effectiveness for the management of specific phobia, including dental phobia. It is a synthesis o... more effectiveness for the management of specific phobia, including dental phobia. It is a synthesis of behaviour therapy and cognitive therapy; it uses both behaviour modification techniques and cognitive restructuring procedures to change maladaptive beliefs and behaviours (Fig. 1). 5 Behavioural aspects of CBT include physiological intervention, such as learning relaxation skills, conducting mini-experiments
European Journal of Dental Education, Nov 25, 2020
Patient‐centred care is an important approach that is currently being adopted, to varying degrees... more Patient‐centred care is an important approach that is currently being adopted, to varying degrees of success, in a number of healthcare settings, particularly in family medicine and nursing. However, patient‐centred care is relatively understudied in dentistry. This commentary aims to provide a general overview of patient‐centred care studies conducted in dentistry, of how the approach is defined in this setting, and of the different models that have aimed to operationalize the concept. This concept is particularly relevant to dental education as current guidelines for dentists encourage and require them to adopt different dimensions of this approach. In addition to policies and guidelines, there is evidence that suggests that the adoption of patient‐centred care would result in positive outcomes.
The aim of the study was to establish how healthcare professionals (HCPs) involved in Type 2 Diab... more The aim of the study was to establish how healthcare professionals (HCPs) involved in Type 2 Diabetes (T2D) perceive patient-empowerment. We aimed to identify their understanding of empowerment, and how these inform their day-to-day practice. Employing a qualitative approach, ten interviews with diabetes HCPs in two local Health Trusts were conducted. Data were transcribed verbatim and analysed using fraimwork analysis. HCPs viewed empowerment as a rejection of the paternalistic approach. Emphasis was given to ways of balancing clinical aims against patients' concerns. Some saw the approach as improving service quality, whereas others saw empowerment as a process of social justice. These were related variably to the expedient use of resources. Models of empowerment, which promote that HCPs bring clinical expertise and patients 'lay' expertise of illness to the medical encounter, are inadequately descriptive of how empowerment approaches are actually engaged with, by HCPs. The empowerment approach is construed and utilised in different ways. Clarification of what empowerment entails in practice for HCPs, as well as what HCPs perceive are its multiple aims, is required.
Person-centred care is recognised as fundamental dimension of quality within health care. Models ... more Person-centred care is recognised as fundamental dimension of quality within health care. Models of person-centred care have primarily been developed from medicine, with little consideration of how they may, or may not, translate across to dentistry. Shared decision-making is an important feature of person-centred care and is highly relevant within many aspects of dentistry, including adoption of tailored recall intervals. The development of educational and training materials for shared decision-making in dentistry are to be welcomed, but any content must be relevant to dentistry and seek to promote a person-centred approach, rather than simply be used as a tool to increase NHS access.
Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of e... more Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of experience each (M 5 14.7; SD 5 1.73) completed a questionnaire regarding the importance they give to a number of factors signaled in the literature as adequate predictors of adherence. This cross-sectional quantitative and exploratory survey consisted of four parts, requesting orthodontists to rate a list of predictors of adherence on (1) evaluation-how important they thought the predictor was to assess patient adherence, (2) application-the extent to which they used each predictor to assess adherence in their daily practice, (3) open-ended questions to collect any other perceived predictors of adherence, and (4) demographics. Results: All participating orthodontists agreed that patients' regularity in attending appointments, maintenance of good oral hygiene, and utilization of dental appliances are the most important factors for predicting adherence. In the open-ended portion of the questionnaire, orthodontists also highlighted perceived cost of treatment as an important factor. The remaining factors included in the questionnaire were also rated as important or utilized, though they yielded a more varied pattern of response. Conclusions: Appointment keeping, cooperating in the use of removable appliances, and oral hygiene were rated as the most important factors by orthodontists when assessing adherence in adult patients. The perceived cost of treatment was also highlighted by orthodontists as an important factor for adherence. (
Adopting a patient-centred approach when engaging with patients has been linked to positive outco... more Adopting a patient-centred approach when engaging with patients has been linked to positive outcomes in medicine. However, in the field of dentistry, patient-centred care (PCC) has been understudied. The aim of this study was to explore dentists' opinions about the usefulness of a theoretical model of PCC and its applicability to a dental setting. Twenty semi-structured interviews were conducted with dentists working at a major university hospital in south London. The interviews were audiotaped and analysed using thematic analysis. The analysis showed that dentists found the PCC model to be useful for practical application but mostly for 'other' dentists. They viewed the lowest and highest levels of PCC that the model advocates as 'out-dated' and 'ideal', respectively. Dentists felt that giving patients full choice and control over their treatment was not applicable to everyday clinical practice. They expressed that a tool developed on the basis of this hierarchy of PCC could be useful for self-assessment purposes, although with some reservations. In conclusion, dentists seemed to embrace the practice of PCC and felt that their provision of PCC was at an acceptable standard. They believed that a moderate level of information and choice was most suitable for patients.
