Influence of behavioral science research on oral health promotion.

To realize the benefits of advances in preventive and problem-focused dentistry, patients must carry out specific oral health behaviors. The behaviors range from seeking preventive care, to keeping appointments, to carrying out home-based self-care regimens. Unfortunately, rates of these behaviors are less than optimal and maximizing patient involvement in dental care is a major challenge facing dentistry. In fact, poor rates of patient adherence remains a significant problem in all areas of health care. Aspects of the treatment regimen itself as well as provider and patient actions impact these outcomes. Theoretical models grounded in the behavioral sciences provide useful frameworks for understanding the process of health behavior change that can be applied to patient care. Research in health promotion and disease prevention have identified a number of psychological, social, and environmental issues related to oral health behaviors and outcomes, including personal barriers, social support, stress and coping, health beliefs, and dental anxiety. These barriers are discussed, and examples of interventions that have incorporated theoretical models and behavioral outcomes and linking them to oral health are provided. Future directions of the expanding area of behavioral science and oral health promotion in clinical practice are discussed.

New diabetes screening criteria for midlife women evaluated for coronary heart disease risk.

The usefulness of new, lowered diabetes diagnostic criterion to identify undiagnosed diabetics in a high-risk sample of women was evaluated. Participants were 228 midlife women undergoing screening for heart attack risk. Fasting plasma glucose levels of participants who were not diagnosed with diabetes were examined to assess the number of women who would meet diagnostic criteria for diabetes using old (140 mg/dL) and new 126 mg/dL) American Diabetes Association criteria. The new criterion identified more women than did the old criterion, particularly African Americans. Use of the new criterion flagged nearly 50% as many women as originally diagnosed as diabetic at the time of screening. Early identification of diabetes may afford earlier, preventive interventions that may reduce morbidity and mortality. Thus, findings from this study suggest that use of the new, lowered diabetes diagnostic criterion may have significant public health benefits for midlife women.

Prospective evaluation of the effects of stress on exercise adherence in community-residing women.

The effects of stress on exercise behavior in community-residing women exercising on their own were assessed. Participants (N = 82) completed a background questionnaire and kept exercise diaries and Weekly Stress Inventories (P. J. Brantley, G. N. Jones, E. Boudreax, & S. L. Catz, 1997) for 8 consecutive weeks. During weeks with a high frequency of stressful events, participants exercised for less time and reported lower self-efficacy for meeting upcoming exercise goals. During weeks of high perceived stress, participants exercised significantly fewer days, omitted more planned exercise sessions, were less satisfied with their exercise, and had lower self-efficacy for meeting exercise goals. Findings suggest that perceptions of stressful events and cognitive reactions to missed exercise may play a significant role in mediating exercise behavior and support the view of exercise relapse as an ongoing process.

Evaluating the treatment integrity of a continuing education program.

Effective Patient Teaching (EPT), a health profession continuing education course, improves educators' teaching skills. The authors, through this dissemination study, aimed to learn whether, through a train-the-trainers approach, others could teach Effective Patient Teaching as its developers intended--that is, the assessment of what has been called "treatment integrity." Trainers' overall fidelity within and between three test sites was good, supporting Effective Patient Teaching's generalizability and transportability.

Continuing education on teaching skills for health professionals. Evaluation of training the trainers.

Effective Patient Teaching (EPT), a health professions continuing education course, improves educators' teaching skills when presented by its developers. This study aimed to determine whether others could teach EPT with similar effectiveness. Four nurse managers who provide staff training and supervision for multiple hospital diabetes care units presented EPT to health care professionals at seven such sites; another seven served as controls. The evaluation included observations of trainers conducting EPT programs in the field, teaching skills ratings of health professionals in both groups, and knowledge test administered to patients. Six months after training, teaching skills scores of health professional EPT participants were better (p < .05) than controls. The EPT program improves participants' teaching skills and maintains these effects in field settings, when presented by faculty not involved in its development.

