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Motivation and Emotion

, Volume 34, Issue 1, pp 15–33 | Cite as

Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance

  • Anne E. Münster HalvariEmail author
  • Hallgeir Halvari
  • Gunnar Bjørnebekk
  • Edward L. Deci
Original Paper

Abstract

The present study: (1) developed a Self-Regulation Questionnaire for Dental Treatment (SRQDT) based on Self-Determination Theory (SDT; Deci and Ryan, Psychol Inq 11:227–268, 2000), and (2) used it to test a SDT process model of oral self-care behaviours and dental clinic attendance. Patients’ perceptions of autonomy supportive (relative to controlling) dental professionals were expected to be positively associated with patients’ psychological needs satisfaction in treatment, which was expected to be positively related to relative autonomous motivation for dental treatment and perceived dental competence, and negatively related to anxiety for dental treatment. In turn, relative autonomous motivation for dental treatment and perceived dental competence were expected to be positively associated with oral self-care behaviours and dental clinic attendance. Anxiety for dental treatment was expected to be negatively related to dental clinic attendance and positively linked to putting off making a dental clinic appointment. Confirmatory factor analysis of the 5 factor SRQDT model fit the data very well, and a structural equation model supported the hypothesized process model.

Keywords

Oral self-care Self-determination theory Dental clinic attendance 

References

  1. Addy, M., & Adriaens, P. (1998). Consensus report of Group A. Epidemiology and etiology of periodontal diseases and the role of plaque control in dental caries. In N. P. Lang, R. Attström, & H. Löe (Eds.), Proceedings of the European workshop on mechanical plaque control (pp. 98–101). Chicago: Quintessence Publishing.Google Scholar
  2. Anderson, J. R. (1990). Cognitive psychology and its implications. New York: W. H. Freeman & Company.Google Scholar
  3. Ashley, P. F., Attrill, D. C., & Ellwood, R. P. (1999). Toothbrushing habits and caries experience. Caries Research, 33, 401–402.CrossRefPubMedGoogle Scholar
  4. Axelsson, P. (1998). Needs-related plaque control measures based on risk prediction. In N. P. Lang, R. Attström, & H. Löe (Eds.), Proceedings of the European workshop on mechanical plaque control (pp. 190–247). Chicago: Quintessence Publishing.Google Scholar
  5. Axelsson, P. (2006). The effect of a needs-related caries preventive program in children and young adults—Results after 20 years. BMC Oral Health, 6(Suppl 1), S7.CrossRefPubMedGoogle Scholar
  6. Backdash, B. (2000). Current patterns of oral hygiene product use and practices. Periodontology, 8, 11–14.CrossRefGoogle Scholar
  7. Bagøien, T. E., & Halvari, H. (2005). Autonomous motivation, involvement in physical activity, and perceived sport competence: structural and mediator models. Perceptual and Motor Skills, 100, 3–21.CrossRefPubMedGoogle Scholar
  8. Baumeister, R., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497–529.CrossRefPubMedGoogle Scholar
  9. Bernstein, D. A., Kleinknecht, R. A., & Alexander, L. D. (1979). Antecedents of dental fear. Journal of Public Health Dentistry, 39, 113–124.CrossRefPubMedGoogle Scholar
  10. Bollen, K. (1989). Structural equations with latent variables. New York: Wiley.Google Scholar
  11. Brothwell, D. J., Jutai, D. K. G., & Hawkins, R. J. (1998). An update of mechanical oral hygiene practices: Evidence-based recommendations for disease prevention. Journal of Canadian Dental Association, 64, 295–306.Google Scholar
  12. Carver, C. S., & Scheier, M. F. (1998). On the self-regulation of behavior. New York: Cambridge University Press.Google Scholar
