Question

how do Health Belief, stage of change-Transtheoretical Theory, Reasoned Action, Attribution Behavior, Locus of Control, Social Learning and Social cognitive ( self-efficacy ) are related to Dental Hygienists ?????

Answer 1

The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health.

Patient education is considered a hallmark of the dental hygiene profession. Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner.

Health Belief Model
The Health Belief Model (HBM) was one of the first attempts to view health within a social context. The underlying principle of the HBM is that individuals with better information make better health decisions, people will find it worthwhile when making health related decisions to keep an open mind. A person who is prepared to accept new concepts, will have a better understanding of self. With a better understanding of how and why they make choices, individuals will be much better able to make them intelligently, independently, and maturely.

The HBM is a staged theory, with each step in the decision making process dependent on the previous decision or belief. According to this theory, an individual must believe that s/he is susceptible to a condition; the condition is serious; there is a successful intervention for the condition; and can overcome all barriers to using the intervention. Each step is dependent on the previous belief. Applying this theory to an oral health condition such as early childhood caries, the primary caregiver must believe that the child is susceptible to dental caries; that primary teeth are important and dental caries is a serious threat to them; that dental caries can be prevented; and must be willing to limit the child's exposure to fermentable carbohydrates, and must assist the child in practicing good oral hygiene.

Transtheoretical Model and Stages of Change
The Transtheoretical Model and Stages of Change is another staged theory that measures an individual's readiness to adopt a new health behavior. Like HBM, Stages of Change is a staged model with each step contingent on the previous step. This theory states that individuals move along a predictable continuum of change; and that each step has distinct characteristics. Accurately assessing where an individual allows health care workers and educators to tailor interventions appropriate to the person's stage of readiness. The six stages of change are: precontemplation, contemplation, preparation, action, maintenance, and termination.

In the precontemplation stage, an individual has no intention of changing a behavior. At this stage, providing information regarding risks may be appropriate to initiate a person's thought for change. In the contemplation stage, the individual is considering making a change within the next six months. The individual will examine the pros and cons of making a change, carefully weighing the benefits of changing versus the costs of changing. To help evaluate the pros and cons of changing, the individual may explore options such as community support programs like smoking cessation programs that assist behavior changes. If the available options seem appropriate and beneficial, the individual may advance to the next stage of preparation. In the preparation stage, the individual is ready to make the change and actively makes plans to enact the change, for example enrolling in a tobacco cessation class. In the action stage, the change has been adopted, and in the maintenance stage, the change has been continuous for at least six months. The termination stage, often not attained, represents a state in which the individual feels as if the prior behavior never existed and is, therefore, highly unlikely to return to the previous behavior.

Theory of Reasoned Action
Theory of Reasoned Action stresses the importance of attitudes and intentions in changing a behavior. According to this theory, the most important determinant of behavior is intention. Very few actions that produce a healthy outcome happen without ample knowledge and full intention to practice the healthy behavior. Two cognitive processes are at work to develop healthy behaviors: 1) belief about what significant others think, and 2) personal motivation to comply with those significant people. Other external variables that will influence attitudes and thus behaviors are internally processed within the context of significance.
According to the Theory of Reasoned Action, people make rational decisions based on their knowledge, personal values and attitudes. Therefore, a person's intent to perform a certain action is the most immediate and relevant predictor of carrying out that action. Behavioral beliefs and normative beliefs are two kinds of beliefs that shape intentions. Behavioral beliefs are the attitudes held by the individual alone. A person forms attitudes based on relative risks, benefits, and possible outcomes. Therefore, personal knowledge and perception of personal health importance influence behavioral beliefs. Normative beliefs are those held by other people who influence the individual. If a certain behavior is expected or is the social norm, or is expected by someone of importance to the individual, those expectations will have a bearing on an individual's intentions and, therefore, affect his or her behavior.

Social Learning and Social Cognitive (Self-Efficacy)
Self-efficacy is a construct of the Social Cognitive Theory proposed by Bandura. Social Cognitive Theory, a revision of Social Learning Theory, states that individuals do not learn or change behavior in a linear fashion. Rather, changes take place bidirectionally; environment, information, and behavior all affect one another. As an individual learns more, behaviors and environment may change, causing more knowledge to be gained, which, in turn, reinforces behavior and healthy environments. Lapses are a part of the learning process as the individual employs personal choices to develop behaviors consistent with individual choice and lifestyle. Individuals with high self-efficacy believe their actions will affect outcome. As a healthy behavior produces results, success reinforces success. Individuals may have no intention of changing a behavior but after experiencing a success, behaviors, knowledge and environments change.

Self-efficacy has been an accurate predictor of oral health in both cross sectional and longitudinal studies. Qualitative analysis of dental attitudes indicated that cognitive experiences, supportive and emotional dimensions, and childhood experiences influence dental attitudes and behaviors.26 Dental self-efficacy was found to be a determinant in oral health and oral hygiene among diabetes patients and for general oral health in elderly patients.

Locus of Control (LOC)
This theory deals with perception of personal control over health issues. Internal locus of control (LOC) occurs when individuals think their personal actions determine their health status. Those with external locus of control means individuals perceive others in control of health decisions and health status. External sources may be fate, chance, luck, God, or powerful others. As originally presented and in much subsequent research, LOC has been considered a global orientation to health behavior. LOC has been found to be predictive for children's dental health. Researchers found children whose mothers had more external LOC were at higher risk for developing dental caries.31 In contrast, other research has found little association between mothers LOC, children's health status, and use of preventive health services. This theory continues to be refined for use in various populations and conditions.

The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health.