published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Paediatric Dentistry / Master / Master of Dental Surgery

Stress inoculation training has been suggested as a viable approach to the treatment of such stress-related behaviors as self reported distress, physiological arousal, and behavioral avoidance. Previous research has concluded that training in coping skills constitutes the"active ingredient" of the treatment package, while education about the nature and effects of stress is not sufficient to produce behavior change. The data-base supporting these conclusions however, is composed primarily of experimental results with analogue or non clinical populations. The present study was designed to compare the relative effectiveness of stress inoculation training and stress education in reducing stress related behaviors in a population confronting a personally relevant stressor. The study utilized a four group repeated measures design which included two treatment groups composed of subjects who were fearful of dental procedures (stress inoculation and stress education) and two control groups. The high fear no treatment control group was also composed of subjects who were fearful of dental procedures but were unable to participate in treatment because of scheduling difficulties. The low fear validation.control subjects were included in order to validate the dependent measures utilized in the study with respect to their ability to discriminate high fear from low fear individuals. Subjects were 13 adult males and 19 adult females. All high fear subjects were either self-referred, referred by their personal dentists, or identified as fearful of dental procedures by their responses to the Dental Anxiety Scale, using a score of one standard deviation above the mean as the criterion for inclusion. Low fear subjects all scored at least one standard deviation below the mean of the same scale. Analysis of covariance, using pre-treatment scores as the covariate, indicated that stress inoculation subjects differed from high fear controls at treatment on the variables of trait anxiety, overall rating of fear of dentistry, number of negative self-statements. the anticipation factor of the Dental Fear Survey, and the behavioral avoidance test. Stress education subjects did not differ from high fear controls on any measure at post treatment. Analysis of covariance aJso indicated however, that there were no significant differences between stress inoculation training and stress education at posttreatment. Because of the regression model's poor fit in the analysis of covariance for the plasma cortisol values (R-square=.12) a repeated measures analysis of variance was utilized for that variable. Results indicated that both stress inoculation and stress education subjects showed significant reductions in plasma cortisol values from pre treatment to post treatment assessment. A small and statistically insignificant reduction was observed for high fear no treatment control subjects. A 10-month follow-up revealed that 100 percent of both the stress inoculation and stress education subjects had seen a dentist whereas only 60 percent of the high fear control subjects had made and kept a dental appointment. Results are discussed in terms of the relative efficacy of the two treatment procedures for use with fearful dental patients and findings are related to predictions generated by Bandura's theory of self-efficacy. / Ph. D.

