Jessamin Cipollina, MA
August 6, 2019
Motivational interviewing (MI) is an evidence-based counseling style that promotes healthy lifestyle changes and behavior patterns. It is used to help patients resolve issues with self-doubt and challenge negative thinking. For example, Nurse Practitioners, Registered Nurses, and Physician Assistants use motivational interviewing with patients with diabetes to engage them in goal setting about making lifestyle changes related to diet, exercise, and weight loss. These lifestyle changes are recognized as health enhancing behaviors that contribute to preventing or delaying the onset of Type 2 Diabetes and improving glycemic control for those who have this chronic condition.
Many dentists encounter patients who have little to no oral health education due to lack of access or guidance. Dentists want to make the most of their time with patients, especially with first-timers and those with dental anxiety. Much anxiety around visiting the dentist and other doctors comes from not knowing what to expect at the office, or self-doubt about personal health. Telehealth and virtual dentistry have the ability to increase health literacy in disadvantaged or hard-to-reach populations; conducting motivational interviewing with patients about their health is a very important part of this process.
A research team at the University at Buffalo recently received a $438,000 grant from the National Institutes of Health (NIH) to develop an online MI intervention for dentists to use with patients. This study aims to demonstrate the effectiveness of MI in improving oral health behaviors as well as develop an effective and low-cost program. A previous study had great success in improving oral health among those struggling with alcohol abuse using MI; this current study will develop a similar program delivered to dental patients electronically.
Evidence-based research is growing around the success of using MI to improve oral health as an alternative to current education strategies. A study conducted in 2017 utilized MI to improve oral health in adolescents. They compared standard health education to an MI intervention and MI combined with risk assessment. Both MI interventions showed improved oral health behaviors, including less snacking and more frequent tooth brushing, among participating teens.
A similar 2018 study compared the effects of a conventional education program with a program that included MI with teens with orthodontics. The results showed that the MI program had significant immediate and long-term outcomes on oral hygiene among participants, as well as greater plaque reduction and gingival care than the conventional education group. MI may be the missing piece to improving oral health care and education in the dental setting.
The use of telehealth technology is growing in dental care. Dentists are utilizing telehealth services to address several health care delivery needs, namely improving access to care for urgent dental issues to reduce emergency room spending nationwide. Dental clinics across the U.S. have reported success in using virtual health applications with patients to answer questions and provide guidance with oral problems requiring immediate care. Telehealth also has the capacity to connect all health care professionals involved in patients’ health care teams and to better promote the importance of oral hygiene in patients’ overall health. In this vein, telehealth technologies have the potential to include providing MI to patients who have fears or doubts about visiting the dentist, whether for dental procedures or a regular check-up.
We know that motivational interviewing is a valuable tool used to engage patients in improving both physical and mental health. Telehealth and virtual dentistry have the potential to improve access to care in underserved areas, as well as provide easy and consistent access to health literacy tools and programs. The ability to receive immediate care and assistance from a dentist has great potential to reduce the instance of emergency dental care and further reduce nationwide spending on dental care. These unique approaches to providing dental care are exciting as they show promise in improving oral health care access and literacy along with reducing dental care costs. It is encouraging that multiple health professions are adopting the use of technology to advance health promotion through use of motivational interviewing. A growing body of evidence supports use of these practices as their own to contribute to the growing demand for health care strategies that make a real difference in the lives of people in urban, suburban, and rural communities.
Sources:
- Glassman P, Harrington M, Mertz E, et al. The virtual dental home: implications for policy and strategy. J Calif Dent Assoc, 2012; 40(7):605-611.
- Rigau-Gay MM, Claver-Garrido E, Benet M, et al. Effectiveness of motivational interviewing to improve oral hygiene in orthodontic patients: a randomized controlled trial. J Health Psychol, 2018; doi: 10.1177/1359105318793719.
- Robinson M. Too lazy to brush and floss? research team will motivate you with online counseling. University at Buffalo News Center, 2019.
- Vorderstrasse AA, Melkus G, Pan W et al. Diabetes LIVE (Learning in Virtual Environments): testing the efficacy of self-management training and support in virtual environments (RCT Protocol). Nurs Res, 2015; 64(6):485-493.
- Wicklund E. Dentists use telehealth to improve access to care – and fight a phobia. mHealth Intelligence, 2019.
- Wu L, Gao X, Lo ECM, et al. Motivational interviewing to promote oral health in adolescents. J Adolesc Health, 2017; 61(3):378-384. doi: 10.1016/j.jadohealth.2017.03.010.