions featured in figure 8 do

all allow the patients to become internally more aware, that could support change, “the beliefs

that people have about themselves are central to the choices they make in shaping their lives”.

26

Figure 9

The results of 83.33% of patients in figure 9 think the questions in figure 8 could be

helpful, aiding in the communication of oral health. This is based to hygienists limited

information of the supporting evidence, surrounding the background of the questions

included in figure 8.

27

Figure 10

The results of 77.78% of patients in figure 10 think that reviewing the questions in figure

8 at appointment intervals, could be helpful in monitoring the patients’ status, on the

perception of their oral health. This is based to hygienists limited information of the

supporting evidence, surrounding the background of the questions included in figure 8.

1 Hygienist in the UAE utilized the question in figure 8 and returned the below feedback.

28

Was it easy, and time efficient to ask these questions?

Definitely.

Did you find the patients reflected more on their oral health, when asked these

questions? If yes, why do you think they did?

Yes, I think they feel they are given a platform to open up.

Do you think these questions could help patients engage more in the long term of

maintaining optimal oral health?

Depending on the patient I think so. They all seemed keen.

Where patients happy to answer these questions?

Older patients, because I think they had less anxiety about the actual cleaning

than the new patients, so they seemed more at ease.

Did you document these answers in their notes, or would it be easy to in the

future?

It is easy to document and I did on the patient file.

Would you find it helpful to use these questions, or style of questions again?

It is very helpful and in fairness I already give the patients an opportunity to

communicate with me and I do ask a lot of questions. I just tailor the questions to

each individual patient. I would maybe include the numerical scoring system. I

have a more emotional system.

Would you find it helpful re-document the answer at appointment intervals to

monitor the patients’ perception on their oral health?

Of course for monitoring.

29

Would you use these questions again?

Yes, but obviously not verbatim unless we make a paper questionnaire.

Would you be interested in using this style of question more to support oral

health promotion?

Yes, but I would limit it to 3 questions max.

What were your overall thoughts in incorporating these questions into your

practice? (i.e. what could be the benefits, and why, what could be the limitations

and why?)

I do see the importance of communicating with patients so we can move into the

future with a better understanding of the psyche of the patient, so we can aim to

be more appealing from a health point of view. Perhaps a

structured questionnaire is good because the patient may

not feel pressurized to give the perfect answer. I think the only limitations are the

patients themselves. I was lucky this week, but I have had experiences

where patients do not want to chit chat about anything.

Limitations of Results, and Ideas for future research

Optimizing on time is important and the style of question included in figure 8, is sensitive to

time constraints. The survey monkey questions I have begun to develop in figure 8 intended

for a toolkit, could be used in a communication toolkit, however these are only the preliminary

steps as it is a vast topic to address all at once. Further development opportunities should be

considered to expand on the existing questions to develop a further cascade of questions that

could be followed to develop an extensive oral health communication toolkit.

30

I have not explored when the most effective time to implement certain questions in

figure 8 could be, and this should be explored further to reach a highly effective oral

health communication toolkit that could be adapted to all scenarios. The questions

asked in figure 8 could be developed further, ensuring an analysis of further

communications strategies are analyzed and included.

Aside from asking patients the questions outlined in figure 8, it is important to remember

creating a good rapport is key, according to (Najavits et al. 2000) this “correlates with

the patient behavior change outcomes”. It is relevant to realize the chosen mode of the

conversation or advice can significantly affect behavior outcomes. Empathizing as a

clinician plays a key role in the communication, as well as being flexible in the

approached communication style.

“The more information is evaluated and applied by the recipient of it, the more likely it is that

such information will be taken on board” (Wilding and Valentine 1997).

Further research is required surrounding the question targeting the hygienists, to

support the re-evaluation of dental hygiene curriculums:-

These questions could include –

What year did you graduate?

Where did you study?

Did your curriculum include a module on behavioral science and communication

on oral health?

31

If a module was included on communication of oral health within your curriculum,

do you feel it was in depth enough to support the delivery of the communication

of oral health in your daily practice?

Business Aspect

Regardless of geographical location, a clinician’s ambition to achieve their full potential

is of great importance. Searching for new ways to overcome existing interferences is

key to the success of reaching the full potential within a business. A clinician skilled

enough to help patients understand an obstacle, will be better equipped to help the

patient overcome the obstacle, moving forward to achieve improved oral health

outcomes, happier patients, job satisfaction and enhanced business outcomes for the

future.

How would my finding help a practice make money?

Happier patients achieving better oral health outcomes are more likely to speak about

their positive outcomes and this in turn would lead to more referrals and more patients.

Minus frustration a dental hygienist is more likely to be an enthusiastic employee who

would possibly feel more motivated to achieve even more resulting in greater

profitability.

Conclusion

Returning to my initial action research question:-


the communications on oral health? Would this toolkit be welcomed by the profession?

32

From summarizing the results, it would appear evident that a simplified communication toolkit

would be welcomed by the dental hygiene profession. Dental hygienists confirmed they do get

frustrated when patients return with reformation of plaque. Hygienists are not achieving

optimal oral health with their patients through their existing communication strategies, so there

is room to improve on current methodologies.

Hygienists would be very open to using a simplified communication toolkit if one was available.

It seems apparent hygienists would use the questions I developed on their patients. The

hygienist that did implement question 5, provided promising feedback. The answers from the

question outlined in figure 8 could be easily documented and re-documented, in the clinical

notes, allowing comparisons from one appointment to the next. All the numbers scored would

allow an opportunity of reflection and to expand upon the score in conversation.