  13. Chestnutt, I. G., Schäfer, F., Jacobson, A. P. M., & Stephen, K. W. (1998). The influence of tooth-brushing and post-brushing rinsing on caries experience in a caries clinical trial. Community Dentistry and Oral Epidemiology, 26, 406–411.CrossRefPubMedGoogle Scholar
  14. Corah, N. L. (1969). Development of a dental anxiety scale. Journal of Dental Research, 48, 596.PubMedGoogle Scholar
  15. Corah, N. L. (1988). Dental anxiety: Assessment, reduction and increasing patient satisfaction. Dental Clinics of North America, 32, 779–790.PubMedGoogle Scholar
  16. Dailey, Y. M., Crawford, A. N., Humphris, G., & Lennon, M. A. (2001). Factors affecting dental attendance following treatment for dental anxiety in primary dental care. Primary Dental Care, 8, 51–56.CrossRefPubMedGoogle Scholar
  17. deCharms, R. (1968). Personal causation: The internal affective determinants of behavior. New York: Academic Press.Google Scholar
  18. Deci, E. L., Eghrari, H., Patrick, B. C., & Leone, D. R. (1994). Facilitating internalization: The self-determination theory perspective. Journal of Personality, 62, 119–142.CrossRefPubMedGoogle Scholar
  19. Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin, 125, 627–668.CrossRefPubMedGoogle Scholar
  20. Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum Press.Google Scholar
  21. Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227–268.CrossRefGoogle Scholar
  22. Donaldson, A. N., Everitt, B., Newton, T., Steele, J., Sheriff, M., & Bower, E. (2008). The effects of social class and dental attendance on oral health. Journal of Dental Research, 87, 60–64.CrossRefPubMedGoogle Scholar
  23. Eli, I. (1993). Dental anxiety: A cause for possible misdiagnosis of tooth vitality. International Endodontic Journal, 26, 251–253.CrossRefPubMedGoogle Scholar
  24. Engel, G. E. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.CrossRefPubMedGoogle Scholar
  25. Halvari, A., et al. (in press). Motivation for dental home care: Testing a self-determination theory model. Journal of Applied Social Psychology. Google Scholar
  26. Halvari, A., & Halvari, H. (2006). Motivational predictors of change in oral health: An experimental test of self-determination theory. Motivation and Emotion, 30, 295–306.CrossRefGoogle Scholar
  27. Halvari, H., Ulstad, S. O., Bagøien, T. E., & Skjesol, K. (2009). Autonomy support and its links to physical activity and competitive performance: Mediations through motivation, competence, action orientation, and harmonious passion, and the moderator role of autonomy support by perceived competence. Scandinavian Journal of Educational Research, 56, 533–555.CrossRefGoogle Scholar
  28. Haugejorden, O., & Klock, K. S. (2000). Avoidance of dental visits: The predictive validity of three dental anxiety scales. Acta Odontologica Scandinavica, 58, 255–259.CrossRefPubMedGoogle Scholar
  29. Health Education Authority. (1996). The scientific basis of dental health education. London: HEA.Google Scholar
  30. Heaton, L. J., Carlson, C. R., Smith, T. A., Baer, R. A., & de Leeuw, R. (2007). Predicting anxiety during dental treatment using patients’ self-reports. JADA, 138, 188–195.PubMedGoogle Scholar
  31. Högglin, C., Hakeberg, M., Ahlquist, M., Sullivan, M., & Berggren, U. (2000). Factors associated with dental anxiety and attendance in middle-aged and elderly women. Community Dentistry and Oral Epidemiology, 28, 451–460.CrossRefGoogle Scholar
  32. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  33. Humphris, G. M., Morrison, T., & Lindsay, S. J. E. (1995). The Modified Dental Anxiety Scale: Validation and United Kingdom norms. Community Dental Health, 12, 143–150.PubMedGoogle Scholar
  34. Kay, E., & Locker, D. (1998). A systematic review of the effectiveness of health promotion aimed at improving oral health. Community Dental Health, 15, 132–144.PubMedGoogle Scholar
