Patient Agreements Aimed at Improving Pediatric Dental Self-Compliance and Self-Efficacy

Abstract

<bold>Purpose:</bold> The purpose of this study was to describe self-selected oral health goals, perceived self-efficacy, self-reported compliance, and perceived barriers to goal accomplishment of patient caregivers at a university-based pediatric dental clinic. The effect of patient agreements on recall rates was also assessed. <bold>Methods:</bold> This was a longitudinal pilot study in which 100 caregiver-patient pairs who presented for new patient or recall examinations were assigned by convenience to an intervention or comparison group. Patients within each of these groups were further categorized by age. Demographic data was collected to identify risk factors, and individualized age-appropriate anticipatory guidance was reviewed. At the baseline appointment, caregivers in the intervention group were asked to select 1 or 2 home care goals to improve upon. Two follow-up surveys were administered: at a two-week phone call, and at a six-month in-person exam. The comparison group was matched for age and only used as comparison for attendance rate. <bold>Results:</bold> The two most frequently selected goals by caregivers were to "brush with fluoride toothpaste at least twice daily" (21%) and to have "toothbrush last thing to touch teeth before bed" (17%). Caregivers reported a mean confidence level of 7.5 (SD = 1.7), with respect to accomplishing selected goals (10 representing high confidence). Of the 33 caregivers contacted in two-weeks by phone, 39% were able to recall their chosen goals correctly. Of the 15 caregivers who returned for the six-month recall examination, 26% were able to recall their goals correctly. There was a higher self-reported compliance with goals at 2 weeks than at 6 months. The barrier in goal implementation most commonly reported in both recalls was a "limited time to accomplish goals/ too busy". There was no difference in recall rate between the intervention and comparison group (p=0.840). <bold>Conclusions:</bold> Caregivers selected goals that were simple and easily incorporated into the daily routine. Therefore, dental providers should not overlook reinforcing simple preventive habits. Caregivers reported high confidence levels in their abilities to achieve these goals. Caregivers had a poor recall of goals yet reported high levels of compliance at the two-week and six-month follow-up phases. The most commonly reported barrier to achieving goals was time limitation. Recall rates were not different between the intervention and comparison group.