REVI EW

Australian Dental Journal 2009; 54: 190197

doi: 10.1111/j.1834-7819.2009.01118.x
Models for individual oral health promotion and their
effectiveness: a systematic review
D Yevlahova,* J Satur*
*Melbourne Dental School, The University of Melbourne, Victoria.
ABSTRACT
Background: There is a recognized need to deliver oral health information to people during clinical encounters to enable
them to develop personal skills in managing their own oral health. Traditional approaches to individual oral health
education have been shown to be largely ineffective and new approaches are required to address personal motivations for
preventive behaviour. This systematic review aims to identify and assess the effectiveness of behaviour models as a basis for
individual oral health promotion.
Methods: Electronic databases were searched for articles evaluating the effectiveness of health behaviour models in oral and
general health between 2000 and 2007. Eighty-nine studies were retrieved and data were extracted from the 32 studies that
met the inclusion criteria.
Results: Thirty-two studies were identied in the elds of clinical prevention and health education, motivational
interviewing (MI), counselling, and models based interventions. MI interventions were found to be the most effective
method for altering health behaviours in a clinical setting.
Conclusions: There is a need to develop an effective model for chairside oral health promotion that incorporates this
evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the
clinical encounter. There is potential to further develop the MI approach within the oral health eld.
Keywords: Behaviour modification, health promotion, health education, oral health, motivational interviewing.
Abbreviations and acronyms: CHPPHF = Cochrane Health Promotion and Public Health Field; CVD = cardiovascular disease; IMB =
Information Motivation Behavioural Model; MI = motivational interviewing; RCT = randomized controlled trial.
(Accepted for publication 2 December 2008.)
INTRODUCTION
There is a recognized need to deliver oral health
information to people during clinical encounters to
enable them to develop personal skills in managing
their own oral health. Dental professionals have
traditionally applied the biomedical model of disease
to target causes of illnesses through preventive and
educational approaches. The underlying theory behind
these approaches is that once individuals acquire the
relevant knowledge and skills, they will then alter their
behaviour to maintain optimal oral health.
1
These
approaches to individual oral health education based
on paternalistic information giving have been shown to
be largely ineffective.
2
They overlook the broader
context determining human behaviours, including fac-
tors such as the social, economic, political and envi-
ronmental circumstances. Collectively, these factors are
known as the social determinants of health.
3,4
While oral ill health conditions are almost com-
pletely preventable, data on the prevalence of disease
indicates that preventive approaches are often inef-
fective. This supports the view that the causes of oral
diseases are grounded in the social determinants of
health and the cultural and social circumstances in
which people live.
5
There is little doubt that oral
health behaviours are inextricably connected to the
other behaviours people apply to cope with their
lives. These social and cultural contributors can be
difcult to consider appropriately within the context
of the clinical dental encounter. There is a need to
advance this thinking to develop a model for effective
chairside oral health promotion for use by oral health
practitioners.
A number of research based health behaviour models
exist to inform more evidence based approaches to
developing personal skills and oral health literacy among
individuals. These client or patient centred health
190 2009 Australian Dental Association
behaviour models draw on psychological theories of
self-efcacy, motivation, counselling and behaviour
change.
6
Such models have been utilized for smoking
cessation, alcohol and substance abuse counselling,
nutritional counselling and HIV AIDS prevention
with some success.
7
Psychological models of behav-
iour change provide a framework for understanding
the processes of change and the inuence of social
circumstances for individuals on their behaviours.
Counselling has a range of meanings, but generally
includes targeted and interactive information giving
approaches that address individual behaviour, thereby
meeting the specic needs of individuals.
8
Moti-
vational interviewing (MI) is an approach that uses
collaborative and empathic interactions to develop a
clients internal and autonomous motivation to
change.
9
The aim of this study was to systematically review
the literature to identify models for health beha-
viour change and evaluate evidence for their effec-
tiveness. This work will inform the development of a
model for oral health promotion in the clinical
encounter.