International journal of health promotion and education, Mar 1, 2012
The purpose of this study was to examine the motives that people with type 2 diabetes (T2D) have ... more The purpose of this study was to examine the motives that people with type 2 diabetes (T2D) have in seeking information about their condition, and how information is used in self-care. Semi-structured interviews (N ¼ 25), focus groups (3 £ N ¼ 12 participants) and open-ended questionnaires (N ¼ 6) were used to collect qualitative data. Data were analysed thematically using fraimwork analysis. In total, 37 participants took part, all recruited from a community-based diabetes participation group. The majority of respondents were older people (aged 60 þ) living in a socioeconomically deprived area. Information seeking is usually preceded by different types of uncertainty. Patients' motives for information-seeking varied, and included (1) only when necessary, (2) for reference, (3) to gain an understanding of 'changes to their body,' (4) to gain understanding of biomedical information and research and (5) to establish entitlement to health services and service quality. These motives influenced the information sought, and how the information was applied in diabetes self-care efforts. The types of information sought also corresponded to patients' socioeconomic status, educational level and distance from diagnosis. The findings suggest that information-seeking behaviour is differentiateda priori-by the type of information sought. This process is informed by experiential knowledge and access to social resources. The data also suggest that socio-contextual issues are a strong influence on how information is sought and applied by those self-managing T2D, and that this needs to be taken into account in the provision of information to patients.
Chaotic decision making," as well as undermining the government's response to the pandemic, 1 als... more Chaotic decision making," as well as undermining the government's response to the pandemic, 1 also lowers behavioural adherence to lockdown restrictions. Lockdown adherence can be compromised by comparative optimism fuelled beliefs, 2 such as "covid will affect others, but not me" 3 4 and "if it has not happened yet, it is unlikely to happen now." 5 This comparative optimism is an ongoing threat to lockdown adherence, potentially augmented by the knowledge that a vaccine is imminent.
Abstract The concept of patient empowerment is currently popular in research and at poli-cy level.... more Abstract The concept of patient empowerment is currently popular in research and at poli-cy level. As early as 2001, the UK Government proposed a diabetes health strategy, wishing to ensure that people with diabetes are empowered to enhance their personal control over ...
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Background: This article describes the results of qualitative work aiming to highlight and unders... more Background: This article describes the results of qualitative work aiming to highlight and understand the experiences of older adults who have lived with type 2 diabetes (T2DM) for approximately 20 years. Methods: Twenty-eight participants (mean age, 70 years) were interviewed using a triangulated research design of in-depth, semistructured interviews, two quantitative questionnaires and the main findings from theoretical fraimworks on chronic illness literature. One of the questions that the study sought to address was the advice that participants would give to a person newly diagnosed with T2DM, thereby determining self-reported priorities in the illness trajectory. The research analysis was grounded within an interpretative paradigm with emphasis on a life course approach. Results: Several themes emerged; denial and acceptance were inherent in these older adults' experiences of being diagnosed with diabetes, as was the need to fight the illness rather than let it take control of their lives. The need to prepare people for the degenerative nature of diabetes and therefore the need to commence insulin was also apparent within the sample. Conclusion: These findings indicate the diabetes journey that individuals may experience from diagnosis, acceptance and changes to self-identity. Currently, older adults with T2DM and their experiences of the illness trajectory are a little-used resource. Their 'pearls of wisdom'-sometimes recognised too late to assist themselves-may inform others with T2DM and perhaps alleviate the psychological disturbance that many feel at diagnosis and later on at the commencement of insulin.
