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Coaching: Phase II of the new revolution in patient motivation

Aug. 23, 2010
It’s time to drop the “c” word (compliance) and replace with a much more effective one – “coaching.”

By Carol Jahn, RDH, MS

There was a time in my dental hygiene career when not recommending floss as the primary choice for interdental cleaning would have felt blasphemous. For a good portion of my clinical days, floss was “it” and everything else was “better than doing nothing at all.”

Times have changed. Most of us have come to understand that many people don’t like to floss. Not only that, in this era of evidence-based care, the reality is that there aren’t as many clinical trials on the efficacy of string floss as we would like to think.(1,2) As well, emerging evidence indicates that those devices once considered “better than nothing” often work as well, and for some parameters, better than string floss.(3,4,5,6,7) See Table 1.

When I talk to dental hygienists around the country, I’m learning that the majority are moving beyond a traditional string floss recommendation for some if not the majority of their patients. Yet, I still hear some of the same frustrations surrounding compliance. “They’ve asked for something easier — we’ve found it and recommend it, and they still don’t do it.” Ouch!Enter Phase II of the revolution. Now it’s time to drop the “c” word (compliance) and replace with a much more effective one — “coaching.” What the difference? Consider these definitions from Merriam-Webster:
  • Compliance: yielding to the wishes of others
  • Coach: to instruct, guide, or prompt

Coaching, especially coaching as used in the business sense, is founded on the idea that motivation is malleable, and everyone has the potential for change. Rather than the show, tell, do approach most of us have used for years, coaching involves collaborating with the patient to help them tap into their own goals, values, and aspirations and use them as a motive and resource for change. It requires shifting from being the expert delivering advice to the coach listening and guiding.(8)

Doing something different often feels uncomfortable. Coaching is a skill as well as an art form. There are many layers to mastery. A great place for dental hygienists to begin is with the guiding principles from motivational interviewing, a healthcare based type of coaching. Motivational interviewing has been found to outperform traditional advice-giving in the treatment of a wide range of behavioral-related conditions and diseases.(9)

Guiding Principles for Coaching(8)

Resist the righting reflex refers to the urge that many of us have when we see behaviors or perhaps absence of behaviors that “must” be corrected. The reason this often backfires is that it is natural to resist being persuaded, and commonly when this occurs there is push back.(8)

Understand what motivates your patients will provide insight into how they perceive their situation and where their values and concerns lie in changing. Giving the patient a voice to this helps them explore the possibilities and take up the argument for change.(8)

Listen to your patient seems like patient education 101; but it is actually a complex skill. Good listening skills involve allowing the patient adequate time to talk without interrupting as well as being able to ask appropriate questions, clarify responses, and summarize meaning.(8)

Empower your patient helps them understand that they can make a significant difference in their own health. In this role, practitioners act as facilitators by helping the patient bring their own expertise to the forefront such as what might be the right interdental aid for them.(8)

There are many great books on coaching including some specific to health care under the title of motivational interviewing authored by Stephen Rollnick. See Table 2. Will it feel awkward when you first start doing this? Absolutely! With time it will start to feel natural, and the responses and results you start to get with patients will make it all worthwhile.

Carol Jahn, RDH, MS, is the senior professional relations manager for Water Pik, Inc. She can be contacted at [email protected].
1. Berchier CE et al. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: A systematic review. Int J Dent Hygiene 2008; 6: 265-279.2. Hujoel PP et al. Dental flossing and interproximal caries: A systematic review. J Dent Res 2006; 85:298-305.3. Slot DE et al. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation. A systematic review. Int J Dent Hygiene 2008; 6:253-264.4. Hoenderdos NL. The efficacy of woodsticks on plaque and inflammation: A systematic review. Int J Dent Hygiene 2008; 6:280-289.5. Barnes CM et al. Comparison of irrigation to floss as an adjunct to tooth brushing: Effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent 2005; 16:71-77.6. Sharma et al. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2008; 133:565-571.7. Rosema NAM et al. The effect of different interdental cleaning devices on clinical parameters. Presented at IADR, Barcelona, Spain. July 17, 2010. Abstract #3797.8. Rollnick S et al. Motivational interviewing in Health Care: Helping Patients Change Behavior. 2008; New York: Guilford Press.9. Rubak S et al. Motivational interviewing: A systematic review and meta-analysis. Br J Gen Pract 2005; 55:305-312.