METHODS
Study selection
A search of the following electronic databases was
used to identify relevant papers for inclusion in the
review: Medline, PsychInfo, Cinahl, ERIC (CSA) and
the Cochrane Library. Keywords included behaviour
modication, health behaviour modication, health
education, health promotion, counselling, motiva-
tional counselling, motivational interviewing, oral
health, general health, smoking cessation, diabetes
prevention, HIV prevention, models, theories,
interventions, effectiveness and individual. The
reference lists from review papers on MI were also
searched.
1012
This yielded 89 studies that were
screened according to the inclusion criteria listed in
Table 1, yielding the 32 studies which were included
in this review. To validate the selection procedure a
second researcher examined the 89 potentially rele-
vant papers against the inclusion criteria, and any
discrepancies were discussed until an agreed decision
was reached.
Quality assessment
The studies were assessed for quality against a com-
bined schema incorporating type of evidence as desig-
nated by the Type of Evidence Schema
13
(Table 2), the
Health Gains Notation framework
14
(Table 3) and the
Cochrane Health Promotion and Public Health Field
(CHPPHF) quality assessment screening questions for
qualitative studies, quantitative studies and systematic
reviews.
15
Table 1. Inclusion and exclusion criteria
Characteristics Inclusion criteria Exclusion criteria
Intervention Studies evaluating the effectiveness of individual oral
health promotion interventions
Studies assessing the effectiveness of dental
materials, techniques and technology
Studies that report evaluations on context, process,
impact and outcomes for individuals and
communities
Studies which have only provided treatment as their
intervention
Studies measuring effectiveness over a minimum
time-frame of one month
Studies evaluating interventions of common risk
factor processes and messages guided by, and
relevant to, the framework for oral health
promotion, including those which do not have oral
health as the primary focus
Studies originating from Australia, NZ, UK,
Canada, USA and Europe
Articles where data on interventions, impact on
health outcomes of people, government regulation
(policy), or funding model are not reported.
Studies which only present observational data, i.e.,
an audit.
Study design Systematic reviews, meta-analyses and randomized
control trials were sought initially. Other
controlled trials and comparative studies were also
considered.
Narrative reviews, editorials, letters, articles
identied as preliminary reports when results are
published in later versions, articles in abstract form
only.
Publication Articles between 2000 and 2007 Studies published prior to 2000
language (English language articles) (Non-English publications)
Table 2. The strength of all studies was evaluated
according to the Type of Evidence Schema shown
below
Type I evidence at least one good systematic review
(including at least one randomized
controlled trial)
Type II evidence at least one good randomized
controlled trial
Type III evidence well-designed interventional studies
without randomization
Type IV evidence well-designed observational studies
Type V evidence expert opinion; inuential reports and
studies
2009 Australian Dental Association 191
Models for individual oral health promotion
Quantitative studies were assessed for quality using
the CHPPHF Quality Assessment Tool for Quantitative
studies.
15
This tool assessed for internal and external
validity and rated the following criteria: selection bias,
allocation bias, confounding, blinding, data collection
methods, withdrawals and dropouts, statistical analysis
and intervention integrity. Qualitative studies and
systematic reviews were assessed and ranked for qual-
ity using the questions developed from the Critical
Appraisal Skills Programme for the CHPPHF.
15
Of
the 32 studies, eight studies were evidence Type V and
were not ranked further for quality. The studies were
ranked for quality and classied as weak, moderate or
strong evidence as outlined in Table 4.
RESULTS
The 32 studies yielded included nine studies of clinical
prevention and health education, three studies of
counselling, nine studies of models based interventions
and 11 studies of motivational interviewing. Level of
evidence was found to be strongest in studies on
counselling interventions, followed by motivational
interviewing interventions, models based interventions,
and lastly, clinical prevention and health education
models, as seen in Table 5.