Improving dietitians' teaching skills.

Many health professionals lack important teaching skills, perhaps adding to patient difficulties in understanding and adopting therapeutic diets. Research suggests that teaching skills improved after dietitians took a continuing education course entitled "Effective Patient Teaching." Our study tested whether dietitians' new skills would persist in the field and whether selected patient outcomes would differ as a result. Thirty staff dietitians from six urban hospitals were videotaped teaching patients, then randomly assigned to take the Effective Patient Teaching course or not (control group). Follow-up videotapes were made after 1 week, 1 month, and 3 months. After each teaching session, patient satisfaction and recall were assessed. Two judges rated 20 teaching skills, which were divided into four subsets for analysis. Repeated measures analyses of variance showed overall gains only for the group that took the Effective Patient Teaching course, which scored higher than the control group at 1 week and 1 month, but not at baseline or 3 months. Gains occurred in presentation skills and essential teaching functions. Throughout the study, interpersonal skills were high and adherence promotion skills were low for dietitians in both groups. Groups did not differ on patient satisfaction or recall. Improvements in dietitians' teaching skills translated to the field immediately after they completed the continuing education program, but not all gains were sustained after 3 months. We recommend that dietitians assess their teaching and adherence promotion skills, obtain training where warranted, and periodically reassess the application of those skills during patient teaching sessions.

Registered dietitians' teaching and adherence promotion skills during routine patient education.

Even following education sessions, dietary adherence among medical patients is generally poor. One contributor to this problem may be the quality of teaching and adherence promotion skills employed by Registered Dietitians, whose behavior during routine patient interactions was evaluated in this observational study. Thirty dietitians were videotaped with one of their patients. Twenty operationally defined skills were rated on a scale from 0 (skill absent) to 3 (excellent). Dietitians' interpersonal skills were good (mean = 2.1, S.D. = 0.35), but all other skills were performed significantly less well (mean scores less than 1.0). Adherence promotion skills were rarely observed. Dietitians need supplemental training to improve teaching and adherence promotion skills.

The relationship between cigarette smoking and chronic low back pain.

This study investigated the extent to which habitual cigarette smoking relates to physical and psychological indices of chronic pain. From a review of patient records, 54% of back pain patients referred for treatment of their pain admitted to smoking cigarettes. Response from a smoking questionnaire showed that 57% of the patients who smoked reported having a need to smoke when they were in pain. Most patients (91%), however, believed that smoking had no effect on their pain intensity. When smoking and nonsmoking back pain patients were compared, the smokers showed significantly higher levels of emotional distress, they tended to remain inactive, and they relied on medication more often than the nonsmoking patients. The results further suggest that pain patients are at risk for increasing smoking behavior when they are experiencing periods of heightened pain intensity.

Cognitive and behavioral features of adolescent coping in high-risk drinking situations.

The present study examined the coping responses used by adolescents in high-risk situations. Sixty-six adolescents described situations in which it was difficult to resist drinking alcohol. Cognitive and behavioral responses in the perceived high-risk alcohol situations were examined. Abusing and nonabusing adolescents reported similar high-risk situations, but differed significantly in the cognitive and behavioral strategies used to cope with drinking pressures. Cognitive strategies associated with abstaining from alcohol use included defining oneself as a nondrinker and viewing other drinkers negatively. Behavioral responses associated with not drinking included engaging in an alternative activity and avoiding or limiting direct exposure to the high-risk situations. Theoretical and clinical implications for effective coping in alcohol situations are discussed.

Coping with drinking pressures: adolescent versus parent perspectives.

Fifteen techniques to limit or stop alcohol consumption were rated by 94 adolescents, aged 12 to 19, and their parents. Factor analysis of effectiveness ratings demonstrated consistency in appraisal of adult options for coping strategies, but significant differences in adolescent and parent views of how teenagers should cope with drinking pressures.