1. Cathy Hollister, RDH, MSPH, PhD Nashville Area Dental Support Center Director United South and Eastern Tribes, Inc. 615-872-7900 mary.hollister@ihs.gov Health Education Models

2. Health Belief Model First model that recognized a social component to health See Nathe, C.N. (2001). Dental public health: contemporary practice for the dental hygienist. Upper Saddle River, NJ: Prentice-Hall, Inc. Theoretical Base Better informed people will make better choices

3. HBM: Key Points Individuals must believe they are susceptible to the problem Example: Mothers must believe their children are susceptible to caries Individuals must believe the condition is serious Mothers must believe baby teeth are important

4. HBM: Key Points- Con’t. Individuals must believe the intervention will work Mothers must believe sleeping with the bottle contributes to ECC Mothers must believe reducing exposure to sugars will reduce risk of ECC Individuals must overcome barriers Parents must be willing to endure crying Parents must have strategies to overcome “grandma overindulgence”

5. Limitations of HBM Information alone rarely leads to a behavior change Behavior changes are not linear Doesn’t provide the tools needed for behavior change

6. New Diseases or Threats TSA Susceptible Global threat from terrorists Airlines have been targets Serious Interventions work Effective screening techniques Complaints about male/female screeners Overcome barriers Accommodate male/female travelers More screening stations Consider flight times

7. Stages of Change Behavior is change happens in stages Change is predictable and follows a pattern

8. Stages Precontemplation No interest in change Contemplation Ready to change but no change has started Preparation Arranging elements necessary for change

9. Stages Action Change has started Maintenance Change has been sustained for 6 months Termination As if the previous behavior never existed

10. Smoking Cessation Pre-contemplation No interest in quitting tobacco use Contemplation Interested in quitting but not yet ready. Gather information Consider heatlh consequences Discuss personal experiences of experiences of others

11. Smoking Cessation Preparation Set a quit date Enroll in a smoking cessation program Purchase quit aids Plan strategies for quitting and triggers Action Quit using tobacco Actively work on behavior change Devise strategies for maintaining behavior

12. Smoking Cessation Maintenance No tobacco use for 6 months Termination No desire for tobacco

13. Theory of Reasoned Action People make rational decisions based on knowledge, values and attitudes Intentions predict behavior Limited value because intentions change quickly

14. Theory of Reasoned Action Social Norms influence behavior Social norms formed within a family, community or society More use of Bottled water Oral health habits formed in families, Head Start

15. Reasoned Action: What is Missing? Information Facts Personal assessment Readiness to change

17. Social Learning Theory LOC and Self Efficacy are Modifications of Social Learning Theory Behavior Environment Knowledge

18. Locus of Control Refers to an individual’s beliefs about control over health or health actions External Health status is influenced by fate, luck, chance or other people

19. Locus of Control Internal Health status is controlled by personal behavior One of several factors that determine health behaviors LOC is an indirect measure of health status

20. Locus of Control LOC and Self-efficacy were associated with ECC in studies of Head Start children Reisine & Litt, 1993 Increased risk of ECC External LOC Lower income More knowledge about dental health Higher stress

21. Self Efficacy High SE means an individual has confidence their actions will affect outcome Involves forethought, preplanning, sense of control Higher self efficacy is frequently associated with better health status

22. Self Efficacy Attained by: Enactive Attainment (Success breeds success) Vicarious Learning Verbal persuasion Associated with oral health in multiple studies

23. Confidence vs Self-Efficacy Confidence: I can do it Self-Efficacy: If I do it, my life will change

24. Sense of Coherance Salutagenesis What keeps people well? Continuum of “ease to dis-ease” dis-ease -----------------------------------------ease ↑

25. Sense of Coherence Network of resources creates system for managing stress Health status is predictable Adequate resources to manage health Health is important enough to spend resources Higher SOC associated with better oral health (Friere, Hardy & Sheiham, 2002)

26. Sense of Coherence Oral Health Network Access to care Trusted dentist Access to healthy foods Belief that oral health is important Source of accurate information

28. HPV Vaccinations UNC Researchers Interviewed Parents of young girls about the vaccine Likely to get vaccine Expressed regret at the thought that their daughter might develop later cervical cancer

29. Barriers Less likely to get vaccine if: Didn’t know where to get it Insurance didn’t cover vaccine Health care providers didn’t have the vaccine Born again Christians less likely to get vaccine

30. HPV Vaccine Health Message “You have hopes and dreams for your daughter, and they don’t include cervical cancer”