02.13.09 Issue #362 Forward This Newsletter To A Colleague

Angie Stone
Angie Stone RDH, BS
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Motivation Or Intimidation For Patient Compliance

As members of a helping profession, dental hygienists deal with compliance issues to help patients achieve optimal oral and systemic health. To obtain compliance, existing behaviors must be altered. Whether hygienists want compliance in the area of oral health, weight loss, tobacco cessation or high blood pressure reduction, they must understand the basic concepts of human motivation before they can help patients achieve their goals. If hygienists have a good understanding of human behavior and motivational theories, they gain a higher level of patient motivation and compliance. Without knowledge of human behavior and motivational approaches and theories, the hygienist may default to intimidation techniques to gain patient compliance and these techniques most often are not effective!

Avoidance and approach are two types of behavior that influence motivation. Avoidance causes people to choose certain behaviors in order to avoid something. In contrast, approach causes people to be driven by want or need. For example, if a person wants to lose weight, he or she may choose avoidance by avoiding desserts. The person realizes that avoiding high calorie foods can result in weight loss. However, in the approach method of motivation, the individual may choose to exercise more, realizing that burning extra calories will result in weight loss. People who are anxious are more likely to engage in avoidant behavior and are typically introverts. On the other hand, people who are less anxious tend to be more extroverted and seem to be driven by approach behaviors. People may use a combination of approach and avoidance to achieve their desired results.

There are also theories of motivation or behavior. Of interest to dental hygienists trying to motivate patients are the reward and goal theories. The reward theory says that people repeat behaviors that make them feel good (positive reinforcement) and discontinue behaviors that make them feel bad (negative reinforcement). The goal theory says that goals give rise to actions. According to this theory, goals create tension and people work toward the goal to reduce that tension.

It is easy to understand how hygienists can motivate through the reward theory. They can offer positive and negative reinforcement based upon patients’ performances. For example, if during a routine professional cleaning visit, the hygienist discovers a patient’s blood pressure is high, it’s appropriate to discuss whether the patient is taking blood pressure medication, if he is watching his diet and if he is exercising. At the next visit, if the hygienist discovers the patient’s blood pressure is lower, it is a great opportunity to provide praise. This positive reinforcement will make the patient feel good and likely continue the behavior that lowered the blood pressure. Of course, if the patient’s blood pressure is still elevated, there should be discussion and questions regarding medication, diet and exercise.

In regard to the goal theory, where do goals come from? This can be answered with the components of motivation: biological processes, learned processes and cognitive processes.

Think about the patient with high blood pressure. The biological component of the high blood pressure may be due to the need to eat. When he is stricken by the need to eat, the foods consumed may play a part in the high blood pressure. Any genetic links to high blood pressure are also biological components—those that are “hard wired” in our brain and body systems. Several learned components may also contribute to high blood pressure, such as consuming fast food and leading a sedentary lifestyle. The cognitive component comes into play when the patient decides, based on new information, that these habits are not beneficial to health and changes are in order. The hygienist’s main role is to educate patients by providing information that can facilitate changes in the cognitive component.

Dental hygienists should possess the tools of motivation, not intimidation. The tools of motivation are

  • possessing an in-depth knowledge of health issues affecting patients
  • the ability to understand patients’ situations
  • being considerate of patients’ emotional states
  • being able to talk with patients so they can understand

When dental hygienists use these qualities, patients stand a better chance of successfully reaching goals. Hygienists who do not possess these qualities need to rely on the intimidation factor and goals will not be reached.

These approaches to motivation can be valuable to hygienists who take the time to learn and understand them. Once they are understood, dental hygienists need to tune into their patients in order to select the best approach to use to motivate each individual patient.

Need help with implementing new systems in your hygiene department to ensure stellar performance? Email hygiene@mckenziemgmt.com.

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