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- Jönsson, Birgitta, 1962-
(author)
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Behavioural Medicine Perspectives for Change and Prediction of Oral Hygiene Behaviour : Development and Evaluation of an Individually Tailored Oral Health Educational Program
- 2010
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Doctoral thesis (other academic/artistic)abstract
- This thesis is about a behavioural medicine approach in periodontal treatment and oral hygiene self-care. The aim of this thesis was to develop, describe, and evaluate an individually tailored oral health educational program on oral hygiene behaviour and non-surgical periodontal treatment success, and to determine factors of importance for predicting oral hygiene behaviour. Two separate studies, both conducted at a specialist clinic for periodontics in a Swedish county council are described. In the first study, the program was developed and described in two experimental single-case studies with multiple baseline designs (Paper I). The second study was a randomised controlled single-blinded trial [n = 113, mean age 51.2, 53% female] in which, the effectiveness of the program was compared with standard treatment on oral hygiene habits, plaque control, and gingivitis (Paper II), periodontal status (Paper III), and attitudes, subjective norms, and self-efficacy (Paper IV). The tailored oral health educational program included a motivational interviewing method and cognitive behavioural techniques, and the individual tailoring for each participant was based on participants’ thoughts and cognitions, intermediate and long-term goals, and oral health status. Participants in the individually tailored program reported higher frequency of daily interdental cleaning and were more confident about maintaining the attained level of behaviour change, had better oral hygiene, and healthier gingival tissue, particularly interproximally. There was a great reduction in periodontal pocket depth and bleeding on probing scores (BoP) for participants in both programs with a greater reduction in BoP scores in the tailored-treatment group. A lower dental plaque score at treatment start increased the predicted probability of attaining treatment success, and self-efficacy towards interdental cleaning predicted oral hygiene behaviour. These studies demonstrate an individually tailored oral health education program is preferable to standard program as an oral hygiene behaviour change interventions in non-surgical periodontal treatment.
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| 2. |
- Jönsson, Birgitta, et al.
(author)
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Cost-effectiveness of an individually tailored oral health educational programme based on cognitive behavioural strategies in non-surgical periodontal treatment
- 2012
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In: Journal of Clinical Periodontology. - 0303-6979 .- 1600-051X. ; 39:7, s. 659-665
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Journal article (peer-reviewed)abstract
- Aim: The aim of this cost-effectiveness analysis (CEA), performed from a societal perspective, was to compare costs and consequences of an individually tailored oral health educational programme (ITOHEP) based on cognitive behavioural strategies integrated in non-surgical periodontal treatment compared with a standard treatment programme (ST).Material and Methods: A randomized (n = 113), evaluator-blinded, controlled trial, with two different active treatments, was analysed with respect to their costs and consequences 12 months after non-surgical treatment. Costs referred to both treatment costs and costs contributed by the patient. Consequences (outcome) were expressed as the proportion of individuals classified as having reached the pre-set criteria for treatment success after non-surgical treatment (successful-NSPT).Results: More individuals in the ITOHEP group reached the pre-set criteria for treatment success than individuals in the ST group did. The CEA revealed an incremental cost-effectiveness of SEK1724 [191.09; pound SEK9.02 = 1 pound (January 2007)] per successful-NSPT case, of which treatment costs represented SEK1189 (131.82) pound, using the unit cost for a dental hygienist.Conclusion: The incremental costs per successful-NSPT case can be considered as low and strengthens the suggestion that an ITOHEP integrated into non-surgical periodontal treatment is preferable to a standardized education programme.
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| 3. |
- Jönsson, Birgitta, et al.
(author)
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Evaluation of an individually tailored oral health educational programme on periodontal health
- 2010
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In: Journal of Clinical Periodontology. - : Blackwell. - 0303-6979 .- 1600-051X. ; 37:10, s. 912-919
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Journal article (peer-reviewed)abstract
- Aim: To evaluate an individually tailored oral health educational programme (ITOHEP) on periodontal health compared with a standard oral health educational programme. A further aim was to evaluate whether both interventions had a clinically significant effect on non-surgical periodontal treatment at 12-month follow-up. Material and Method: A randomized, evaluator-blinded, controlled trial with 113 subjects (60 females and 53 males) randomly allocated into two different active treatments was used. ITOHEP was based on cognitive behavioural principles and motivational interviewing. The control condition was standard oral hygiene education (ST). The effect on bleeding on probing (BoP), periodontal pocket depth, "pocket closure" i.e. percentage of periodontal pocket >4 mm before treatment that were <5 mm after treatment, oral hygiene [plaque indices (PlI)], and participants' global rating of oral health was evaluated. Preset criteria for PlI, BoP, and "pocket closure" were used to describe clinically significant non-surgical periodontal treatment success. Results: The ITOHEP group had lower BoP scores 12-month post-treatment (95% confidence interval: 5-15, p<0.001) than the ST group. No difference between the two groups was observed for "pocket closure" and reduction of periodontal pocket depth. More individuals in the ITOHEP group reached a level of treatment success. Lower PlI scores at baseline and ITOHEP intervention gave higher odds of treatment success. Conclusions: ITOHEP intervention in combination with scaling is preferable to the ST programme in non-surgical periodontal treatment.
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| 4. |
- Jönsson, Birgitta, et al.
(author)
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Factors influencing oral hygiene behaviour and gingival outcomes 3 and 12 months after initial periodontal treatment : an exploratory test of an extended Theory of Reasoned Action
- 2012
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In: Journal of Clinical Periodontology. - : Blackwell. - 0303-6979 .- 1600-051X. ; 39:2, s. 138-144
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Journal article (peer-reviewed)abstract
- Aim: The aim was to empirically test the extended Theory of Reasoned Action (TRA) and the prospective direct and indirect role of attitudes, beliefs, subjective norms, self-efficacy, and a cognitive behavioural intervention in adult's oral hygiene behaviour and gingival outcomes at 3-and 12-month follow-up. Materials and Methods: Data were derived from an RCT evaluating the effectiveness of oral hygiene educational programs integrated in non-surgical periodontal treatment (n = 113). Before baseline examination, participants completed a self-report questionnaire. Structural equation modelling using maximum likelihood estimation with bootstrapping was used to test the direct and indirect (mediated) pathways within the extended TRA model. Results: The extended TRA model explained a large amount of variance in gingival outcome scores at 12 months (56%). A higher level of self-efficacy at baseline was associated with higher frequencies of oral hygiene behaviour at 3 months. Being female was linked to more normative beliefs that, in turn, related to greater behavioural beliefs and self-efficacy. Gender was also related to behavioural beliefs, attitudes and subjective norms. Both frequency of oral hygiene behaviour at 3 months and the cognitive behavioural intervention predicted gingival outcome at 12 months. Conclusions: The model demonstrated that self-efficacy, gender and a cognitive behavioural intervention were important predictors of oral hygiene behavioural change.
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