Motivational interviewing for oral health

Motivational interviewing (MI) was introduced in the early 1980s for the treatment of alcoholism and since been used to reduce other risky behaviours (smoking, gambling) as well as promote healthy behaviours e.g. exercise, oral health and weight loss. MI attempts to understand the patient’s expectations, beliefs, perspectives, and concerns about changing their health behaviors, and links educational approaches with the patients’ readiness to change and willingness to hear the information.

The aim of this review was to examine the effect of parent-directed or parent-child dyad-directed motivational interviewing to improve paediatric health behaviors relative to controls.

Methods

Searches were conducted in the PubMed, PsycINFO, CINAHL, The Cochrane Library, ERIC, and Web of Science databases. English language randomised controlled trials (RCTs) examining modifiable paediatric health behaviors (<18 years old) using MI or motivational enhancement conducted with only a parent or both a parent and child were considered. Two reviewers independently selected studies and abstracted data. Study quality was assessed using a 14-item checklist and treatment fidelity using the National Institutes of Health (NIH) Treatment Fidelity Framework.

Results

25 studies were included.
12 studies considered weight and obesity, 8 smoking, 4 oral health and 1 alcohol.
All of the studies delivered MI in person for at least one session; approximately half were supplemented by telephone counseling and/or print.
MI was associated with significant improvements in health behaviors (e.g., oral health, diet, physical activity, reduced screen time, smoking cessation, reduced second hand smoke) and reduction in body mass index.
MI may also outperform comparison groups in terms of dental caries, but more studies are needed.
MI interventions were more successful at improving diets for Caucasians and when the intervention included more MI components.

Conclusions

The authors concluded:

There is evidence to support the use of parent- involved motivational interviewing in improving a variety of paediatric health behaviors and outcomes (e.g., oral health, diet, physical activity, reduced screen time, smoking cessation, reduced secondhand smoke, body mass index).
Parent-involved MI improves paediatric oral health behaviors. MI may be useful for reducing dental caries, but more studies are needed.
Parent-involved MI interventions were more successful at improving diet when the intervention included a greater number of MI components.
There is insufficient evidence to support the use of MI interventions for other weight-related outcomes (i.e., proportion of overweight/obese, waist circumference, proportion of body fat) or objectively measured secondhand smoke exposure.

Comments

This review of MI was not primarily focused on oral health interventions, as the focus was on the use of MI to improve a range of paediatric health behaviours. The review was also limited to English language studies, although an extensive range of databases was searched. We have previously highlighted reviews focused just on the use of MI in oral health (see links) but these were not restricted to paediatric studies. The 4 oral health studies that were included found a significant effect for MI on oral health behaviours and management and also suggested an affect on reducing paediatric caries. All 4 of these studies were included in the meta-analysis by Gao et al (Dental Elf – 4^th July- 2013) and support their findings.