Clinical prevention and health education
Of the nine studies found in the area of clinical
prevention and health education, four studies did not
meet the quality assessment criteria and were not
included in this synthesis.
Health education for the purposes of this category
means information and expert advice provision with a
passive patient. There was strong evidence to suggest
that clinical prevention, treatment and educational
interventions are not the most effective approaches to
reducing disease levels amongst individuals and com-
munities. A qualitative study of preventive advice
delivered by physicians in clinical encounters identied
many barriers to integration of prevention into routine
practice.
16
Some of the barriers included patients
motivation to carry out preventive measures, physi-
cians workload and priorities, physicians lack of
insight regarding patients risk behaviours, unclear
recommendations, personal attitudes and beliefs. The
participating physicians in the study also felt that they
were not reaching the vulnerable populations who are
at higher risk of disease. A study that applied a Child
Advocacy Training Model of Prevention discovered
similar challenges to integration of prevention into
practice, including time limitations, varied motivation
among practitioners and lack of available resources.
17
Results of a qualitative study on adolescents view of
oral health education indicated that oral health edu-
cation provided in a clinical encounter is generally
positively but vaguely remembered and not always
applied into practice.
18
The study showed that even
participants who displayed knowledge of certain oral
health topics did not always succeed in practising
healthy habits.
Clinical prevention and health education interven-
tions using standardized messages have failed to achieve
sustainable improvements in oral health and, therefore,
cannot be considered to signicantly reduce caries
prevalence of populations.
1,19
These programmes have
been described as palliative in nature, ignoring the
underlying factors that create poor oral health.
1
Counselling
Of the three studies found in the area of counselling,
one was a systematic review and two were randomized
controlled trials (RCTs). Counselling was dened as
targeted and interactive information giving approaches
that address individual behaviour, thereby meeting
the specic needs of individuals.
8
Only one of the
three studies found the counselling approach to have
signicant effects on disease levels. A systematic review
of multiple risk factor intervention comprised of
counselling, education and drug therapy found the
approach to be ineffective in achieving reductions in
Table 3. The effectiveness of all studies was evaluated
according to the Health Gains Notation shown below
1. Benecial effectiveness clearly
demonstrated
2. Likely to be benecial effectiveness not so rmly
established
3. Trade-off between benecial
and adverse effects
effects weighed according to
individual circumstances
4. Unknown insufcient inadequate for
recommendation
5. Unlikely to be benecial effectiveness is not as clearly
demonstrated as for 6
6. Likely to be ineffective or
harmful
ineffectiveness or harm
clearly demonstrated
Table 4. Quality ranking criteria
Reviewer
quality
ranking
Type of
evidence
Weak 05 Poor or no quality ranking because
of a lack of information
or poorly designed study methods
Moderate 67.0 IVV Well reported but weaker
study designs or better studies
lacking information. May also
include multi-strategy programmes
with poor attribution or process
and impact evaluations but
no outcomes reported
Strong 7.110 IIII Well-designed studies with good
methods reporting including
RCTs and systematic reviews
192 2009 Australian Dental Association
D Yevlahova and J Satur
cardiovascular disease (CVD) mortality when used in
general or workforce populations of middle-aged
adults.
20
This interventions results also stated that
the counselling approach led to some lifestyle changes
that resulted in small reductions in blood pressure,
cholesterol, salt intake and weight loss. However, these
changes were found to have little or no inuence on
risk of heart attack or death. One RCT of individual
counselling showed no signicant effect of this
approach on sick leave levels of the participants and
conrmed that more research is required in this area.
8
Another RCT looked at effectiveness of oral hygiene
and dietary counselling, and non-invasive preventive
measures, on reducing DMFS among children with
active initial caries.
21
The approach was found to be
successful in reducing total need for restorative care
although lesion-specic results in regard to reversing
active caries lesions were not reported in the studys
ndings.
