By Jameson Management Consultant Nancy Dukes, RDH
What does it require to have a patient join you on a journey to wellness? Clinicians often struggle to change the habits — and, therefore, the lives — of patients for their ultimate good. Over the years, many feel discouraged after educating their patients time and time again with less than the desired results.
Why do patients not get it? After all, our efforts are for their benefit. All we desire is for our patients to be as healthy as they can be. Is that an unreasonable goal? Sometimes it seems to be, considering the reception and commitment we receive from patients.
So what makes the difference?
How do we create forever-committed patients? How do we get the point across that it is their health that is at risk? In 15 years of clinical practice, I have discovered that success for the patient begins with our ability to communicate. We must communicate effectively to educate our patients about the importance of treatment recommendations, and we must communicate effectively to develop a relationship of trust that leads to acceptance of those recommendations.
It all begins with an invitation to join you on a lifelong journey to wellness. The itinerary consists of specific steps that must be taken based on the individual patient's needs, desires, conditions, and expected results. The critical factor in getting the patient to sign on for the journey and not abandon the trip along the way is patient education based on each patient's personality, health history, state of wellness or disease, motivators, and objections. Unless the patient understands "what's in this for me," he/she will not have the necessary desire to sign on for the journey.
The trip to wellness is indeed a multifaceted journey, regardless of the current state of health. Each patient is unique and must realize that he/she is being treated in that manner. All treatment that we recommend and provide must be explained in terms of the benefits to that particular patient. Why should the patient join us on the journey? What are the side trips along the way and the destinations that interest the patient? The answers to these questions can be found by focusing on the attitudes and beliefs of individuals.
In the 1950s, social psychologists Godfrey Hochbaum, Irwin Rosenstock, and Stephen Kegels first developed what is known as the "Health Belief Model." The HBM is a psychological model that attempts to explain and predict health behaviors. It was first developed as a result of research to understand why individuals did not participate in a health screening program. Since this time, the lessons learned have been used to teach various health-care professionals to apply the basic principles in clinical practice. It may be that this model holds the key to effecting behavioral changes in patients, which will then result in healthier lifestyles.
HBM is based on the idea that an individual is willing to participate in health interventions and highly values being healthy. It concludes that it is possible to predict whether someone will change behaviors by understanding the individual's perception of the disease, identifying his/her motivating factors, and predicting the likelihood that he/she will take some action. It has been discovered that the most influential factor that might prevent an individual from engaging in healthier behaviors is the perceived barriers in the mind of the patient. It was not the opinions of the health-care provider, but the perception of the patient that was most important.
In dentistry, as a result of patient surveys, the ADA has identified four basic barriers to seeking dental care. According to patients surveyed, the reasons for not seeking care were cost, lack of perceived need, time, and fear of the dentistry itself. The exciting part about this knowledge is that, once identified, any or all of these barriers can be overcome.
Using this psychological model in our patient-education program may very well be the key to engaging greater numbers of patients on the journey to wellness. The components of the Health Belief Model that we must understand are:
• Perceived Susceptibility — Importance (personalized risks)
• Perceived Severity — Risks (consequences involved in continued current behavior)
• Perceived Benefits — Effects/results one can expect
• Perceived Barriers — What the costs are in time, money, and effort
• Cues to Action — Preparations necessary for change (how-to instruction)
• Self-Efficacy — Confidence and commitment in one's ability to be successful
For behavior change to take place and succeed, patients must:
• Feel threatened by their current behavioral patterns (lack of dental care)
• Believe that a specific change will be beneficial (expected results of treatment)
• Trust that this valued outcome will result at an acceptable cost (comfortable financial arrangements)
Patients must see themselves as competent (self-efficacious) to implement the change. They must have moved through the HBM to a state of readiness for treatment and commitment. They must desire to join the journey to wellness. Taking each patient through this cycle to a state of readiness becomes our goal as clinicians if we are to achieve the level of success we desire for our patients. To help patients become ready for treatment, clinicians must educate them through effective communication addressing these factors:
• Personalized risks of periodontal or dental disease
• The consequences of compromised oral health for the patient's total body health
• Recommended patient actions and resulting individual benefits
• How barriers or objections can be reduced or eliminated
• How patients can make the necessary changes
• How we can train and guide patients to achieve success
All six steps must be understood by the clinician and the patient from the patient's perspective. It is through this individualized approach that we can empower patients to join us on a journey resulting in healthier lifestyles.
Patient education, rooted in communication skills and coupled with an understanding of human behavior, makes the difference. The journey to wellness can become a WOW adventure for all, patient and clinician alike.
I invite you to expand your horizons in the area of patient motivation by joining in a series of articles to discover the keys that will enable us to book more passengers than we ever imagined on this journey to wellness. Areas for further exploration on this Journey to Hygiene Excellence will include the following: Comprehensive Health Evaluation, Systemize Your Data Collection and Documentation, Treatment Planning and ADA Coding, Building Relationships of Trust Through Effective Patient Education, Case Presentation and Treatment Acceptance, and Building Retention and Referrals While Offering a Healthy New Patient Flow.