  35. Kennedy, S., Goggin, K., & Nollen, N. (2004). Adherence to HIV medications: Utility of the theory of self-determination. Cognitive Therapy and Research, 28, 611–628.CrossRefGoogle Scholar
  36. Kleinknecht, R. A., & Bernstein, D. A. (1978). The assessment of dental fear. Behavior Therapy, 9, 626–634.CrossRefGoogle Scholar
  37. Kuvaas, B. (2006a). Performance appraisal, satisfaction and employee outcomes: Mediating and moderating roles of work motivation. International Journal of Human Resource Management, 17, 504–522.CrossRefGoogle Scholar
  38. Kuvaas, B. (2006b). Work performance, affective commitment, and work satisfaction: The roles of pay administration and pay level. Journal of Organizational Behavior, 27, 365–385.CrossRefGoogle Scholar
  39. Logan, H., Baron, R. S., Keely, K., Law, A., & Stein, S. (1991). Desired and felt control as mediators of stress in a dental setting. Health Psychology, 10, 352–359.CrossRefPubMedGoogle Scholar
  40. Lund, A. K., & Kegeles, S. S. (1984). Rewards and adolescent health behavior. Health Psychology, 3, 351–369.CrossRefPubMedGoogle Scholar
  41. McCaul, K. D., Glasgow, R. E., & O’Neill, H. K. (1992). The problem of creating habits: Establishing health-protective dental behaviors. Health Psychology, 11, 101–110.CrossRefPubMedGoogle Scholar
  42. McGrath, C., & Bedi, R. (2001). Can dental attendance improve quality of life? British Dental Journal, 190, 262–265.CrossRefPubMedGoogle Scholar
  43. Milgrom, P., Vignehsa, H., & Weinstein, P. (1992). Adolescent dental fear and control: Prevalence and theoretical implications. Behaviour Research and Therapy, 30, 367–373.CrossRefPubMedGoogle Scholar
  44. Milgrom, P., Weinstein, P., & Getz, T. (1995). Treating fearful dental patients. Seattle: Continuing Dental Education University of Washington.Google Scholar
  45. Moore, R., Abrahamsen, R., & Brødsgaard, I. (1996). Hypnotherapy compared with group therapy and individual desensitization for dental anxiety. European Journal of Oral Sciences, 104, 612–618.CrossRefPubMedGoogle Scholar
  46. Muthen, B., & Kaplan, D. (1985). A comparison of some methodologies for the factor analysis of non-normal Likert variables. British Journal of Mathematical and Statistical Psychology, 38, 171–189.Google Scholar
  47. Nicolas, E., Collado, V., Faulks, D., Bullier, B., & Hennequin, M. (2007). A national cross-sectional survey of dental anxiety in the French adult population. BMC Oral Health, 7, 12.CrossRefPubMedGoogle Scholar
  48. Nuttall, N. M., Bradnock, G., White, D., Morris, J., & Nunn, J. (2001). Dental attendance in 1988 and implications for the future. British Dental Journal, 190, 177–182.CrossRefPubMedGoogle Scholar
  49. Palmeira, A. L., Teixeira, P. J., Branco, T. L., Martins, S. S., Minderico, C. S., Barata, J. T., et al. (2007). Predicting short-term weight loss using four leading health behaviour change theories. International Journal of Behavioral Nutrition and Physical Activity, 4, 14.CrossRefPubMedGoogle Scholar
  50. Pelletier, L. G., Dion, S. C., Slovenic-D’Angelo, M., & Reid, R. (2004). Why do you regulate what you eat? Relationship between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motivation and Emotion, 28, 245–277.CrossRefGoogle Scholar
  51. Pohjola, V., Lahti, S., Tolvanen, M., & Hausen, H. (2008). Dental fear and oral health habits among adults in Finland. Acta Odontologica Scandinavica, 66, 148–153.CrossRefPubMedGoogle Scholar
  52. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.CrossRefPubMedGoogle Scholar
  53. Quetish Taani, D. S. M. (2002). Dental anxiety and regularity of dental attendance in younger adults. Journal of Oral Rehabilitation, 29, 604–608.CrossRefGoogle Scholar
