Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2011

Open Access 01-12-2011 | Research article

Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist

Authors: Trilby Coolidge, Erik Skaret, Masahiro Heima, Elissa K Johnson, M Blake Hillstead, Nadia Farjo, Oyvind Asmyhr, Philip Weinstein

Published in: BMC Oral Health | Issue 1/2011

Login to get access

Abstract

Background

The Transtheoretical Model suggests that individuals vary according to their readiness to change behavior. Previous work in smoking cessation and other health areas suggests that interventions are more successful when they are tailored to an individual's stage of change with regards to the specific behavior. We report on the performance of a single-item measure ("Ladder") to assess the readiness to change dental-avoidant behavior.

Methods

An existing Contemplation Ladder for assessing stage of change in smoking cessation was modified to assess readiness to go to a dentist. The resulting Ladder was administered to samples of English-speaking adolescents (USA), Spanish-speaking adults (USA), and Norwegian military recruits (Norway) in order to assess construct validity. The Ladder was also administered to a sample of English-speaking avoidant adolescents and young adults who were enrolled in an intervention study (USA) in order to assess criterion validity. All participants also had dental examinations, and completed other questionnaires. Correlations, chi square, t tests and one-way ANOVAs were used to assess relationships between variables.

Results

In two samples, participants who do not go to the dentist had significantly more teeth with caries; in a third sample, participants who do not go to the dentist had significantly worse caries. Ladder scores were not significantly related to age, gender, caries, or dental fear. However, Ladder scores were significantly related to statements of intention to visit a dentist in the future and the importance of oral health. In a preliminary finding, Ladder scores at baseline also predicted whether or not the participants decided to go to a dentist in the intervention sample.