21
Signicantly less caries developed in the
experiment group compared to the control group, with
mean DMFS increments for the experimental and
control groups being 2.56 (95% CI 2.07, 3.05) and
4.60 (3.99, 5.21), respectively (p < 0.0001): with a
prevented fraction of 44.3 per cent (30.2 per cent, 56.4
per cent). The results indicate that this approach can
signicantly reduce dental decay among caries active
children living in areas of low caries risk. However, the
results also showed that frequent counselling sessions
alone had little effect on oral health habits and dietary
habits of the participants, other than increasing the use
of xylitol and uoride lozenges. The large number
of uoride and chlorhexedine varnish applications
received by children in the experimental group
undoubtedly also contributed to the reduction in DMFS
increment obtained among this group. The three studies
did not report their ndings in regard to sustainability
of effects, or the time and cost-effectiveness of the
counselling approach.
Models based interventions
Of the nine studies found using interventions based on
behaviour models, four studies were systematic reviews,
one study was a RCT and two studies were observa-
tional. There were two studies found that did not meet
the quality assessment criteria, thus these studies are
not included in this report.
The studies yielded in this eld found most interven-
tions based on models of health behaviour change to be
effective in reducing disease levels and risk behaviours
in different settings. Two systematic reviews focused
on Behaviour Change Models in Smoking Cessation.
Results from a systematic review showed that smoking
cessation programmes in pregnancy reduce the propor-
tion of women who smoke, consequently reducing the
incidence of low birth weight and preterm birth.
22
Another systematic review examined the evidence for
effectiveness of integrating behavioural interventions
for tobacco use in dental services.
23
This study con-
cluded that tobacco cessation counselling interventions
based on behaviour change models delivered by dental
professionals may be effective in helping tobacco users
to quit. A systematic review focusing on family based
programmes and their effect on preventing adolescent
smoking showed that childrens decisions to smoke are
inuenced by their family and friends, reinforcing the
signicance social circumstances and surroundings have
on the health decision-making process.
24
One systematic review found psychological models of
behaviour change, such as the Health Belief Model, the
Theory of Planned Behaviour, the Theory of Reasoned
Action, the Locus of Control and the Protection
Table 5. Quality ranking distribution of type of evidence
Model Weak Moderate Strong
Clinical prevention and health education Palmer, 2004 Chamberlain et al., 2005 Watt, 2005
Shih, 2005 Hudon et al., 2004
Plourde, 2006 Vanobbergen et al., 2004
Phelan, 2006 Ostberg, 2005
Motivational interviewing Emmons, 2001 Martino et al., 2007 Knight et al., 2006
Britt, 2004 Kasil et al., 2006 Dunn et al., 2001
Tappin et al., 2005
Burke et al., 2003
McCambridge et al., 2005
Channon et al., 2007
Kalishman et al., 2005
Counselling Proper et al., 2004
Ebrahim et al., 2006
Hausen et al., 2007
Behaviour change models Rise, 2004 Laatikainen et al., 2007 Eime et al., 2004
Bourbeau et al., 2004 Buchaman et al., 2006 Lumley et al., 2004
Carr et al., 2006
Renz et al., 2007
Thomas et al., 2007
2009 Australian Dental Association 193
Models for individual oral health promotion
Motivation Theory, to be effective in improving
adherence to oral hygiene instructions amongst adults
with periodontal disease.
25
Psychological approaches to
behaviour change resulted in improved plaque scores
and was associated with enhanced self-reported brush-
ing and ossing. The results of this study also showed
improved self-efcacy beliefs in relation to ossing.
However, no effect on dental knowledge or self-efcacy
beliefs in relation to toothbrushing was found. A RCT
applied ecological principles of behaviour change to a
safety behaviour intervention on prevention of injuries
in the recreational game of squash.
26
Ecological
principles of behaviour change provide a comprehen-
sive perspective on intra-personal factors, policies and
physical environmental inuences on health-related
behaviours, such as the use of protective eyewear
during sport. The study concluded that behaviour
change models provide comprehensive and a particu-
larly relevant set of principles and guidelines for
approaching safety initiatives in sports.
