Motivation has been shown to have roots in physiological, behavioural, cognitive and social areas and is rooted in a basic impulse to optimize wellbeing, minimize physical pain and maximize pleasure. Motivation also plays an important role in perceived dental competence and treatment seeking behaviour among dental patients. Different theories and models such as the push-pull model and the self-determination theory have sought to explain the various intrinsic and extrinsic influences affecting the patients’ motivation to undergo or refuse treatment.
The role of motivation in dental care is thought to play a major role in influencing dental health behaviour. A previous study which reviewed the behaviour self-regulation model in context of self-care showed that patient motivation was influenced by dental professional and the incentives and rewards offered during the treatment phase. Halvari et al. developed a self-regulation questionnaire for dental treatment which showed that autonomous motivation for dental competence were positively associated with oral self-care behaviour and dental clinic attendance.
The study of Pac et al. assessed motivation among periodontal patients using the zychlinscy scale and found it to be a reliable tool. It also assessed the correlation between the scale and clinical parameters and found that patients with greater motivation had better oral hygiene. However, the tool does not assess the extrinsic and intrinsic influences that motivate the patient to agree for a treatment. Gao et al. assessed the effect of motivational interviewing (MI) in improving oral health through a systematic review and found that four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. The study emphasized on the need for further studies with methodological rigor for a better understanding of the roles of MI in dental practice
There is a definite paucity in studies evaluating the role of motivation in treatment seeking behaviour of periodontal patients. The research hypothesis of this study is that is no significant relationship between motivation and treatment seeking behaviour among periodontal patients. Hence this study is an attempt to assess the role of motivation in periodontal care by using the Dental Treatment Motivation Scale (DTMS) which in itself is a shortened version of a
Self-regulation questionnaire for dental treatment subsequently modified based on a questionnaire used for assessing motivation in Type-2 diabetic patients. Chronic periodontitis is a multifactorial disease. Along with microorganisms which are responsible for the initiation of the inflammatory reaction leading to subsequent periodontal tissue loss, several other local and systemic factors have been shown to play important modifying roles in enhancing the inflammatory or destructive effects of microorganisms.
The Dental Treatment Motivation Scale is a modification of Treatment Self-Regulation Questionnaire (TSRQ). The TSRQ is a set of questionnaires concerning why a subject would engage in healthy behaviour, solicit treatment for some disease, try to change an unhealthy behaviour, follow a treatment regimen or engage in some other health related behaviour. All questionnaires have the same purpose; which is to assess the degree to which one’s motivation for a particular behaviour is autonomous or self-determined.
The instrument used for data collection consisted of sociodemographic questions in addition to the Dental Treatment Motivation Scale (DTMS) questionnaire. The DTMS is a Likert scale composed of 15 items in which 7 (Q no: 1, 2, 5, 7, 10, 13 & 15) and 8 (Q no: 3, 4, 6, 8, 9, 11, 12 & 14) questions assess intrinsic and extrinsic motivation respectively. The scale measures autonomous and controlled motivations to adopt a healthy attitude towards periodontal treatment. Answers are organized on a Likert scale of 1 to 5 ranging from “strongly disagree” to “strongly agree”. The score of each dimension is obtained by the total sum of all answers of the items in each dimension by the total score. The study was translated into the local language. To check for the consistency the study was back translated into English by two independent bilingual dentists.
The questionnaire showed a good degree of reliability making it a valid tool for periodontal treatment planning. The results of the study showed that the subjects showed high motivation towards periodontal treatment thus rejecting the null hypothesis and accepting the alternate hypothesis. The intrinsic motivation component scored more than the extrinsic component. Motivation is an important component for treatment seeking behaviour.
Overall the study showed a high degree of motivation for treatment seeking behaviour facilitated by both intrinsic and extrinsic factors. Internalization and integration is a process by which extrinsically motivated behaviour can become self-determined. A number of extrinsic factors have also played a small role in motivating treatment related behaviour in this study such as the professional help, appreciation and social acceptability. Dentists can play a major role by facilitating treatment seeking behaviour through professional advice and reinforcements and thus help in integrating and internalizing extrinsic behaviour to an intrinsic motivation. A subjects’ dentist, his peers and his family can play an important role in bringing about a positive health related behaviour. To conclude, the study tested the Dental Treatment Motivation Scale (DTMS) to assess motivation for seeking periodontal therapy. The scale showed good consistency as well as validity and can be used for assessing motivations for other dental treatments as well. The limitation of this study is that the sample size was small and correlation with the actual clinical condition was not carried out. More longitudinal studies with larger samples in a multicentre setting are warranted to further explore the feasibility and acceptability of DTMS.
Oruba Z, Pac A, Olszewska–Czyż I, Chomyszyn-Gajewska M. The significance of motivation in periodontal treatment: The influence of adult patients’ motivation on the clinical periodontal status. Community Dental Health [serial online]. September 2014;31(3):183-187. Available from: CINAHL, Ipswich, MA.
About the Author:
Dr.Hisham M Safadi (Hisham Safadi ) BDS & MSc Leadership and Management in Health Care Practice from the University of Salford where his Master dissertation subject is the effect of Emotional Intelligence on improving Dentistry care in Middle East. Born and raised in the Emirates of Ras Al Khaimah, United Arab Emirates. Dr.Safadi had start his professional career as a dentist then turn to the field of managing medical facilities and reforming delivery of health care services. His main interest is business consultancy, leadership and entrepreneurship.
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