Self-direction or Autonomy

Patient autonomy is an essential factor in motivating effective changes in health behaviors. By providing support of patient autonomy, patients are more motivated to manage their health, feel more confident about managing their health and showed improvement in health outcomes.14,15

In order to develop patient autonomy, the dental professional must be willing to relinquish authority as the ‘expert’ and accept that the patient is the ‘expert’ on what he knows, feels and is willing to implement. The process of active learning put learners in control of their learning, which leads to the patient taking responsibility for their oral health. It is the responsibility of the dental practitioner to assist patients in developing the skills needed to make informed decisions about healthy behaviors.5

In order to assist patients in developing the skills they need to be successful, dental providers need to be familiar with the various learning styles patients may exhibit. Attention to learning styles can lead to more effective learning and a patient who can make the decisions necessary to make changes in oral health behaviors. There are many inventories of learning styles, but the most common are Gardner’s Multiple Intelligences and Kolb’s Learning Styles.

Gardner’s Multiple Intelligences consists of the following.1

  • Verbal
  • Logical/Mathematical
  • Visual/Spatial
  • Music/Rhythmic
  • Kinesthetic/Body
  • Interpersonal
  • Intrapersonal

Generally, dental practitioners communicate healthcare information verbally. According to Gardner’s Multiple Intelligences, to be effective providers need to appeal to patients with different learning styles by using several methods to communicate information. To make teaching more effective, supplement verbal information with written materials, audio or videotapes or resources from the Internet. In a systematic review, demonstration was the only teaching strategy with a large effect on patient outcomes and the recommendation is for a combination of approaches. The advent of cameras that attach to loupes may allow for personalized oral self-care videos to be delivered to patients for review at home.6

Kolb’s Learning Styles include the following:1

  • Concrete Experience (CE) refers to being involved in hands-on application of new skills.
  • Reflective Observation (RO) refers to watching others do a new skill.
  • Abstract Conceptualization (AC) refers to creating theories to explain observations.
  • Active Experimentation (AE) refers to using theories to solve problems and make decisions.

Some view Kolb’s Learning Styles as a continuum, but patients tend to develop a preference for one style over the others. The patient with a CE learning style prefers active participation when learning new information, i.e., utilizing a toothbrush in his or her own mouth for demonstration. Those with a RO learning style prefer to watch the dental practitioner demonstrate the new skill before attempting it on their own. The AC learner prefers to understand the theory behind a new skill. And finally, the AE learner uses the theory behind a new skill to understand how to apply it his or her own mouth to improve oral health. A systematic review of effective teaching strategies in patient education found demonstration to be the most effective with the following approaches having a small to moderate effect on patient outcomes: traditional lecture, discussion, computer technology, written material, audiotapes, videotapes and verbal.6

Providing the patient with the basic knowledge and skills they need to improve and maintain their oral health will enhance their ability to be self-directed or autonomous in their learning.