Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist

Abstract

BackgroundThe Transtheoretical Model suggests that individuals vary according to their readiness to change behavior. Previous work in smoking cessation and other health areas suggests that interventions are more successful when they are tailored to an individual's stage of change with regards to the specific behavior. We report on the performance of a single-item measure ("Ladder") to assess the readiness to change dental-avoidant behavior.MethodsAn existing Contemplation Ladder for assessing stage of change in smoking cessation was modified to assess readiness to go to a dentist. The resulting Ladder was administered to samples of English-speaking adolescents (USA), Spanish-speaking adults (USA), and Norwegian military recruits (Norway) in order to assess construct validity. The Ladder was also administered to a sample of English-speaking avoidant adolescents and young adults who were enrolled in an intervention study (USA) in order to assess criterion validity. All participants also had dental examinations, and completed other questionnaires. Correlations, chi square, t tests and one-way ANOVAs were used to assess relationships between variables.ResultsIn two samples, participants who do not go to the dentist had significantly more teeth with caries; in a third sample, participants who do not go to the dentist had significantly worse caries. Ladder scores were not significantly related to age, gender, caries, or dental fear. However, Ladder scores were significantly related to statements of intention to visit a dentist in the future and the importance of oral health. In a preliminary finding, Ladder scores at baseline also predicted whether or not the participants decided to go to a dentist in the intervention sample.ConclusionsThe data provide support for the convergent and divergent construct validity of the Ladder, and preliminary support for its criterion validity. The lack of relationship between dental fear and Ladder scores suggests that avoidant individuals may be helped to decide to go to a dentist using interventions which do not explicitly target their fear.

Do children’s previous dental experience and fear affect their perceived oral health-related quality of life (OHRQoL)?

“…This finding is surprising, particularly because irregular dental visits have been reported to be associated with more numerous caries and untreated caries [32, 33]. Our findings also contradict other studies, in which poor OHRQoL was associated with not having visited the dentist in the previous year [10].…”

Disclosure of Personalized Rheumatoid Arthritis Risk Using Genetics, Biomarkers, and Lifestyle Factors to Motivate Health Behavior Improvements: A Randomized Controlled Trial

“…Outcome measures. We measured motivation to improve behaviors based on Prochaska's stages of readiness for change using validated contemplation ladder scales (range 0-10, higher score indicating more motivation to change) at the following time points: baseline and immediately, 6 weeks, 6 months, and 12 months post-intervention (25,26). Rungs on the ladder correspond to stages of motivation to change behavior according to the trans-theoretical model as a progression through precontemplation, contemplation, preparation, action, and maintenance (27).…”

Dental attendance among low-income women and their children following a brief motivational counseling intervention: A community randomized trial

“…Participants received incentives throughout the study in the form of gift cards (up to $80), a baby gift, and toothpaste/toothbrushes for mothers/children. Study measures included mother’s readiness to visit the dentist (scoring range 0–10, where higher scores indicate greater readiness; Coolidge et al, 2011), prenatal depression (Center for Epidemiologic Studies Depression Scale [CES-D]; scoring range 0–60, where higher scores indicate more depressive symptoms; Radloff, 1977), maternal perceived stress (Perceived Stress Scale [PSS]: scoring range 0–40, where higher scores indicate greater stress; Cohen & Williamson, 1988), maternal oral health impact (Oral Health Impact Profile short form [OHIP]: scoring range 0–56, where higher scores indicate lower oral health quality of life; de Oliveira & Nadanovsky, 2006), and maternal dental anxiety questions [M-DAS]: scoring range 5–25, where higher scores indicate greater dental anxiety; Humphris et al, 1995). Post-partum: readiness to take child to the dentist, maternal dental anxiety, maternal depression, maternal perceived stress, maternal self-efficacy, maternal oral health knowledge, and fatalism (Adair et al, 2004; Finlayson et al, 2005).…”