Generally, unless health professionals were unusually insensitive to patients’ reactions, health education often had a patronising ring to it.
Therefore, when a dental health provider who believes he or she knows what is best for the patient ‘educates’ a person who is tacitly assumed to know nothing, it is a safe bet that little of value eventuates.
QUOTE: Many dental practitioners can labour under the assumption that when people have knowledge about oral hygiene they will act upon that knowledge. It is a rational assumption, but human behaviour is more complicated than that.
This has been called the ‘empty vessel’ approach to oral health education: the patient is empty and waiting for the health professional to ‘pour in’ the knowledge. But studies have shown that this is not the best approach.
This approach was enshrined in an early World Health Organisation (WHO) report, which saw the need to teach educational theory and methods to student dentists so that they could successfully “motivate” their patients and the public to behave as dentists would like them to.
It also shows itself unconsciously in terminology such as tooth-brushing drills, a so-called educational method in which children were taught to brush their teeth in a semi-military manner.
The empty vessel approach also dated from a time when the guild model of professionalism was accepted, a model that saw the all-knowing professional as dominant in dentist-patient relations.
In more recent years, greater acceptance has been given to the idea that the recipients of all this attention might have some thoughts of their own. But we must remember that people have a right and duty to participate individually and collectively in the planning and implementation of their health care. It is recognised universally that participant’s involvement was essential for success in oral health education, and what is taught needed to be compatible with local customs and culture as well as with scientific knowledge.
It is a basic precept that everyone has a right to the best available knowledge about caring for his or her own health. However, knowledge alone does not lead to action. Many dental practitioners can labour under the assumption that when people have knowledge about oral hygiene they will act upon that knowledge. It is a rational assumption, but human behaviour is more complicated than that. Knowledge dissemination is a fundamental part of the mission of dental health professionals, but dental care workers have to steel themselves to accept that much of their effort will go unheeded.
School-based oral health education programmes, by definition, are aimed at more cohesive groups rather than at the public at large. Whatever approach is to be adopted, it will require a plan of action, with appropriate involvement of all parties concerned and clear delineation of responsibilities. In order for the public at large to be aware of what is necessary, here are the fundamental components of a school-based programme for the promotion of oral health:
– Oral health services, meaning preventive procedures, health screening and treatment, referral, and follow-up.
– Health instruction, to include both personal and health topics.
– A healthy environment, with attention to all aspects of the school environment that could affect the health of students or school personnel.
Even though schoolchildren are more homogeneous than the public as a whole, any group of them still has a variety of beliefs and attitudes; in a multicultural society such as we have here, the differences can be profound.
Methods used in school programmes should therefore be a mix of small groups and mass approaches, and some are clearly more successful than others. The more successful approaches, as shown by teachers and administrators, and by the oral health of the participants, use a fair degree of active involvement. This finding applies to all ages and social groups, for active involvement increased the effectiveness of programmes conducted with employed adults and with mothers with young children.
Nursing home residents who monitored their own progress toward oral hygiene goals showed improvements in psychological well-being and self-esteem as well as in oral hygiene.
On the other hand, programmes that involve less individual participation can increase knowledge of oral disease mechanisms and its prevention but have less impact on attitudes, beliefs, and behaviour. The mass media, which by definition do not develop personal involvement, are generally seen as effective in disseminating basic knowledge, but whether they do much to influence behavioural change is uncertain.
I have learnt from public oral health campaigns, which I have played an integral part of for many years, that personal involvement is needed to effect behavioural change. When the cultural competence needed to accommodate to the astonishing cultural variety in Guyana is added in, designing programmes for personal involvement becomes a challenge.
The most intensive form of oral health education is one-to-one instruction. Although oral health education is clearly an integral part of professional responsibility, simply passing across information does not by itself lead to desirable action; personal involvement (again) is necessary.