Bibliography

Aristotle (1953) The Nichomachean Ethics. Trans. J.A.K. Thompson. Harmondsworth;

Penguin.

Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: W.H Freeman.

Becker, M.H., and L.A. Maiman. (1975). Sociobehavioral determinants of compliance with

health and medical care recommendations. Med Care 13(1):10-24.

Brehm (1966). A Theory of Psychological Reactance. New York: Academic Press. Brehm,

S.S., and J.W. Brehm (eds.). (1981). Psychological Reactance: A Theory of Freedom and

33

Control. New York: Academic Press.

Burke, B.L.H. Arkowitz, et al. (2003). The efficacy of motivational interviewing: A meta -

analysis of controlled clinical trials. J Consult Clin Psychol 71(5):843-861.

Burke, B.L. C.W. Dunn, et al. (2004). The emerging evidence base for motivational

interviewing: A meta-analytic and qualitative inquiry. J Cognitive Psychotherapy 18(4):309-

322.

Helman, C. (2006) Suburban Shaman: Tales from Medicine’s front Line. London:

Hammersmith.

Hemsley B., Balandin S. & Worrall L. (2012) Nursing the patient with complex communication

needs: time as a barrier and a facilitator to successful communication in hospital. Journal of

Advanced Nursing 68 (1), 116–126.

Hettema, J., J. Steele, et al. (2005). Motivational interviewing. Annual Review of Clinical

Psychology 1:91-111.

House of Lords Science and Technology Select Committee. Second report of session

2010 – 2012. Behavioral Change Report.

Najavits, L.M., P. Crits-Bhristoph, et al. (2000). Clinicians’ impact on the quality of substance

34

use disorder treatment. Subs Use Misues 35(12-14):2161-2190.

Rollick, S., P. Mason, et al. (ends.) (1999). Health Behaviour Change: A Guide for

Practitioners. Edinburgh: Harcourt Brace.

Rollick, S., W.R. Miller, et al. (ends.). (2007). Motivational Interviewing in Health Care. New

York: Guilford Press.

Ruback, S., A. Sandbaek, et al. (2005). Motivational interviewing: A systematic review and

meta-analysis. Br J Gen Pract 55 (513):305-312.

Ryan, R.M., and E. Deci. (2000). Self-determination theory and the facilitation of intrinsic

motivation, social development, and well-being. Am Psychol 55(1):68-78.

Wilding, J., and E. Valentine (eds.) (1997). Superior Memory. London: Psychology Press.

World Health Organisation (WHO). (2003). Adherence to Long-Term Therapies:

Evidence for Action. Geneva, Switzerland: World Health Organization

Word Count - 5372

35

Appendices

Appendix 1

Your participation in the below survey is greatly appreciated and your identity will appear

anonymous. All data collated is intended to purely reflect the honest opinion of professionals

working within Dentistry in the UAE, to advance the Oral Health Care & Wellbeing for the

public.

Designation – __Hygienist_ __________________

Scale -

1 - unaware / low priority

10 - very aware / high priority

1. What percentage of the Dental Hygienists full skill set is being implemented?

i. ____________%

2. How aware are dentists within the UAE of the role of the dental hygienists?

i. Please highlight - 1 2 3 4 5 6 7 8 9 10

ii. How proactive are the dentists in integrating Hygienists into their practice

model?

Please highlight - 1 2 3 4 5 6 7 8 9 10

iii. Is oral health a priority amongst the public?


iv. Is oral - systemic health a priority amongst the profession?


36

v. Is oral - systemic health a priority amongst the public?


3. What percentage of your patients are orally healthy (For Dental Clinicians)

_____________%

Thank you for your time.

Regards Victoria Wilson

Appendix 2

Have you ever felt frustrated that your patients continue to present with reformation of

plaque?

Never

Frequently

Occasionally

What percentage of your patients achieve perfect oral health? (i.e 0% plaque & 0%

Bleeding on probing)

70% - 100%

50% - 70%

30% - 50%

1% - 30%

0%

Do you frequently feel you are repeating yourself to your patients, following a similar

structure, from one appointment to the next?

Yes

37

No

If there was a simplified communication toolkit available for Hygienists, intended to aid

in promoting oral health for your patients, would you be open to use it in

the communication of oral health.

Very Open

Not very open

Mark the squares below, if you would consider using the question on your patients.

On a scale of 1 -10 how important is your oral health to you? (score 1 low importance,

10 high importance)

On a scale of 1-10 how open are you to wanting to enhance your oral health? (score1

not very open, 10 very open)

On a scale of 1-10 how much do you want your mouth to remain to be optimally clean

and healthy? (score 1 not very much, 10 very much)

On a scale of 1-10 do you see many benefits, if your mouth was maintained to

be optimally clean and healthy? (score 1 not many, score 10 many)

On a scale of 1-10, how strongly do you feel about returning for your dental hygiene

appointment? (score 1 not bothered, 10 feel strongly)

Do you think the questions in question 5 could be helpful to aid in the communications

of oral health?

Yes

Maybe

No

Do you think reviewing the questions, in question 5 at appointment intervals could be

38

helpful in monitoring your patients’ status, on their perception of their oral health?

Yes

Maybe

No

39

FINAL V3 Action Research Project

Documents

Transcript of FINAL V3 Action Research Project