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Behaviour change

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Behaviour change: motivating, action planning and habit forming

Key recommendation

Provide all children with personalised oral health promotion advice.

(Strong recommendation; moderate certainty evidence)

Based on a review of the literature, SIGN guideline 13823 recommended that oral health promotion strategies should:

  • facilitate daily toothbrushing with fluoride toothpaste 
  • be based on recognised oral health behaviour theory and models such as motivational interviewing
  • be specific to individuals and tailored to their particular needs and circumstances

The social history gathered during the assessment gives an understanding of the child’s current oral health practice, the parent/carer’s ability and attitude towards maintaining oral health and their motivation to take responsibility for it (see Assessing parent/carer motivation). 

As knowledge does not readily translate into behaviour change, providing caries prevention advice alone has limited success in influencing patients. However, there is evidence that using a brief motivational interviewing (MI) approach and forming an action plan increases the likelihood of parents/carers or older children adopting desired oral health behaviours.56 This broadly applicable approach to support behaviour change is summarised in the Route map of health behaviour change below.

To use brief motivational interviewing successfully as part of an approach to supporting patients to adopt healthy behaviours ideally requires understanding of the theory gained through training and experience. 

Diagram showing the steps of motivational interviewing

The situation as it is now

Step 1: Explore current practice and attitudes using a Motivational Interviewing Approach

Gain empathy:

Seek permission
Open questions
Affirmations
Reflective listening
Summarising

Develop Discrepancy, roll with resistance

Elicit change talk

The situation as we would like it to be

Step 2: Educational intervention

Improve knowledge and skills

Making it happen

Step 3: Action planning

Set time, date and place to start

Keeping it that way

Step 4: Encouraging habit formation

Achieve sufficient repetition

Step 5: Repeat at each recall visit

Developing an individualised action plan to encourage the child’s habit formation 

Identify a convenient time and place for the preventive behaviour to occur (e.g. toothbrushing after breakfast and last thing at night), a date for when the task is to be started (ideally from the day of the appointment) and who is to carry it out.

  • If difficulties are reported, alternatives may be necessary. For example, if the child is often too tired for toothbrushing last thing at night, agree an earlier time.  

Identify a trigger as a reminder for the child or parent/carer to carry out the preventive behaviour (e.g. when the child gets ready for bed).

Agree a date to review progress (e.g. assess oral hygiene at the next visit).

Agree the action plan with the child and parent/carer and write this down for them if necessary, possibly on a copy of a food and drink diary or toothbrushing chart. 

Record the action plan in the child's notes so that it can be referenced at subsequent visits.

At subsequent visits, encourage, give further support and review the action plan and revise it, if necessary.

While discussing the action plan, assess the parent/carer or child’s ability and motivation to comply and if there is doubt about this, discuss collaboration with other healthcare professionals (e.g. health visitor, school nurse, Childsmile dental health support worker) as a source of community/home support for the child and include this in the action plan. 

Examples of action plans

  • For a 6-year-old child, the parent/carer will supervise the child’s brushing at home every morning after breakfast and brush the child’s teeth for them every evening after dinner, when the child gets ready for bed.
  • When preparing the child’s packed lunch, the parent/carer will give the child water instead of a sugar-containing drink every day.
  • A child will note on a toothbrushing chart every time they brush their teeth at home and bring the chart back at the next visit to receive a sticker.