Randomised clinical trial of a motivational interviewing intervention to improve oral health education amongst older adults in Philadelphia: 12-month evaluation of non-clinical outcomes.

OBJECTIVES: We conducted a trial to assess the treatment fidelity of an individual-based oral health education intervention utilising motivational interviewing (MI) techniques and its efficacy when compared to a group-based traditional oral health education intervention (TOHE) and a standard of care group (SC) in a sample from Philadelphia during a 12-month follow-up. BACKGROUND: There is lack of information on how different types of oral health educational interventions affect older adults on non-clinical outcomes including changes in oral health-related quality of life (OHRQoL), oral health self-efficacy (SE) and oral health knowledge (OHK). MATERIALS AND METHODS: One hundred and eighty patients were randomly allocated to TOHE, MI and SC groups. Treatment fidelity was measured in 16 non-study patients. The MI intervention was administered by a public health dental hygienist (PHDH). All interviews were audio-recorded and coded by an expert using the Motivational Interviewing Treatment Integrity (MITI) Code. Multivariable longitudinal regression analyses accounting for baseline demographics and correlated errors due to repeated measures via generalised estimating equation were conducted following an intention to treat approach. RESULTS: Over the 1-year follow-up, SE and OHRQoL scores significantly improved amongst the MI group whereas both outcomes worsened amongst the SC group. During the same period, SE and OHRQoL did not change in the TOHE group. CONCLUSION: Findings from the study support the fidelity of this intervention and the improvement of all non-clinical outcomes after 12 months amongst the MI group.

Motivational interviewing and oral health education: Experiences from a sample of elderly individuals in North and Northeast Philadelphia.

BACKGROUND: Health education has a focus on knowledge dissemination and advice giving, which seldom translates into behavioral changes. Motivational interviewing (MI) has potential for helping elderly patients. However, most oral health studies conducted to date have excluded older individuals, and the outcomes examined have been exclusively clinical. This study examines the treatment fidelity of an individual-based MI intervention and assesses baseline characteristics related to older adults' self-efficacy (SE), oral-health-related quality of life (OHRQoL), oral health knowledge, and facilitators, barriers, and confidence on achieving MI goals. METHODS: A convenience sample of 60 seniors was recruited. Participants were obtained through the flow of patients at dental clinics, and received a 45-min individual-based MI education session during a scheduled dental appointment. RESULTS: Regarding MI treatment fidelity, basic proficiency or higher was achieved in all global areas. Significant correlations were found between SE and OHRQoL scores and rating elements of the MI intervention (P = 0.0001). Lack of knowledge related to connections between poly pharmacy and caries risk, and the importance of use of fluorides were evident. CONCLUSION: Findings from the study support the reliability of this new MI intervention. Dental professionals are encouraged to adopt the spirit of MI in their one-on-one patient counseling.