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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 patientsrom ollowing advice and explain why‘concordance’ – where a patient isempowered to take ownership o theirhealth and treatment in partnership withthe healthcare practitioner – is a moreeective approach than ‘compliance’.The traditional approach to motivatingpatients to change behaviour is otentermed the ‘compliance’ model andinvolves the oral hygiene proessionalexplaining the health acts o thesituation, and prescribing an oralhygiene or treatment regimen usinglogical arguments ocusing on long-termbenet. ‘Compliance’ in a healthcaresetting makes two assumptions: . thepractitioner ‘knows best’; and 2. patientswill ollow instructions regardless o theirown belies or wishes.So why do some patients apparentlyignore what seem to be simpleinstructions, despite the act that youradvice will benet their oral healthor directly impact on the success o atreatment plan? The concept o ‘non-compliance’ is not new and is one thathealthcare proessionals have consistentlystruggled with. First documented as arback as 200 BC, Hippocrates is creditedwith saying: “Be alert to the aults o
Why dON’T PATIENTS
Dispensing advice to patientsabout their oral health routineis part of your everyday role.But do you sometimes feel yourwords are falling on deaf ears?Do patients claim that theyare following your advice buttheir gingival condition or toothdecay tells you otherwise?
always follow advice?
UNDERSTANDING PATIENT MOTIVATION
I
sm nt ntn
There has been much written aboutcommunication between health proessionalsand 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 belies or wishes.
Concordance:
A therapeutic alliance betweenhealth proessional and patient, in which theyshare decisions and negotiation takes placebetween equals. The patient’s knowledgeand belies 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 orproessional infuence.
Motivation:
The reason(s) that someone(including yoursel) engages in a particularcourse o action. The level o motivation canbe measured by what they choose to do, theintensity o activity, their perormance andhow well they sustain the activity.
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patients who lie about their taking omedicines prescribed and when things gowrong, reuse 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 benetso 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 eortor a hoped-or, long-term benet.
dgu nnt
In recent years it has become acceptedthat a dierent 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, whileoverestimating the extent to which theyconsult patients and elicit their views(Makoul, 995).With this in mind, a number oprogrammes have been initiated byhealthcare organisations, patient supportgroups and pharmaceutical companies,like GlaxoSmithKline, that provideresources to improve patient and providereducation. These address the barriersto ‘compliance’ and aim to improvepatient outcomes by taking an approachbased around ‘concordance’ and patientempowerment. Inormation resourceshave been designed to empower thepatient with knowledge and support thedialogue between the patient and theirhealthcare provider.
dnttr gu
In 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 bioeedback 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 brushinghabits are better than they are clearly hasimplications for practitioners wishing tochange their patients’ behaviour.
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o a treatment plan, patients oten 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 University’s School o DentalSciences, 2005). The act that patientsthink their brushing habits are betterthan they are clearly has implicationsor practitioners wishing to change theirpatients’ behaviour.Another study observed that whilepatients’ brushing and fossing abilityincreased dramatically over  weeksollowing two sessions o oral hygieneinstructions, with benets 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.
Prtnrhp pprh
These studies highlight some o the issuesaced by practitioners and oer useulinsights into how patient dialogue andmotivation can be improved. Currentattitudes in relation to this are centred onbuilding a true partnership with patientsthat involves approaching all treatmentdecisions in an attitude o
‘concordance’
rather than
‘compliance’
. This means that“Do as I tell you” should give way to “Let’sdiscuss your treatment options and agreewhat’s best or you”.It is clear that a number o actors impactupon a patient’s 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 benets provided bythe treatment. For example, in terms operiodontitis, 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 discussedurther 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 tochange a light bulb? Only one – but thelight bulb must want to change.
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