Motivating the Unmotivated

Beth Monnin, RDH, MSEd, clinic coordinator and assistant professor in the Department of Dental Hygiene at the University of Cincinnati Blue Ash College in Cincinnati, and a member of Dimensions of Dental Hygiene’s Peer Review Panel, discusses how dental hygiene students can help patients find the ‘why’ in self-care routines. 

As dental hygienists, we face a constant stream of unmotivated patients who do not floss and brush regularly, but it is the uncooperative ones that impact us the most. Dental hygienists can motivate these patients, it just takes a little patience, determination, and finding their personal reason to change their behavior, or their “why.” 

There are a lot of different theories and stages of motivational interviewing, but I find the Prochaska and DiClemente Stages of Change the most simple and relatable. Steps include willingness, ability, and readiness.¹ Clinicians should also follow the OARS principle anytime there is a discussion about oral/overall health. The OARS principle consists of using Open-ended questions, making Affirmations, using Reflections, and good Summarizing. By using these methods, dental hygienists can help patients discover their “Why?” Our “Why” is an internal motivation for doing what we do. 

It takes minutes to motivate a person, and our appointments allow 30-60 minutes with each patient. So, just imagine what you can accomplish. The key to motivating patients, especially the uncooperative ones, is to get them to “buy in” to the process by discovering their “why.”

(For more information on finding inspiration and inspiring people to take action, check out the books Start With Why and Finding Your Why by Simon Sinek.)

CASE STUDY

Mr. Nomanners, a healthy 35-year old, has been consistent with his every 6-month dental hygiene appointments. However, his self-care is very poor. He has yet to develop periodontal disease or even have a new caries lesion, so his motivation is extremely low and, quite frankly, he is skeptical about the role of oral hygiene in oral disease prevention. Now he needs to hear “why.”

New Approach:

Dental hygienist: Why do you not brush and floss regularly? 

Patient: I don’t know. I know you tell me I need to, but it seems like an unnecessary task. 

Dental hygienist: I understand your feelings, sometimes I would rather go straight to bed than brush and floss my teeth, but it only takes 2 minutes. 

Patient: Do you really floss? 

Dental hygienist: Yes, I floss because it helps remove bacteria from underneath my gumline. Did you know that bacteria from your mouth can go to your heart and contribute to other health conditions? 

Patient: Yea, I heard that, but I am healthy, so I am not worried. 

Dental hygienist: What motivates you in life? 

Patient: My family. 

Dental hygienist: If you don’t want to brush and floss for you, then brush and floss for your family so they don’t have to take care of you due to health issues. 

Patient: I will try (eye roll). 

Dental hygienist: How about we set a goal of brushing once every day and flossing three times a week? 

Patient: No response.

Six months later, Mr.Nomanners returns and states he has been better about brushing and flossing. When asked why he changed, he indicated that he never thought about how his lack of proper oral hygiene could affect his health and, ultimately, his family. In this scenario, the hygienist found what motivated the person and used that to develop a reason. All steps of OARS were utilized in this instance, and the patient made his own decision (found his “why”) to start brushing and flossing. 

We can preach to patients, but unless we can relate it to something that directly impacts them, it may not appear to be relevant. The dental hygienist knew the patient had the ability but had to find his willingness and readiness for change. 

HELPING PATIENTS FIND THEIR ‘WHY’

Now for a personal experience about a young man I helped to quit smoking. I asked him what he would purchase if he had extra money. He indicated a car. I then asked him how many packs of cigarettes he smoked, and together we did the math. He had never thought about how much money he was spending on cigarettes. One pack was around $2, which added up to $730 a year in the mid-1990s. At his 6-month appointment, he told me he had quit smoking. At his next appointment, he told me he bought a new car. He found his “why.”

In my 25 plus years in the dental hygiene profession, I have helped many patients change habits by simply letting them decide. Dental hygienists need to go beyond the direct influences of negative behaviors (or lack of positive habits) and focus on helping patients decide how their habits can affect others. This may not work with everyone, nothing ever does, but this positive approach to behavior change is supported by evidence. Always find a positive reason for the patient to change behavior or incorporate new behavior. I found my “why” in dental hygiene and,by using these techniques, you can help patients find theirs.

REFERENCE

1. Hall K, Gibbie T, Lubman D. Motivational interviewing techniques. Facilitating behaviour change in the general practice setting. Psychology Strategies. 2021;41:660–667.