Conclusions

The data provide support for the convergent and divergent construct validity of the Ladder, and preliminary support for its criterion validity. The lack of relationship between dental fear and Ladder scores suggests that avoidant individuals may be helped to decide to go to a dentist using interventions which do not explicitly target their fear.
Appendix
Available only for authorised users
Literature
1.
DiClemente CC, Velasquez MM: Motivational Interviewing and the Stages of Change. Motivational Interviewing: Preparing People for Change. Edited by: Miller WR, Rollnick S. 2002, New York: Guilford Press, 201-216. 2
2.
Prochaska JO, Norcross JC, DiClemente CC: Changing for Good. 1994, New York: Harper Collins
3.
Burke BL, Arkowitz H, Menchola M: The efficacy of Motivational Interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psych. 2003, 71: 843-861. 10.1037/0022-006X.71.5.843.CrossRef
4.
Hettema J, Steele J, Miller WR: Motivational Interviewing. Ann Rev Clin Psychol. 2005, 1: 91-111. 10.1146/annurev.clinpsy.1.102803.143833.CrossRef
5.
Resnicow K, DiIorio C, Soet JE, Ernst D, Borrelli B, Hecht J: Motivational Interviewing in health promotion: it sounds like something is changing. Health Psychol. 2002, 21: 444-451. 10.1037/0278-6133.21.5.444.CrossRefPubMed
6.
Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakoxski W, Fiore C, Harlow LL, Redding CA, Rosenbloom D, Rossi SR: Stages of change and decisional balance for 12 problem behaviors. Health Psychol. 1994, 13: 39-46. 10.1037/0278-6133.13.1.39.CrossRefPubMed
7.
Ingoldsby EM: Review of interventions to improve family engagement and retention in parent and child mental health. J Child Fam Stud. 2010, 19: 629-645. 10.1007/s10826-009-9350-2.CrossRefPubMedPubMedCentral
8.
Costanza ME, Luckmann R, White MJ, Rosal MC, LaPelle N, Cranos C: Moving mammogram-reluctant women to screening: a pilot study. Ann Behav Med. 2009, 37: 343-349. 10.1007/s12160-009-9107-6.CrossRefPubMedPubMedCentral
9.
Valanis B, Whitlock EE, Mullooly J, Vogt T, Smith S, Chen C, Glasgow RE: Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions. Prev Med. 2003, 37: 442-450. 10.1016/S0091-7435(03)00165-8.CrossRefPubMed
10.
Sinclair KS, Campbell TS, Carey PM, Langevin E, Bowser B, France CR: An adapted postdonation motivational interview enhances blood donor retention. Transfusion. 2010, 50: 1778-1186. 10.1111/j.1537-2995.2010.02618.x.CrossRefPubMedPubMedCentral
11.
McConnaughy EA, Prochaska JO, Velicer WF: Stages of change in psychotherapy: measurement and sample profiles. Psychother Theory Res Pract. 1983, 20: 368-375. 10.1037/h0090198.CrossRef
12.
Carey KB, Purnine DM, Maisto SA, Carey MP: Assessing readiness to change substance abuse: a critical review of instruments. Clin Psychol Sci Pract. 1999, 6: 245-266. 10.1093/clipsy/6.3.245.CrossRef
13.
Biener L, Abrams DB: The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol. 1991, 10: 360-365. 10.1037/0278-6133.10.5.360.CrossRefPubMed
14.
Crittenden KS, Manfredi C, Lacey L, Warnecke R, Parsons J: Measuring readiness and motivation to quit smoking among women in public health clinics. Addict Behav. 1994, 19: 497-507. 10.1016/0306-4603(94)90005-1.CrossRefPubMed
15.
Stephens S, Cellucci T, Gregory J: Comparing stage of change measures in adolescent smokers. Addict Behav. 2004, 29: 759-764. 10.1016/j.addbeh.2004.02.004.CrossRefPubMed
16.
Amodei N, Lamb RJ: Convergent and concurrent validity of the Contemplation Ladder and URICA scales. Drug Alcohol Depend. 2004, 73: 301-306. 10.1016/j.drugalcdep.2003.11.005.CrossRefPubMed
17.
Mullan A, Markland D: Variations in self-determination across the stages of change for exercise in adults. Motiv Emot. 1997, 21: 349-362. 10.1023/A:1024436423492.CrossRef
18.
Rieger E, Touyz S, Schotte D, Beumont P, Russell J, Clarke S, Kohn M, Griffiths R: Development of an instrument to assess readiness to recover in anorexia. Int J Eat Disord. 2000, 28: 387-396. 10.1002/1098-108X(200012)28:4<387::AID-EAT6>3.0.CO;2-Y.CrossRefPubMed
19.
Stein LAR, Minugh PA, Longabaugh R, Wirtz P, Baird J, Nirenberg TD, Woolard RF, Carty K, Lee C, Mello M, Becker B, Gogineni A: Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers. Psychol Addict Behav. 2009, 23: 185-195. 10.1037/a0015648.CrossRefPubMedPubMedCentral
20.
Slavet JD, Stein LAR, Colby AM, Barnett NP, Monti PM, Golembeske C, Lebeau-Craven R: The Marijuana Ladder: measuring motivation to change marijuana use in incarcerated adolescents. Drug Alcohol Depend. 2006, 83: 42-48. 10.1016/j.drugalcdep.2005.10.007.CrossRefPubMed
21.
Petry NM: Stages of change in treatment-seeking pathological gamblers. J Consult Clin Psychol. 2005, 73: 312-322. 10.1037/0022-006X.73.2.312.CrossRefPubMed
22.
Honda K, Sheinfeld Gorin S: A model of stage of change to recommend colonoscopy among urban primary care physicians. Health Psychol. 2006, 25: 65-73. 10.1037/0278-6133.25.1.65.CrossRefPubMed
23.
Hogue A, Dauber S, Dasaro C, Morgenstern J: Predictors of employment in substance-using male and female welfare recipients. J Subst Abuse Treat. 2010, 38: 108-118. 10.1016/j.jsat.2009.09.003.CrossRefPubMedPubMedCentral