An observational study looking at diabetes preven-
tion through lifestyle interventions found that this
approach is feasible in primary health care settings,
leading to reductions in risk factors.
27
Another obser-
vational study searched for evidence of effectiveness of
the Transtheoretical Model of Behaviour Change in
reducing consumption of carbonated drinks by adoles-
cents.
28
The results showed that 45 per cent of
adolescents in the sample reported some attempts to
modify their behaviour. The study supported the
Transtheoretical Models predictions in regards to the
balance between the pros and cons (the positives and
negatives of making the change) varied depending on
which stage of change the individual was in. Thus, this
studys ndings suggest that this model of behaviour
change may be a useful framework through which
more tailored health promotion interventions can be
designed.
Motivational interviewing
Eleven studies that used the motivational interviewing
(MI) approach to behaviour change were found. Of
these studies, two were systematic reviews, one was a
meta-analysis of controlled trials, ve were RCTs and
three were observational. Of the 11 studies found on
MI, two did not meet the quality assessment criteria
and were not included in this synthesis. Evidence shows
that MI has been applied to a variety of elds inclu-
ding diabetes, asthma, hypertension, heart disease, sub-
stance abuse, smoking, HIV risk reduction, diet and
exercise.
10,11,2932
Most studies displayed positive results for the
effectiveness of MI in altering behaviours. One system-
atic review found positive results for the effects of MI
on psychological, physiological and lifestyle change
outcomes
11
and concluded that MI has the potential to
be an effective intervention in physical health care
settings. Results of a systematic review indicated that
60 per cent of 29 studies yielded at least one signicant
behaviour change,
29
conrming this models potential
to positively inuence individual behaviour. This study
found MI to be potentially cost-effective, taking less
time than comparison methods and only slightly adding
to the total time of usual care. On the other hand, the
results of one RCT suggested that MI alone was not
cost-effective when applied to smoking cessation inter-
ventions in specic target groups, such as heavily
addicted pregnant women who continue to smoke at
maternity bookings.
30
A meta-analysis of adaptations of MI found that 51
per cent of people who received MI treatment were
improved at follow-up compared with 37 per cent
receiving no treatment or treatment as usual.
10
Regard-
less of comparison group, the effects of adaptations of
MI did not appear to fade over time. Clients were
prepared for change over a small number of sessions,
and further sessions were organized to help clients to
initiate and maintain change. This study also found that
the MI interventions were shorter than alternative
methods by an average of 180 minutes. The results of
this study suggested that adaptations of MI could have
positive consequences for a wide range of important life
problems beyond target symptoms, concluding that MI
impacts clients in broad and socially relevant ways, in
addition to bringing about target symptom relief.
10
The results of a RCT indicated that MI is an effective
method of facilitating behaviour changes in teenagers
with diabetes type 1, specically in producing long-term
improvements in glycaemic control, psychosocial well-
being and quality of life.
31
Another study (cluster
randomized trial) showed that a single one-hour session
of MI led to signicant changes in drug use after three
months. However, after 12 months the changes had
largely, but not entirely, faded. The study concluded
that deterioration of effect is the most prob-
able explanation, however taking into consideration
the reactivity to a three-month assessment, a late
Hawthorne effect cannot be ruled out.
33
The use of an adapted MI model (the Information
Motivation Behavioural (IMB)) Model for HIV risk
reduction counselling concluded that even a brief single
exposure to this style of HIV prevention counselling
could reduce HIV transmissions.
32
The study found
that motivational counselling demonstrated most posi-
tive outcomes for women in regard to HIV risk
reduction. On the other hand, men who received full
IMB sessions evidenced relatively greater use of risk-
reduction behavioural skills and relatively lower rates
of unprotected intercourse over six months follow-up,
and had fewer sexually transmitted diseases. A study
that taught medical students to apply brief motivational
194 2009 Australian Dental Association
D Yevlahova and J Satur
interviewing to promote client behaviour change within
the time constraints imposed by a busy medical practice
showed a positive response from the participants. The
medical students were interested in the approach and
were committed to incorporating MI into their future
medical practice.
