The feasibility, acceptance, and key features of a prevention-focused oral health education program for HIV+ adults

Abstract

Poor oral health is common in HIV+ adults. We explored the feasibility, acceptance and key features of a prevention-focused oral health education program for HIV+ adults. This was a pilot sub-study of a parent study in which all subjects (n=112) received a baseline periodontal disease (PD) examination and provider-delivered oral health messages informed by the Information-Motivation-Behavioral Skills (IMB) Model. Forty-one parent study subjects were then eligible for the sub-study; of these subjects, a volunteer sample was contacted and interviewed 3–6 months after the baseline visit. At the recall visit, subjects self-reported behavior changes that they had made since the baseline. PD was re-assessed using standard clinical assessment guidelines and results were shared with each subject. At recall, individualized, hands-on oral hygiene coaching was performed and patients provided feedback on this experience. Statistics included frequency distributions, means and chi-square testing for bivariate analyses. Twenty two (22) HIV+ adults completed the study. At recall, subjects had modest, but non-significant (p>0.05) clinician observed improvement in PD. Each subject reported adopting, on average, 3.8 (± 1.5) specific oral health behavior changes at recall. By self-report, subjects attributed most behavior changes (95%) to baseline health messages. Behavior changes were self-reported for increased frequency of flossing (55%) and tooth-brushing (50%), enhanced tooth-brushing technique (50%), and improved eating habits (32%). As compared to smokers, non-smokers reported being more optimistic about their oral health (p=.024) at recall and were more likely to have reported changing their oral health behaviors (p=.009). All subjects self-reported increased knowledge after receiving hands-on oral hygiene coaching performed at the recall visit. In HIV+ adults, IMB-informed oral health messages promoted self-reported behavior change; subjects preferred more interactive, hands-on coaching. We describe a holistic clinical behavior change approach that may provide a helpful framework when creating more rigorously-designed IMB-informed studies on this topic.

HIV‐related stigma in the dental setting: a qualitative study

“…As well, this cohort contained many subjects (78%) who had utilized dental services within the past year; thus responses from PLWHA who underutilize dental services (e.g., last dental visit >2 years ago) may be underrepresented. As well, 32% had previously been in our dental research studies; such experiences may have encouraged greater use of available dental services …”

“…Mean age was 49‐years old and mean year of HIV seroconversion was 1996, with a mean time since HIV seroconversion of 15.7 (±7.2) years. Most subjects had seen a dentist in the past year and 32% of subjects had previously been involved in our prior dental research studies and/or a separate, ongoing longitudinal study, “Immune and Inflammatory Consequences of Intensive Periodontal Disease Treatment in HIV+ Adults,” (R21 DE21376‐01).…”

In Defense of Flossing: Part II-Can We Agree It's Premature to Claim Flossing Is Ineffective to Help Prevent Periodontal Diseases?

“…Given the importance of prevention in oral health promotion, we have developed a set of plain language guidelines that providers may consider to promote patients’ effective cleaning between their teeth. These suggestions (See Tables 1, 2 and 3) are based upon the development of OHSIM, existing health behavior change theory and previously published work on oral health coaching by our group 45, 46 .…”

“…You could try using a Likert scale from 1 (very low) to 10 (very high) to determine “where they are” 45, 47, 49 . Some people are more motivated towards positive outcomes than by scare tactics (i.e., stressing negative outcomes).…”

Using smartphone video “selfies” to monitor change in toothbrushing behavior after a brief intervention: A pilot study

“…However, in spite of one’s best efforts, a significant percentage of patient’s may relapse back into their old and improper TB habits. [11,12] Recently, researchers have speculated that proactive interference (when learning a new behavior is impeded by interference of knowledge and habits tied to an old behavior) may have an important influence in reverting to improper, old TB habits. [12] Adopting a more effective TB technique can be challenging; this is especially true when TB has been practiced for a number of years without proper supervision, guidance, and reinforcement.…”