Koula Asimakopoulou

The management of dental anxiety: time for a sense of proportion?

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

Neuropsychological functioning in older people with Type 2 diabetes: the effect of controlling for confounding factors

Aims and methods Neuropsychological functioning was examined in a group of 33 older (mean age 62.40 ± 9.62 years) people with Type 2 diabetes (Group 1) and 33 non‐diabetic participants matched with Group 1 on age, sex, premorbid intelligence and presence of hypertension and cardio/cerebrovascular conditions (Group 2).

Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management

BACKGROUND Plaque control in patients with periodontal disease is critically dependent upon self-care through specific oral hygiene-related behaviours. OBJECTIVES To determine the relationship between adherence to oral hygiene instructions in adult periodontal patients and psychological constructs. To determine the effect of interventions based on psychological constructs on oral health-related behaviour in adult periodontal patients. DATA SOURCES The Cochrane Oral Health Groups Trials Register, MEDLINE, EMBASE and PsycINFO. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were grouped according to the study design, and appraised using an appropriate methodology, either the Newcastle-Ottawa assessment for observational studies, or the Cochrane criteria for trials. RESULTS Fifteen reports of studies were identified. LIMITATIONS There was a low risk of bias identified for the observational studies. Older trials suffered from high risk of bias, but more recent trials had low risk of bias. However, the specification of the psychological intervention was generally poor. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The use of goal setting, self-monitoring and planning are effective interventions for improving oral hygiene-related behaviour in patients with periodontal disease. Understanding the benefits of behaviour change and the seriousness of periodontal disease are important predictors of the likelihood of behaviour change.

Back to basics: Re-examining the role of patient empowerment in diabetes

The concept of patient empowerment is currently popular in research and at policy level. As early as 2001, the UK Government proposed a diabetes health strategy, wishing to “ensure that people with diabetes are empowered to enhance their personal control over the day to day management of their diabetes in a way that enables them to experience the best possible quality of life” [1] (p. 21). It went on to say that “users of the NHS should have choice, voice and control over their lives, build confidence and be active partners in their care”. This strategy is reflected in the abundance of papers within the area. A search conducted in July 2010 on Scopus, yielded 17,102 publications, which included ‘empowerment’ in the title, abstract or keywords. Of these, at least 353 were about empowerment in diabetes. There can be no doubt then, that empowerment is a popular topic yet, it is surprising to discover a lack of concordance about the meaning and scope of the term. The UK Government strategy highlighted above, is a case in point. The need to empower diabetes patients is explicitly stated but the means to achieve empowerment in practice is not. This observation reflects a generalised lack of clarity around what ‘empowerment’ actually means.

The impact of different time frames of risk communication on Type 2 diabetes patients’ understanding and memory for risk of coronary heart disease and stroke

Aims  We examined the impact of communicating risk of coronary heart disease (CHD) and stroke, using three time frames (1, 5 or 10 years), on Type 2 diabetic (T2D) patients’ understanding of risk of CHD/stroke and their memory for these risks.

The contributions of behaviour change science towards dental public health practice: a new paradigm

Conventional behavioural models, such as social cognition models, to improve oral health have been proposed for a long time but have failed to consistently explain reliable amounts of variability in human behaviours relevant to oral health. This paper introduces current work from the behavioural sciences aiming to better understand the process through which behaviour change may take place. Given the shortcomings seen so far in attempts to explain behaviour through traditional models it is proposed that a new approach is adopted. This commentary outlines this new approach, grounded in current work by mainstream behaviour change experts. We propose that attempts to use unreliable theoretical models to explain and predict oral health behaviour should now be replaced by work following this new paradigm.

The context of empowerment and self-care within the field of diabetes

There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu’s concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically ‘policed’ field of diabetes is explored using empirical data from a study of diabetes health-care professionals’ understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.

A model of patient-centred care – turning good care into patient-centred care

This paper builds on previous work reviewing patient-centred care in dentistry and acknowledges work that has questioned the measurement and effectiveness of patient-centredness in practice. In an attempt to move the debate from rhetoric to practice and enhance the practical utility of the concept, we present a practical hierarchy of patient-centredness that may aid the practical application of patient-centred care in clinical practice by making explicit a series of stages that a dental care professional needs to move through in order to provide care that is patient-centred. The model presented is illustrated through practical examples. The various stages inherent in it are described with the aim of making clear the perhaps automatic and taken for granted assumptions that are often made by dental care professionals and patients through the course of a consultation. Our aim is to encourage dental consultations to have more open, unambiguous communication, both about the risks and benefits of courses of action and about the choices available to patients.

The role of information and choice in patient‐centred care in diabetes: a hierarchy of patient‐centredness

This paper reviews some popular models of patient-centred care and acknowledges work that has questioned the measurement and effectiveness of patient-centredness in practice. In an attempt to enhance testing the concept practically, we propose a practical hierarchy of patient-centredness that we hope will aid the practical application of patient-centred care in clinical practice. The proposed hierarchy is illustrated through a practical example and the various stages inherent in it are described. This paper concludes with a call that this theory-driven hierarchy of patient-centredness be tested out in practice with the view of confirming or revising it where appropriate so that it might serve as a useful clinical tool in future. Copyright

Dentist–patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance

Background There is a lack of information about the extent to which patients recall key facts of dental consultations. Forgetting health advice undermines adherence with such instructions and is a potential problem. This study assessed the quantity and type of information recalled in a dental consultation, dentist–patient agreement over the contents of the consultation, and the relationship of such recall with patient satisfaction. Methods Using a cross-sectional design, questionnaire data were obtained from patients recruited through a letter and presenting for a routine dental consultation. General issues discussed, specific information about oral health given, dentist-performed procedures, and agreed future actions were reported independently in writing, by patients and also by the treating dentist immediately postconsultation. Additionally, patients completed a dental visit satisfaction questionnaire. Results Responses (n = 26, 55% response rate) were content-analyzed, and data on the number and type of information that was recalled were obtained. Interrater reliability was established. Inferential testing showed differences in dentist–patient recall, dentist–patient agreement, and the association between patient recall and satisfaction. Dentists recalled more information than patients (P = 0.001). Dentists further reported giving more dental health education (P = 0.006) and discussing more future actions (P = 0.002) than patients actually remembered. Technical (eg, crowns/bridges) rather than psychosocial (eg, pain/embarrassment) issues were reported more often (P = 0.001) by both dentists and patients. Dentist–patient agreement over issues discussed and procedures performed was higher (kappa = 0.210–0.310) than dental health education agreement and agreed future actions (kappa = 0.060–0.110). There was no relationship between patient recall and patient satisfaction with the consultation (P = 0.240). Conclusion Patients do not recall as much advice and agreed actions about future dental care as dentists believe they have discussed. These results have implications for patient adherence with oral health instructions.