24.
Stanton WR, Lowe JB, Gillespie AM: Adolescents' experiences of smoking cessation. Drug Alcohol Depend. 1996, 43: 63-70. 10.1016/S0376-8716(97)84351-7.CrossRefPubMed
25.
Coolidge T, Chambers MA, Garcia LJ, Heaton LJ, Coldwell SE: Psychometric properties of Spanish-language adult dental fear measures. BMC Oral Health. 2008, 8: 15-10.1186/1472-6831-8-15.CrossRefPubMedPubMedCentral
26.
Kvale G, Berg E, Raadal M: The ability of Corah's Dental Anxiety Scale and Spielberger's State Anxiety Inventory to distinguish between fearful and regular Norwegian dental patients. Acta Odontol Scand. 1998, 56: 105-9. 10.1080/00016359850136076.CrossRefPubMed
27.
Thomson WM, Locker D: Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Study. Community Dent Oral Epidemiol. 2000, 28: 414-418. 10.1034/j.1600-0528.2000.028006414.x.CrossRefPubMed
28.
Milgrom P, Weinstein P, Getz T: Treating Fearful Dental Patients: A Patient Management Handbook. 1995, Seattle: University of Washington Continuing Dental Education, 2
29.
World Health Organization: A Guide to Oral Health Epidemiological Investigations. 1979, Geneva
30.
Weinstein P, Coolidge T, Raff CA, Riedy CA: Recruiting rural dentally-avoidant adolescents into an intervention study. Eur Arch Paed Dent. 2009, 10: 233-236.CrossRef
31.
Skaret E, Weinstein P, Milgrom P, Kaakko T, Getz T: Factors related to severe untreated tooth decay in rural adolescents: a case-control study for public health planning. Int J Paed Dent. 2004, 14: 17-26. 10.1111/j.1365-263X.2004.00517.x.CrossRef
32.
Amarante E, Raadal M, Espelid I: Impact of diagnostic criteria on the prevalence of dental caries in Norwegian children aged 5, 12 and 18 years. Community Dent Oral Epidemiol. 1998, 26: 87-94. 10.1111/j.1600-0528.1998.tb01933.x.CrossRefPubMed
33.
34.
Coolidge T, Hillstead MB, Farjo N, Weinstein P, Coldwell SE: Additional psychometric data for the Spanish Modified Dental Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey. BMC Oral Health. 2010, 10: 12-10.1186/1472-6831-10-12.CrossRefPubMedPubMedCentral
35.
Mejàre I, Källestål C, Stenlund H: Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: a prospective radiographic study. Caries Res. 1999, 33: 93-100.CrossRefPubMed
36.
Shwartz M, Gröndahl H-G, Pliskin JS, Boffa J: A longitudinal analysis from bite-wing radiographs of the rate of progression of approximal carious lesions through human dental enamel. Archs Oral Biol. 1984, 29: 529-536. 10.1016/0003-9969(84)90074-8.CrossRef
37.
Humphris GM, Freeman R, Campbell J, Tuutti H, D'Souza D: Further evidence for the reliability and validity of the Modified Dental Anxiety Scale. Int Dent J. 2000, 50: 367-370.CrossRefPubMed
38.
Schuller AA, Willumsen T, Holst D: Are there differences in oral health and oral health behavior between individuals with high and low dental fear?. Community Dent Oral Epidemiol. 2003, 31: 116-121. 10.1034/j.1600-0528.2003.00026.x.CrossRefPubMed
39.
Skaret E, Raadal M, Kvale G, Berg E: Factors related to missed and cancelled dental appointments among adolescents in Norway. Eur J Oral Sci. 2000, 108: 175-183. 10.1034/j.1600-0722.2000.108003175.x.CrossRefPubMed
40.
Armfield JM, Stewart JF, Spencer AJ: The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health. 2007, 7: 1-10.1186/1472-6831-7-1.CrossRefPubMedPubMedCentral
41.
Vassend O: Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993, 31: 659-666. 10.1016/0005-7967(93)90119-F.CrossRefPubMed
42.
Skaret E, Raadal M, Kvale G, Berg E: Missed and cancelled appointments among 12 - 18-year-olds in the Norwegian Public Dental Service. Eur J Oral Sci. 1998, 106: 1006-1012. 10.1046/j.0909-8836.1998.eos106605.x.CrossRefPubMed
43.
Dental health. Personnel and costs, dental status and dental visits. 2010, Oslo: Central Bureau of Statistics, Statistics of Norway, 2010; Report 29. ISBN 978-82-537-7860-0.
Metadata
Title
Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist
Authors
Trilby Coolidge
Erik Skaret
Masahiro Heima
Elissa K Johnson
M Blake Hillstead
Nadia Farjo
Oyvind Asmyhr
Philip Weinstein
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2011
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/1472-6831-11-4

Other articles of this Issue 1/2011

BMC Oral Health 1/2011 Go to the issue

Research article

Effect of nanoporous TiO2 coating and anodized Ca2+ modification of titanium surfaces on early microbial biofilm formation

Research article

Reaction of rat connective tissue to mineral trioxide aggregate and diaket

Research article

Comparison between observed children's tooth brushing habits and those reported by mothers

Research article

Oral health in the Japan self-defense forces - a representative survey

Research article

Validation of a multifactorial risk factor model used for predicting future caries risk with nevada adolescents

Technical advance

A new portable monitor for measuring odorous compounds in oral, exhaled and nasal air