Prevention Strategy: Effecting Behavior Change

Behavior change in an individual can reduce a person’s risk of disease, yet changing behavior in patients has proven to be difficult.3 Educating a patient is valuable and offers information and skills that enhance an individual’s ability to make healthy choices, yet there is no guarantee that the patient will always make the best choices. For example, while the important advice to reduce the amount and frequency of sugar consumption (and when possible, limit it to mealtimes) seems clear-cut and easy to follow, sugar consumption continues to increase, particularly in the US (Figure 1).

Figure 1.
Figure 1 - Global Soda Consumption vs GDP (per capita)
Annual global consumption of sodas vs. GDP per capita clearly demonstrate a much higher level of sugar consumption (sodas) in the US compared to other nations.
Adapted from Sugar, Consumption at a Crossroads. Credit Suisse4

There are multiple theoretical models that demonstrate why changing a behavior, particularly a socially and culturally important one such as a feeding behavior, is difficult. However, outlined here is the most useful information compiled from these various theories, and the most practical tips that dental professionals can put to use in their practice to promote oral health.

Patients do not always act rationally: It is important that dental professionals do not assume that just by providing information their patients will behave in a rational way and immediately take action that follows that advice.3 Not only do patients not always act rationally, multiple studies have found that information from health professionals, increased awareness, and possessing more knowledge about the cause of disease are not strong enough motivators to change a habitual behavior.3,5,6 Dental professionals must, therefore, learn to think of behavior change as a process and support the change, rather than thinking that behavior change is instantaneous and simply based on information.3

There are multiple and complex barriers to change: One of the main barriers experienced by people who are considering change is the attitudes of those around them, which are typically influenced by ethnicity and culture. The beliefs and expectations of an individual’s family members and peers have a very strong effect on a person’s ability to change. Thus, it may be important to recruit family members or friends who support a behavior change to express frequently to the patient that the recommended change is a good thing. Other social or psychological barriers may include factors such as distrust of medical healthcare providers, fear of medical settings, and anxiety or fear which breeds denial that there is a problem. Behavior change can also be hindered by financial or socioeconomic circumstances such as lack of health services where the patient lives, insufficient money to pay for dental visits and services, and transportation difficulties.3

Another set of barriers are related to communication, such as not being fluent in the language the dentist speaks, illiteracy, limited understanding of scientific or technical terms due to poor education, learning disabilities that hinder the understanding of instructions or advice, or unclear communication from the dentist.3