  54. Ramsey, D. S. (2000). Patient compliance with oral hygiene regimes: A behavioral relf-regulation analysis with implications for technology. International Dental Journal, 50, 304–311.Google Scholar
  55. Reeve, J., Nix, G., & Hamm, D. (1999). The experience of self-determination in intrinsic motivation. Unpublished manuscript, University of Iowa.Google Scholar
  56. Rouse, R. A., & Hamilton, M. A. (1990). Dentists’ technical competence, communication, and personality as predictors of dental patient anxiety. Journal of Behavioral Medicine, 13, 307–319.CrossRefPubMedGoogle Scholar
  57. Ryan, R. M., & Connell, J. P. (1989). Perceived locus of causality and internalisation: Examining reasons for acting in two domains. Journal of Personality and Social Psychology, 57, 749–761.CrossRefPubMedGoogle Scholar
  58. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68–78.CrossRefPubMedGoogle Scholar
  59. Sandell, R., Camner, L. G., & Sarhed, G. (1994). The dentist’s attitudes and their interaction with patient involvement in oral hygiene compliance. British Journal of Clinical Psychology, 33, 549–558.PubMedGoogle Scholar
  60. Saxer, U. P., Barbakov, J., & Yankell, S. L. (1998). New studies on estimated and actual toothbrushing times and dentifrice use. The Journal of Clinical Dentistry, 9, 49–51.PubMedGoogle Scholar
  61. Scheutz, F., & Heidmann, J. (2001). Determinants of utilization of dental services among 20- to 34-year-old Danes. Acta Odontologica Scandinavica, 59, 201–208.CrossRefPubMedGoogle Scholar
  62. Schuurs, A. H. B., & Hoogstraten, J. (1993). Appraisal of dental anxiety and fear questionnaires: A review. Community Dentistry and Oral Epidemiology, 21, 329–339.CrossRefPubMedGoogle Scholar
  63. Sheiham, A., Maizels, J., Cushing, A., & Holmes, J. (1985). Dental attendance and dental status. Community Dentistry and Oral Epidemiology, 13, 304–309.CrossRefPubMedGoogle Scholar
  64. Skaret, E., Raadal, M., Kvale, G., & Berg, E. (1999). Dental anxiety and dental avoidance among 12–18-year olds in Norway. European Journal of Oral Sciences, 107, 422–428.CrossRefPubMedGoogle Scholar
  65. Skaret, E., Raadal, M., Kvale, G., & Berg, E. (2000). Factors related to missed and cancelled dental appointments among adolescents in Norway. European Journal of Oral Sciences, 108, 175–183.CrossRefPubMedGoogle Scholar
  66. Solberg, P. A., & Halvari, H. (2009). Perceived autonomy support, personal goal content, and emotional well-being among elite athletes: Mediating effects of reasons for goals. Perceptual and Motor Skills, 108, 721–743.CrossRefPubMedGoogle Scholar
  67. Solberg, P. A., Halvari, H., & Ommundsen, Y. (2009). Psychological well-being: The importance of autonomy support and basic needs satisfaction in physical exercise among elderly. Oslo: The Norwegian School of Sport Sciences, Unpublished.Google Scholar
  68. Svarstad, A. M. (2007). Cardiac rehabilitation: Perceived autonomy support, motivation for physical activity, and physical exertion. Oslo: NIH, Master Thesis.Google Scholar
  69. Teixeira, P. J., Going, S. B., Houtkooper, L. B., Cussler, E. C., Metcalfe, L. L., Blew, R. M., et al. (2006). Exercise motivation, eating, and body image variables as predictors of weight control. Medicine and Science in Sports and Exercise, 38, 179–188.CrossRefPubMedGoogle Scholar
  70. ter Horst, G., & de Wit, C. A. (1993). Review of behavioral research in dentistry 1987–1992: Dental anxiety, dentist-patient relationship, compliance and dental attendance. International Dental Journal, 43, 265–278.PubMedGoogle Scholar
  71. Utistog, M. (2007). Motivasjon for fysisk aktivitet hos langtidssykemeldte ved 4 ukers arbeidsrettet rehabilitering. [Autonomously supportive clinic rehabilitation after long term sickness: Its effects on change in motivation, perceived autonomy and competence support, change in physical activity and future perceived competence to exercise regularly.] Oslo: NIH, Masteroppgave.Google Scholar