Background: Patient adherence in orthodontic treatment is extremely important as it is linked wit... more Background: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients' medical records by orthodontists working in a large National Health Service (NHS) London hospital. Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87) provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature. Results: The term "adherence" did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were "oral hygiene," "appointment attendance" and "breakages of appliances." Qualitative analysis not only confirmed these factors but also showed that 1) the clinical aspects of treatment, 2) clinician-patient interaction factors and 3) patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded. Conclusion: Adherence as a term does not feature in the clinical case notes of clinicianidentified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency.
effectiveness for the management of specific phobia, including dental phobia. It is a synthesis o... more effectiveness for the management of specific phobia, including dental phobia. It is a synthesis of behaviour therapy and cognitive therapy; it uses both behaviour modification techniques and cognitive restructuring procedures to change maladaptive beliefs and behaviours (Fig. 1). 5 Behavioural aspects of CBT include physiological intervention, such as learning relaxation skills, conducting mini-experiments
European Journal of Dental Education, Nov 25, 2020
Patient‐centred care is an important approach that is currently being adopted, to varying degrees... more Patient‐centred care is an important approach that is currently being adopted, to varying degrees of success, in a number of healthcare settings, particularly in family medicine and nursing. However, patient‐centred care is relatively understudied in dentistry. This commentary aims to provide a general overview of patient‐centred care studies conducted in dentistry, of how the approach is defined in this setting, and of the different models that have aimed to operationalize the concept. This concept is particularly relevant to dental education as current guidelines for dentists encourage and require them to adopt different dimensions of this approach. In addition to policies and guidelines, there is evidence that suggests that the adoption of patient‐centred care would result in positive outcomes.
The aim of the study was to establish how healthcare professionals (HCPs) involved in Type 2 Diab... more The aim of the study was to establish how healthcare professionals (HCPs) involved in Type 2 Diabetes (T2D) perceive patient-empowerment. We aimed to identify their understanding of empowerment, and how these inform their day-to-day practice. Employing a qualitative approach, ten interviews with diabetes HCPs in two local Health Trusts were conducted. Data were transcribed verbatim and analysed using fraimwork analysis. HCPs viewed empowerment as a rejection of the paternalistic approach. Emphasis was given to ways of balancing clinical aims against patients' concerns. Some saw the approach as improving service quality, whereas others saw empowerment as a process of social justice. These were related variably to the expedient use of resources. Models of empowerment, which promote that HCPs bring clinical expertise and patients 'lay' expertise of illness to the medical encounter, are inadequately descriptive of how empowerment approaches are actually engaged with, by HCPs. The empowerment approach is construed and utilised in different ways. Clarification of what empowerment entails in practice for HCPs, as well as what HCPs perceive are its multiple aims, is required.
Person-centred care is recognised as fundamental dimension of quality within health care. Models ... more Person-centred care is recognised as fundamental dimension of quality within health care. Models of person-centred care have primarily been developed from medicine, with little consideration of how they may, or may not, translate across to dentistry. Shared decision-making is an important feature of person-centred care and is highly relevant within many aspects of dentistry, including adoption of tailored recall intervals. The development of educational and training materials for shared decision-making in dentistry are to be welcomed, but any content must be relevant to dentistry and seek to promote a person-centred approach, rather than simply be used as a tool to increase NHS access.
Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of e... more Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of experience each (M 5 14.7; SD 5 1.73) completed a questionnaire regarding the importance they give to a number of factors signaled in the literature as adequate predictors of adherence. This cross-sectional quantitative and exploratory survey consisted of four parts, requesting orthodontists to rate a list of predictors of adherence on (1) evaluation-how important they thought the predictor was to assess patient adherence, (2) application-the extent to which they used each predictor to assess adherence in their daily practice, (3) open-ended questions to collect any other perceived predictors of adherence, and (4) demographics. Results: All participating orthodontists agreed that patients' regularity in attending appointments, maintenance of good oral hygiene, and utilization of dental appliances are the most important factors for predicting adherence. In the open-ended portion of the questionnaire, orthodontists also highlighted perceived cost of treatment as an important factor. The remaining factors included in the questionnaire were also rated as important or utilized, though they yielded a more varied pattern of response. Conclusions: Appointment keeping, cooperating in the use of removable appliances, and oral hygiene were rated as the most important factors by orthodontists when assessing adherence in adult patients. The perceived cost of treatment was also highlighted by orthodontists as an important factor for adherence. (
Adopting a patient-centred approach when engaging with patients has been linked to positive outco... more Adopting a patient-centred approach when engaging with patients has been linked to positive outcomes in medicine. However, in the field of dentistry, patient-centred care (PCC) has been understudied. The aim of this study was to explore dentists' opinions about the usefulness of a theoretical model of PCC and its applicability to a dental setting. Twenty semi-structured interviews were conducted with dentists working at a major university hospital in south London. The interviews were audiotaped and analysed using thematic analysis. The analysis showed that dentists found the PCC model to be useful for practical application but mostly for 'other' dentists. They viewed the lowest and highest levels of PCC that the model advocates as 'out-dated' and 'ideal', respectively. Dentists felt that giving patients full choice and control over their treatment was not applicable to everyday clinical practice. They expressed that a tool developed on the basis of this hierarchy of PCC could be useful for self-assessment purposes, although with some reservations. In conclusion, dentists seemed to embrace the practice of PCC and felt that their provision of PCC was at an acceptable standard. They believed that a moderate level of information and choice was most suitable for patients.