12
Only one study was found that
applied MI to oral health counselling. The results of
this observational study suggest that MI and the
Transtheoretical Model of Behaviour Change might
be useful in constructing and focusing oral health
counselling for school children that concentrates on
personal dynamics of change.
34
DISCUSSION
In this review many approaches and models for health
behaviour modication have been identied. Effective-
ness of these approaches was evaluated and the studies
were ranked for quality. All of the studies and models
have conrmed the complexity of behaviour modica-
tion and the need to develop effective approaches to
health promotion in the clinical context.
It is important to identify the clients specic needs
and concerns when attempting to alter a habit that is
damaging to that persons health. For individuals to
change their behaviour they must learn to integrate new
skills and knowledge into their everyday life. As the
skills are applied to different situations, the individual
develops a sense of self-efcacy and condence in their
ability to perform actions, manage challenges and
overcome barriers to change. Self-efficacy has been
found to play a significant role in determining which
activities a person will perform or avoid,
35
thus it must
not be undervalued when designing a health promotion
intervention. There is evidence to suggest that tradi-
tional approaches to health education based on infor-
mation giving and expert advice are largely ineffective,
with success rates of only 5 to 10 per cent.
36,37
In
addition to this, knowledge gain alone rarely leads to
sustained changes in behaviour.
38
Thus, there is a need
for more effective approaches that focus on the broader
context which determine patterns of behaviour.
The concept of readiness to change may help explain
why simple provision of advice is limited in its
effectiveness.
39
Readiness for change can be understood
as an individuals current thoughts, feelings and atti-
tudes regarding their intention to institute change in
habits.
40,41
It has been found that people who are asked
to make radical changes to lifestyle vary over time in
their readiness to change.
42
For an individual to be
ready to change, they must feel both condent in their
ability to make changes and realize that change is
important to them.
43
Therefore, sensitivity to the
clients degree of readiness to change becomes an
essential part of the communication and negotiation
process. Interventions need to recognize the various
stages clients may be in, in order to tailor appropriate
measures to meet needs effectively.
The value of the Transtheoretical Model of Behaviour
Change is to explain how individuals change their
behaviour and to describe their readiness for change.
34
There has been a considerable amount of research
conducted using the Transtheoretical Model as a theo-
retical framework for behaviour change.
44
This frame-
work assumes that behaviour change is a dynamic, non-
linear process that involves a number of distinct stages
(pre-contemplation, contemplation, preparation, imple-
mentation and maintenance) through which an individ-
ual will pass as they adapt a new behaviour or alter a
current behaviour. This model may assist the develop-
ment of effective health promotion programmes by
ensuring that interventions are designed to target the
particular needs and beliefs of individuals and their
readiness to implement and sustain change.
The Transtheoretical Model provides a framework
for understanding the change process itself, while the
MI approach provides a means of facilitating this
change process.
45
Motivational interviewing is an
evidence-based, client-centred, practical and personal-
ized counselling approach that is based on Prochaska
and DiClementes Transtheoretical Model of Behaviour
Change.
9
The focus of this approach is also to prepare
people for behaviour change through helping clients to
explore and resolve ambivalence about change and
make their own decisions about why and how to
proceed.
43,46
Thus, the persons decisions about behav-
iour change are simply supported and guided by the
health practitioner. MI helps to build trust, reduce the
individuals resistance to change and aims to alter how
the client responds to problematic situations.
MI inuences the decision-making process by actively
engaging clients in an evaluation of their behaviour and
the negative aspects of change.