  72. Van der Weijden, G. A., Timmermann, M. F., Nijboer, A., Lie, M. A., & Van der Velden, U. (1993). A comparative study of electric toothbrushes for the effectiveness of plaque removal in relation to toothbrushing duration. Timer-study. Journal of Clinical Periodontology, 20, 476–481.CrossRefPubMedGoogle Scholar
  73. Vassend, O. (1993). Anxiety, pain and discomfort associated with dental treatment. Behaviour Research and Therapy, 31, 659–666.CrossRefPubMedGoogle Scholar
  74. Viinikangas, A., Lahti, S., Yuan, S., Pietilä, I., Freeman, R., & Humphris, G. (2007). Evaluating a single dental anxiety question in Finnish adults. Acta Odontologica Scandinavica, 65, 236–240.CrossRefPubMedGoogle Scholar
  75. Vlachopoulos, S. P., & Michailidou, S. (2006). Development and initial validation of a measure of autonomy, competence, and relatedness in exercise: The Basic psychological needs in exercise scale. Measurement in Physical Education and Exercise Science, 103, 179–201.CrossRefGoogle Scholar
  76. Wardle, J. (1982). Fear of dentistry. British Journal of Medical Psychology, 55, 119–126.PubMedGoogle Scholar
  77. White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297–333.CrossRefPubMedGoogle Scholar
  78. WHO. (1986). Ottawa charter for health promotion. Genève: WHO/HPR/HEP/95.1.Google Scholar
  79. Williams, G. C., Cox, E. M., Kouides, R., & Deci, E. L. (1999). Presenting the facts about smoking to adolescents: The effects of an autonomy supportive style. Archives of Pediatrics and Adolescent Medicine, 153, 959–964.PubMedGoogle Scholar
  80. Williams, G. C., & Deci, E. D. (1996). Internalization of biopsychosocial values by medical students: A test of self-determination theory. Journal of Personality and Social Psychology, 70, 767–779.CrossRefPubMedGoogle Scholar
  81. Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998a). Supporting autonomy to motivate glucose control in patients with diabetes. Diabetes Care, 21, 1644–1651.CrossRefPubMedGoogle Scholar
  82. Williams, G. C., Grow, V. M., Freedman, Z., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology, 70, 115–126.CrossRefPubMedGoogle Scholar
  83. Williams, G. C., McGregor, H. A., Sharp, D., Levesque, C., Kouides, R. W., Ryan, R. M., et al. (2006). Testing a self-determination theory intervention for motivating tobacco cessation: Supporting autonomy and competence in a clinical trial. Health Psychology, 25, 91–101.CrossRefPubMedGoogle Scholar
  84. Williams, G. C., McGregor, H. A., Zeldman, A., Freedman, Z. R., & Deci, E. L. (2004). Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychology, 23, 58–66.CrossRefPubMedGoogle Scholar
  85. Williams, G. C., Rodin, G. C., Ryan, R. M., Grolnick, W. S., & Deci, E. L. (1998b). Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychology, 17, 269–276.CrossRefPubMedGoogle Scholar
  86. Wisløff, T. F., Vassend, O., & Asmyhr, O. (1995). Dental anxiety, utilisation of dental services, and DMFS status in Norwegian military recruits. Community Dental Health, 12, 100–103.PubMedGoogle Scholar
  87. Woolgrove, J., & Cumberbatch, G. (1986). Dental anxiety and regularity of dental attendance. Journal of Dentistry, 14, 209–213.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Anne E. Münster Halvari
    • 1
    Email author
  • Hallgeir Halvari
    • 2
  • Gunnar Bjørnebekk
    • 3
  • Edward L. Deci
    • 4
  1. 1.Faculty of Odontology, Department of Dental Hygienist EducationUniversity of OsloOsloNorway
  2. 2.Buskerud University CollegeBuskerudNorway
  3. 3.The Norwegian Centre for Child Behavioral DevelopmentOsloNorway
  4. 4.University of RochesterRochesterUSA

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