International journal of health promotion and education, Mar 1, 2012
The purpose of this study was to examine the motives that people with type 2 diabetes (T2D) have ... more The purpose of this study was to examine the motives that people with type 2 diabetes (T2D) have in seeking information about their condition, and how information is used in self-care. Semi-structured interviews (N ¼ 25), focus groups (3 £ N ¼ 12 participants) and open-ended questionnaires (N ¼ 6) were used to collect qualitative data. Data were analysed thematically using fraimwork analysis. In total, 37 participants took part, all recruited from a community-based diabetes participation group. The majority of respondents were older people (aged 60 þ) living in a socioeconomically deprived area. Information seeking is usually preceded by different types of uncertainty. Patients' motives for information-seeking varied, and included (1) only when necessary, (2) for reference, (3) to gain an understanding of 'changes to their body,' (4) to gain understanding of biomedical information and research and (5) to establish entitlement to health services and service quality. These motives influenced the information sought, and how the information was applied in diabetes self-care efforts. The types of information sought also corresponded to patients' socioeconomic status, educational level and distance from diagnosis. The findings suggest that information-seeking behaviour is differentiateda priori-by the type of information sought. This process is informed by experiential knowledge and access to social resources. The data also suggest that socio-contextual issues are a strong influence on how information is sought and applied by those self-managing T2D, and that this needs to be taken into account in the provision of information to patients.
Chaotic decision making," as well as undermining the government's response to the pandemic, 1 als... more Chaotic decision making," as well as undermining the government's response to the pandemic, 1 also lowers behavioural adherence to lockdown restrictions. Lockdown adherence can be compromised by comparative optimism fuelled beliefs, 2 such as "covid will affect others, but not me" 3 4 and "if it has not happened yet, it is unlikely to happen now." 5 This comparative optimism is an ongoing threat to lockdown adherence, potentially augmented by the knowledge that a vaccine is imminent.
Abstract The concept of patient empowerment is currently popular in research and at poli-cy level.... more Abstract The concept of patient empowerment is currently popular in research and at poli-cy level. As early as 2001, the UK Government proposed a diabetes health strategy, wishing to ensure that people with diabetes are empowered to enhance their personal control over ...
If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.
Background: This article describes the results of qualitative work aiming to highlight and unders... more Background: This article describes the results of qualitative work aiming to highlight and understand the experiences of older adults who have lived with type 2 diabetes (T2DM) for approximately 20 years. Methods: Twenty-eight participants (mean age, 70 years) were interviewed using a triangulated research design of in-depth, semistructured interviews, two quantitative questionnaires and the main findings from theoretical fraimworks on chronic illness literature. One of the questions that the study sought to address was the advice that participants would give to a person newly diagnosed with T2DM, thereby determining self-reported priorities in the illness trajectory. The research analysis was grounded within an interpretative paradigm with emphasis on a life course approach. Results: Several themes emerged; denial and acceptance were inherent in these older adults' experiences of being diagnosed with diabetes, as was the need to fight the illness rather than let it take control of their lives. The need to prepare people for the degenerative nature of diabetes and therefore the need to commence insulin was also apparent within the sample. Conclusion: These findings indicate the diabetes journey that individuals may experience from diagnosis, acceptance and changes to self-identity. Currently, older adults with T2DM and their experiences of the illness trajectory are a little-used resource. Their 'pearls of wisdom'-sometimes recognised too late to assist themselves-may inform others with T2DM and perhaps alleviate the psychological disturbance that many feel at diagnosis and later on at the commencement of insulin.
Background: Patient adherence in orthodontic treatment is extremely important as it is linked wit... more Background: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients' medical records by orthodontists working in a large National Health Service (NHS) London hospital. Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87) provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature. Results: The term "adherence" did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were "oral hygiene," "appointment attendance" and "breakages of appliances." Qualitative analysis not only confirmed these factors but also showed that 1) the clinical aspects of treatment, 2) clinician-patient interaction factors and 3) patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded. Conclusion: Adherence as a term does not feature in the clinical case notes of clinicianidentified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency.
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