44,47
Studies on MI have
found that clients feel listened to and understood by
their health practitioner, while the health practitioners
gain a greater sense of achievement from recognizing
developments in the clients readiness to change as
important progress, rather than seeing the concrete
behaviour change as the only goal.
48
This approach appears to be consistent with a
number of models of health behaviour, sharing con-
structs such as patients expectations about the conse-
quences of engaging in the behaviour, the inuence of a
persons perception of personal control over the
behaviour and the social context of the behaviour. In
contrast to traditional health education approaches
where the professional often assumes the expert role,
MI places the client in the role of the expert; therefore
the client decides how to interpret and integrate the
information in the context of their own lives and social
circumstances, and whether it is relevant.
49
MI provides
health practitioners with a means of tailoring their
2009 Australian Dental Association 195
Models for individual oral health promotion
interventions to suit the patients needs and degree of
readiness to change.
48
The concepts of readiness, importance and con-
dence are useful to the extent that they allow the
practitioner to understand the social context of the
behaviour.
50
Adopting a client-centred consulting style
involves heightened sensitivity to the clients social and
environmental circumstances. This allows the practi-
tioner to bring the underlying social determinants of
health into the consultation and generate patient
motivation more appropriately.
Addressing causes of oral disease in isolation from
the clients life and social circumstances is ineffective in
both the short and long term. There is a need to develop
effective approaches for chairside oral heath promotion
that allow oral health professionals to focus more on
the underlying determinants of oral disease during the
clinical encounter and to respect the expertise that
patients have in their own lives. This allows dental
practitioners to adjust provision of care appropriately
to meet patients specic needs and support their skills,
and ability to maintain their oral health. While this
study will contribute to the development and testing of
a model for chairside oral health promotion, it is also
useful in informing the practice of individual clinicians.
In understanding the broader context that determines
behaviour, it is possible to be more effective in working
with people to minimize disease-causing behaviours
and harmful habits.
There is a considerable body of theory and research
that suggests that MI may be effective for clinical areas
beyond addiction, for which it was originally devel-
oped.
51
Most of the studies included in this report
found the approach to be cost-effective and benecial to
the clients. The results from this systematic review have
shown that levels of MI training, MI skill and the
optimal duration for MI interventions in health care
settings remain unknown as often these data were not
reported. There is an urgent need for more rigorous,
good quality trials and research to assess the effective-
ness of MI in domains outside addiction in order for its
broader application to be considered.
CONCLUSIONS
This study has reviewed the evidence for health
promotion and behaviour change targeted at individu-
als within a health practitioner consultation. Following
quality assessment, 32 studies conducted between 2000
and 2007, were reviewed and strong evidence is
synthesized in this report.
Clinical prevention and health education approaches
alone have been found to be unsuccessful in achieving
sustainable improvements in oral health. A conceptual
movement away from the traditional biomedical
downstream and victim blaming approaches, to one
addressing the upstream underlying social determi-
nants of oral health is necessary. Thus, there is a need
for more supportive rather than judgemental
approaches to oral health behaviour change. Motiva-
tional interviewing, based on the Transtheoretical
Model, has been found to be one of the most effective
approaches to altering clients behaviours. This ap-
proach has been successfully utilized in a variety of
elds, including substance abuse, smoking, HIV risk
reduction, diabetes and obesity. There is potential to
developthis approach further within the oral health eld.
ACKNOWLEDGEMENTS
The study was supported by a research grant from the
Research Committee of the Melbourne Dental School,
The University of Melbourne and the Victorian branch
of the Australian and New Zealand Division of
International Association for Dental Research
(ANZIADR). We also acknowledge the contribution
of Ms Cara Waller in the validation process.
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Address for correspondence:
Dr Julie Satur
Head Oral Health Therapy
Senior Lecturer
Melbourne Dental School
The University of Melbourne
720 Swanston Street
Melbourne VIC 3010
Email: juliegs@unimelb.edu.au
2009 Australian Dental Association 197
Models for individual oral health promotion