Mastery and perceived autonomy support are correlates of Dutch diabetes patients’ self-management and quality of life

Objective

The aim of this study was to assess the associations between type 2 diabetes patients’ mastery and perceived autonomy support and their self-management skills and health-related quality of life (HRQOL).

Methods

A cross-sectional questionnaire survey was conducted among 3352 patients with type 2 diabetes. Key variables were assessed with validated questionnaires.

Results

Patients’ mastery and perceived autonomy support correlated positively with their self-management skills (r = 0.34, p < 0.001; r = 0.37, p < 0.001) and HRQOL (r = 0.37, p < 0.001; r = 0.15, p < 0.001). In the linear regression analysis, mastery and perceived autonomy support were positive correlates of self-management (β = 0.23; p < 0.001; β = 0.25; p < 0.001). Patients with more physical or psychological complications had significantly lower scores on mastery, perceived autonomy support, self-management and HRQOL.

Conclusion

Our results indicate the importance of mastery in relation to diabetes patients’ perceived autonomy support, self-management skills and HRQOL.

Practice implications

Since a greater sense of mastery is likely to increase patients’ autonomous motivation to cope with their disease, interventions can aim to influence patients’ motivational regulation. In addition, we confirmed the need for autonomy support to improve patients’ self-management skills. Professionals can be trained to be autonomy-supportive, which relates to person-centered approaches such as motivational interviewing (MI).     

Supportive care needs in patients with cardiovascular disorders

Objectives

Unmet medical needs are a focus in cardiovascular disorder (CVD) research. However, few studies have investigated patients’ perceived needs. The present study examined supportive care needs in patients with CVD and their relation to health characteristics.

Methods

In total 260 in-patients with CVD were consecutively assessed with the supportive care needs survey. Primarily, frequency and content of unmet needs were examined. Secondarily, CVD-diagnoses were compared and correlations with risk factors, treatment characteristics, mood-state and quality of life were analyzed.

Results

Supportive care needs were indicated by 21% of all patients: unmet health information (37%) and psychological (23%) needs were most frequent. The number of unmet needs did not differ between most CVD-diagnoses. Unmet needs were not related to cardiac risk factors. However, treatment characteristics (r = .17–.23, p < .01), anxiety (r = .44–.71, p < .01), depression (r = .38–.63, p < .01), physical (r = .21–.47, p < .01) and mental (r = .29–.65, p < .01) quality of life were associated with unmet needs.

Conclusions

Supportive care needs are common in patients with CVD. They are based on patients’ treatment characteristics, emotions and subjective well-being rather than on cardiac factors.

Practice implications

Needs assessments in patients with CVD could detect unmet needs, enhance patient education and communication and, therefore, effectively target patients’ perceived needs and medical needs.     

Breast cancer patients’ trust in physicians: The impact of patients’ perception of physicians’ communication behaviors and hospital organizational climate

Objective

To examine whether patients’ perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians’ communication behaviors as perceived by the patients and patient characteristics.

Methods

Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed.

Results

80.5% of the patients responded to the survey. 37% of the variance in patients’ trust in physicians can be explained by the variables included in our final model (N = 2226; R² adj. = 0.372; p < 0.001). Breast cancer patients’ trust in their physicians is strongly associated with their perception of a hospital's organizational climate. The impact of their perception of physicians’ communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust.

Conclusions

A trusting physician–patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians’ communication behaviors.

Practice implications

With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.     

Self-management support in “real-world” settings: An empowerment-based intervention

Objective

This study examined the impact of a 6-month, empowerment-based diabetes self-management support (DSMS) intervention on clinical outcomes, self-care behaviors, and quality of life (QOL) compared to a 6-month control period.

Methods

This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes. Baseline, 6-month, and 12-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL. During the control period, participants received weekly educational newsletters. During the intervention period, participants attended weekly DSMS groups as frequently as they needed. Sessions were guided by participants’ self-management questions and concerns, and also emphasized experiential learning, coping, problem-solving, and goal-setting.

Results

The control period found significant improvements for diastolic BP (p < 0.05), serum cholesterol (p < 0.001), following a healthy diet (p < 0.01), and monitoring blood glucose (p < 0.01). The intervention period found significant additional improvements for A1C (p < 0.001), weight (p < 0.05), BMI (p < 0.05), and LDL (p < 0.001). Compared to the control period, participation in the intervention led to a significant reduction in A1C (p < 0.01).

Conclusion

Findings suggest that an empowerment-based, DSMS intervention is promising for improving and/or maintaining diabetes-related health, particularly A1C.

Practical implications

Incorporating empowerment principles in DSMS interventions may be useful for supporting patients’ self-management efforts in “real-world” settings.     

Communication matters: The impact of communication and participation in decision making on breast cancer patients’ depression and quality of life

Objective

This study explored the impact of breast cancer patients’ experiences of physician–patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment.

Methods

Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later.

Results

Patients who rated their level of information at baseline as high were less depressed after three (p = .010) and six months (p < .001) and experienced higher quality of life after three (p < .001) and six months (p = .049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p < .001) and had lower depression scores three months later (p = .005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact.

Conclusion

The findings reveal the significance of physician–patient communication and stress the meaning of baseline depression for later adjustment.

Practice implications

A high level of information and tailoring the involvement in decision making to patients’ desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.     

Motivational interviewing by HIV care providers is associated with patient intentions to reduce unsafe sexual behavior

Objective

Motivational interviewing (MI) can promote behavior change, but HIV care providers rarely have training in MI. Little is known about the use of MI-consistent behavior among untrained providers. This study examines the prevalence of such behaviors and their association with patient intentions to reduce high-risk sexual behavior.

Methods

Audio-recorded visits between HIV-infected patients and their healthcare providers were searched for counseling dialog regarding sexual behavior. The association of providers’ MI-consistence with patients’ statements about behavior change was assessed.

Results

Of 417 total encounters, 27 met inclusion criteria. The odds of patient commitment to change were higher when providers used more reflections (p = 0.017), used more MI consistent utterances (p = 0.044), demonstrated more empathy (p = 0.049), and spent more time discussing sexual behavior (p = 0.023). Patients gave more statements in favor of change (change talk) when providers used more reflections (p < 0.001) and more empathy (p < 0.001), even after adjusting for length of relevant dialog.

Conclusion

Untrained HIV providers do not consistently use MI techniques when counseling patients about sexual risk reduction. However, when they do, their patients are more likely to express intentions to reduce sexual risk behavior.

Practice implications

MI holds promise as one strategy to reduce transmission of HIV and other sexually transmitted infections.     

A comparison of GP,pharmacist and nurse prescriber responses to patients’ emotional cues and concerns in primary care consultations

Objective

Recognising patients’ cues and concerns is an important part of patient centred care. With nurses and pharmacists now able to prescribe in the UK, this study compared the frequency, nature, and professionals’ responses to patient cues and concerns in consultations with GPs, nurse prescribers and pharmacist prescribers.

Methods

Audio-recording and analysis of primary care consultations in England between patients and nurse prescribers, pharmacist prescribers and GPs. Recordings were coded for the number of cues and concerns raised, cue or concern type and whether responded to positively or missed.

Results

A total of 528 consultations were audio-recorded with 51 professionals: 20 GPs, 19 nurse prescribers and 12 pharmacist prescribers. Overall there were 3.5 cues or concerns per consultation, with no difference between prescriber groups. Pharmacist prescribers responded positively to 81% of patient's cues and concerns with nurse prescribers responding positively to 72% and GPs 53% (PhP v NP: U = 7453, z = −2.1, p = 0.04; PhP v GP: U = 5463, z = −5.9, p < 0.0001; NP v GP: U = 12,070, z = −4.9, p < 0.0001).

Conclusion

This evidence suggests that pharmacists and nurses are responding supportively to patients’ cues and concerns.

Practice implications

The findings support the importance of patient-centredness in training new prescribers and their potential in providing public health roles.     

The influence of patient expectations regarding cure on treatment decisions

Objective

To test whether cancer patients’ expectations for cure prior to interacting with their oncologist influence their decisions to follow treatment recommendations. Further, to test whether patients’ expectations for cure are affected by the strength of the oncologist–patient alliance or the extent to which companions (if present) share patients’ expectations for cure.

Methods

Interactions of 101 patients (and 114 companions) with oncologists about treatment were coded for the strength of the oncologist–patient alliance. Prior to the interaction, patients and companions reported expectations about whether the patient would be cured of cancer. After the interaction, patients reported whether they intended to follow the recommended treatment.

Results

Patients who expected a cure were more likely to report an intention to follow oncologists’ treatment recommendation when the strength of their alliance with their oncologist was weaker (B = −0.51, p < .05). Patients whose expectations for cure matched their companions’ expectations were less likely to report intentions to follow treatment recommendations (B = −0.28, p < .05).

Conclusion

Patients who have an expectation of being cured of cancer prior to meeting with their oncologist are more likely to intend to follow recommended treatment when their alliance with the oncologist is weaker and their companions do not believe they will be cured.

Practice implications

To better understand patient treatment decisions and improve overall cancer care, oncologists should be aware of the complex ways that patients’ expectations about cure influence treatment choices.     

Literacy-appropriate educational materials and brief counseling improve diabetes self-management

Objective

In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care.

Methods

We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients’ activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up.

Results

Statistically significant (p ≤ 0.001) and clinically important (effect sizes = 0.29–0.42) improvements were observed in participants’ activation, self-efficacy, diabetes-related distress, self-reported behaviors, and knowledge. Improvements were similar across literacy levels. Spanish speakers experienced both greater improvement in diabetes-related distress and less improvement in self-efficacy levels than English speakers.

Conclusion

A diabetes self-management support package combining literacy-appropriate patient education materials with brief counseling suitable for use in primary care resulted in important short-term health-related psychological and behavioral changes across literacy levels.

Practice implications

Coupling literacy-appropriate education materials with brief counseling in primary care settings may be an effective and efficient strategy for imparting skills necessary for diabetes self-management.     

Impact of life-threatening risk information on the evolution of patients’ anxiety and risk recall: The specific context of informed consent for experimental stem cell transplant

Objective

This study examines risk recall and evolution of patients’ anxiety after transmission of life-threatening risk information in an informed consent procedure for experimental HSCT.

Methods

Informed consent interviews were audio-recorded and transcribed. Patient risk recall was obtained through comparing information provided in the interview to information recalled by patients following the interview. The evolution of patients’ anxiety was assessed through comparing patients’ post- to patients’ pre-interview anxiety using the STAI-State. Physicians’ communication skills and risk framing were analyzed.

Results

Twenty patients were included. Patients recalled on average 4 risks (S.D. = 1.6) out of 9 different risks transmitted (S.D. = 2) which corresponds to a recall rate of 44% (S.D. = 15.5). Patients’ anxiety remained on average stable (Mean = 0.4; S.D. = 9.1). Linear regression analysis showed that risk recall was predicted positively by the number of risks transmitted (B = .30; P = .032) and by patients’ problem-focused coping (B = .21; P = .008). The evolution of anxiety was predicted positively by the number of times benefits were transmitted (B = .83; P = .003) and negatively by the level of anxiety before the interview (B = −.50; P = .001).

Conclusion

Results show the limits of patients’ risk recall in the context of informed consent for a life-threatening procedure.

Practice implications

This study highlights the necessity to develop strategies allowing tailoring of risk transmission to every patient's needs.     

Validation of an Information–Motivation–Behavioral Skills model of diabetes self-care (IMB-DSC)

Objective

Comprehensive behavior change frameworks are needed to provide guidance for the design, implementation, and evaluation of diabetes self-care programs in diverse populations. We applied the Information–Motivation–Behavioral Skills (IMB) model, a well-validated, comprehensive health behavior change framework, to diabetes self-care.

Methods

Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the IMB framework.

Results

More diabetes knowledge (r = 0.22 p < 0.05), less fatalistic attitudes (r = −0.20, p < 0.05), and more social support (r = 0.27, p < 0.01) were independent, direct predictors of diabetes self-care behavior; and through behavior, were related to glycemic control (r = −0.20, p < 0.05).

Conclusions

Consistent with the IMB model, having more information (more diabetes knowledge), personal motivation (less fatalistic attitudes), and social motivation (more social support) was associated with behavior; and behavior was the sole predictor of glycemic control.

Practice implications

The IMB model is an appropriate, comprehensive health behavior change framework for diabetes self-care. The findings indicate that in addition to knowledge, diabetes education programs should target personal and social motivation to effect behavior change.     

Sequence-analysis of video-recorded practitioner–patient communication about smoking in general practice: Do smokers express negative statements about quitting?

Objective

To examine the extent to which smokers express negative statements about quitting and the extent to which these statements influence general practitioners’ (GPs’) and practice nurses’ (PNs’) (dis)continuation of guideline-recommended smoking cessation care.

Methods

Fifty-two video-consultations were observed (GP-consultations: 2007–2008; PN-consultations: 2010–2011). Dialogues were transcribed verbatim and professionals’ and patients’ speech units were coded and analysed using sequential analyses (n = 1424 speech units).

Results

GPs focused on asking about smoking (GPs: 42.4% versus PNs: 26.2%, p = 0.011) and advising them to quit (GPs: 15.3% versus PNs: 3.5%, p < 0.001), whereas PNs focused on assisting them with quitting (GPs: 25.4% versus PNs: 55.2%, p < 0.001). Overall, patients expressed more negative statements about quitting than positive statements (negative: 25.3% versus positive: 11.9%, p < 0.001), especially when PNs assessed their willingness to quit (OR 3.61, 95% CI 1.44–9.01) or assisted them with quitting (OR 2.23, 95% CI 1.43–3.48).

Practice implications

An alternative approach to smoking cessation care is proposed in which GPs’ tasks are limited to asking, advising, and arranging follow-up. This approach seems the least likely to evoke negative statements of patients about quitting during dialogues with GPs and is compatible with the tasks and skills of PNs who could, subsequently, assist smokers with quitting.     

Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents

Objective

Physicians’ use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown.

Methods

We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time.

Results

Physicians used more MI consistent techniques with female patients (p = 0.06) and with heavier patients (p = 0.02). Physicians with prior MI training also used more MI consistent techniques (p = 0.04) and asked more open-ended questions (p = 0.05). Pediatricians had a higher MI Spirit score than family physicians (p = 0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p = 0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p = 0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p = 0.02).

Conclusion

Physicians’ weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time.

Practice implications

Physicians might consider using MI techniques more and attempt to use these equally with all adolescents.     

Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery?

Objective

To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction.

Methods

Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret.

Results

Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p < 0.001), more than one treatment being offered (p < 0.001), and fewer questions raised by patients/companions (p < 0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients’ feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret.

Conclusion

These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction.

Practice implications

The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons.     

Does being informed and feeling informed affect patients’ trust in their radiation oncologist?

Objective

We investigated whether the content of information provided by radiation oncologists and their information giving performance increase patients’ trust in them.

Methods

Questionnaires were used to assess radiotherapy patients (n = 111) characteristics before their first consultation, perception of information giving after the first consultation and trust before the follow-up consultation. Videotaped consultations were scored for the content of the information provided and information giving performance.

Results

Patients mean trust score was 4.5 (sd = 0.77). The more anxious patients were, the less they tended to fully trust their radiation oncologist (p = 0.03). Patients’ age, gender, educational attainment and anxious disposition together explained 7%; radiation oncologists’ information giving (content and performance) explained 3%, and patients’ perception of radiation oncologists’ information-giving explained an additional 4% of the variance in trust scores.

Conclusion

It can be questioned whether trust is a sensitive patient reported outcome of quality of communication in highly vulnerable patients.

Practice implications

It is important to note that trust may not be a good patient reported outcome of quality of care. Concerning radiation oncologists’ information giving performance, our data suggest that they can particularly improve their assessments of patients’ understanding.     

The role of disease management programs in the health behavior of chronically ill patients

Objective

Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients.

Methods

This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1.

Results

Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients’ physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (p < 0.01), changes in physical activity (p < 0.001), and percentage of smokers at T0 (p < 0.05) predicted physical quality of life at T1. Project managers reported that DMPs improved patient–professional interaction. The ability to set more concrete targets improved patients’ health behaviors.

Conclusions

DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients.

Practice implications

Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients.     

Shared decision-making in cardiology: Do patients want it and do doctors provide it?

Objective

Doctors should involve their patients in making decisions about their care. We studied patients with heart disease to assess if shared decision-making occurs and to study factors that predict patients’ choices or influence cardiologists’ behaviour.

Methods

85 patients attending for arteriography were assessed to elicit preferred involvement in decision-making, perception of involvement, and confidence in the decision.

Results

40% of patients wished to be involved in decisions. Preferences were unrelated to demographic factors. Cardiologists involved patients more in decisions concerning severe disease (p = 0.056). Involvement varied between cardiologists (p = 0.001). The mean duration of consultations was 5.5 min. Patients’ confidence in decisions correlated with duration (p = 0.001), explicit reference to a decision that needed to be made (p = 0.0026), and perceived, but not observed, involvement in decision-making (p = 0.05).

Conclusion

This study highlighted the complexity of doctor–patient communication. Irrespective of preferences for involvement, patients were more confident in decisions in which they perceived more involvement or which were the products of longer consultations.

Practice implications

Patients’ confidence in clinical decisions can be increased by increasing consultation length and increasing their perception of involvement. Patients perceive more involvement in decisions when doctors specifically identify the need for treatment decisions early in the consultation.     

Provider communication effects medication adherence in hypertensive African Americans

Objective

To evaluate the effect of patients’ perceptions of providers’ communication on medication adherence in hypertensive African Americans.

Methods

Cross-sectional study of 439 patients with poorly controlled hypertension followed in community-based healthcare practices in the New York metropolitan area. Patients’ rating of their providers’ communication was assessed with a perceived communication style questionnaire,while medication adherence was assessed with the Morisky self-report measure.

Results

Majority of participants were female, low-income, and had high school level educations, with mean age of 58 years. Fifty-five percent reported being nonadherent with their medications; and 51% rated their provider's communication to be non-collaborative. In multivariate analysis adjusted for patient demographics and covariates (depressive symptoms, provider degree), communication rated as collaborative was associated with better medication adherence (β = −.11, p = .03). Other significant correlates of medication adherence independent of perceived communication were age (β = .13, p = .02) and depressive symptoms (β = −.18, p = .001).

Conclusion

Provider communication rated as more collaborative was associated with better adherence to antihypertensive medications in a sample of low-income hypertensive African-American patients.

Practice implications

The quality of patient–provider communication is a potentially modifiable element of the medical relationship that may affect health outcomes in this high-risk patient population.     

A multicenter,prospective, quasi-experimental evaluation study of a patient education program to foster multiple sclerosis self-management competencies

Objective

To determine the impact of the self-management training program “S.MS” for new multiple sclerosis (MS) patients.

Method

Multicenter, prospective, quasi-experimental study with 31 MS patients in the intervention group (training program) and 33 participants in the control group (CG) (brochures). Data were collected before, after and 6 months after the interventions. Analysis of change was done by ANCOVA with repeated measurements.

Results

At baseline, participants in CG were younger at the time of diagnosis, suffered more frequently from relapsing–remitting MS and took more MS-medication on a permanent basis. The intervention had a stable significant effect on each dimension of self-management ability, on total self-management ability (ES = 0.194, p < 0.001), on anxiety (ES = 0.193, p = 0.001), and on disease-specific quality of life (ES = 0.120, p = 0.007). Regarding depression, a significant interaction effect of time and intervention could be observed (ES = 0.106, p = 0.011). No effect was found on disease-specific knowledge. High participant acceptance was reported.

Conclusion

“S.MS” participation was associated with a significant and sustained improvement of self-management abilities, anxiety and disease-specific quality of life in a quasi-experimental study design. Using RCT or CRT-designs would be desirable to further improve the evidence of treatment effectiveness.

Practice implications

This study provides substantial evidence that “S.MS” fosters patients’ self-management ability.     

The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model

Objective

In an effort to examine the decreasing oral health trend of Australian dental patients, the Health Belief Model (HBM) was utilised to understand the beliefs underlying brushing and flossing self-care. The HBM states that perception of severity and susceptibility to inaction and an estimate of the barriers and benefits of behavioural performance influence people's health behaviours. Self-efficacy, confidence in one's ability to perform oral self-care, was also examined.

Methods

In dental waiting rooms, a community sample (N = 92) of dental patients completed a questionnaire assessing HBM variables and self-efficacy, as well as their performance of the oral hygiene behaviours of brushing and flossing.

Results

Partial support only was found for the HBM with barriers emerging as the sole HBM factor influencing brushing and flossing behaviours. Self-efficacy significantly predicted both oral hygiene behaviours also.

Conclusion

Support was found for the control factors, specifically a consideration of barriers and self-efficacy, in the context of understanding dental patients’ oral hygiene decisions.

Practice implications

Dental professionals should encourage patients’ self-confidence to brush and floss at recommended levels and discuss strategies that combat barriers to performance, rather than emphasising the risks of inaction or the benefits of oral self-care.