Orientador: Antonio Bento Alves de Moraes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T18:51:34Z (GMT). No. of bitstreams: 1 Drugowick_RayenMillanao_D.pdf: 965418 bytes, checksum: 78d58d7485a59a0f72f4f9fefbf6c5c1 (MD5) Previous issue date: 2011 / Resumo: O objetivo deste estudo foi avaliar o comportamento do dentista e da criança em sessões seqüenciais de atendimento odontológico com utiliza¿.o de contenção física (CF). Participaram um dentista e seis crianças, que apresentavam comportamentos n.o-colaborativos, com 4 a 5 anos de idade. Estas foram distribuídas aleatoriamente nas condições; A, B e C; que tinham seis, sete e oito sessões, respectivamente. A dentista podia utilizar qualquer estratégia de manejo do comportamento. Era permitido ao dentista utilizar CF na 3ª e 5ª sessão na condição A; na 4ª e 6ª na Condição B e na 5ª e 7ª na Condição C. As 42 sessões foram filmadas e as respostas dos participantes categorizadas em intervalos de 15 segundos. Os dados foram apresentados em taxas de respostas por minuto por sessão (Capítulo 1) e taxa de respostas por minuto acumulada por rotina (Capítulo 2). No Capítulo 1, participaram um dentista e três crianças e teve o objetivo de identificar os efeitos da CF sobre o comportamento do dentista e da criança. Pode-se observar que a Recusa das três crianças diminuíram e que Choro e Reclamação aumentaram no decorrer das sessões. O dentista empregou CF em todas as sessões, de todas as crianças, em que esta era permitida, at. mesmo em sessões em que as taxas de recusa da criança eram menores em relação ao choro. Concluiu-se que a CF foi uma estratégia aversiva para o dentista e para as crianças. No Capítulo 2, que participaram um dentista e outras três crianças e objetivou analisar funcionalmente os comportamentos do dentista frente aos comportamentos de não colaboração da criança durante o atendimento odontológico, com ou sem o uso de contenção física, observou-se que a estratégia mais utilizada pelo dentista foi explicação (em todas as sessões) e CF (nas sessões com permissão de CF). Após o uso de CF, as respostas de choro iniciaram. O profissional não conseguiu discriminar os comportamentos de recusa e choro e utilizou CF até mesmo nos momentos em que as taxas de recusa, mais prováveis de impedir a execução do tratamento, eram menores do que as de choro. Pode se concluir que a estratégia de instrução não foi eficaz na produção de comportamentos de colaboração nas crianças e que a CF foi aversiva, já que reduziu os comportamentos que impediam a realização do tratamento e produziu reações emocionais e de protesto. No geral, pode se concluir que a estratégia utilizada pelo dentista para modificar o comportamento da criança foi a CF. Para todas as crianças, a contenção física mostrou-se ser uma estratégia aversiva que ocasionou respostas emocionais e não permitiu a aquisição de comportamentos de colaboração com o tratamento. Para o dentista, a contenção física também foi aversiva e não permitiu que este emitisse comportamentos que poderiam favorecer a colaboração da criança. A estratégia mais utilizada pelo dentista nas sessões em que estava, ou não, impedido de empregar a contenção física, não foi eficaz na produção de comportamentos que permitissem a realização do tratamento / Abstract: The aim of this study was to evaluate the dentist's and the child's behavior in dental care sessions utilizing physical restraint (PR). One dentist and three children (P1, P2 and P3) who presented non-cooperative behavior, aged 4 and 5 years old, participated in this study. They were randomly assigned in the conditions A, B and C, which contained 6, 7 and 8 sessions, respectively. PR (condition A) could occur in the 3rd and 5th session, in the 4th and 6th session (B) and 5th and 7th session (C). The sessions were filmed and the participant's responses were categorized in every 15 seconds. The data was presented in response rate per minute. In Chapter 1, one dentist and three children participated and the aim was to identify the effects of PR on dentist's and child's behavior. It was possible to observe that the children's refusal to cooperate decreased, and that crying and complaining increased throughout the sessions. The dentist used PR in all the session in which it was allowed, even in sessions where the refusal rate of the child was lower than the crying rate. PR proved to be aversive and its use is not recommended as a psychological strategy. In Chapter 2, one dentist and three children participated and the purpose was to functionally describe the dentist's behaviors based on the child's non-cooperation conduct during dental treatment, with or without the use of PR. It was observed that the strategy used by the dentist was more explanation and PR. After the use of PR, the children started to cry. The professional failed to discriminate the behaviors of refusal and cry and used PR even at situations in which the rates of refusal, most likely to preclude the treatment, were lower than those of crying. It can be concluded that the strategy instruction was not effective and that the PR was aversive, since it reduced the behaviors that precluded the treatment and produced emotional reactions and protest. In general, it can be concluded that the strategy used by the dentist to modify the child's behavior was PR. For all children, PR proved to be an aversive strategy and did not allow the acquisition of compliance behaviors with treatment. For the dentist, PR was also aversive and did not allow the acquisition of behaviors that could facilitate child's cooperation. The most common strategy used by the dentist in the sessions with and without PR was instruction. This was not effective in producing behaviors that allow treatment accomplishment / Doutorado / Saude da Criança e do Adolescente / Doutor em Ciências

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: Patient-provider communication has been studied extensively in the last two decades, and many researchers have confirmed the importance of communication between patient and provider in medical contexts. In spite of increased research in patient-provider communication in dentistry, dental care providers still report that patients often do not accurately follow oral health recommendations. Thus, there is the need for additional study on how patients make sense of the oral health information they receive and how they translate that information into action. This study aimed to obtain insight into how dental care patients perceive and make sense of the information they receive from their dentist and how they translate that information into action. Methods: 16 patients and 8 dentists from Indiana School of Dentistry’s (IUSD) Graduate Prosthodontic Clinic in Indianapolis, Indiana were included. Two in-depth interviews, one immediately following the dental visit and one 7-10 days later, were conducted with the patients, and one short interview was conducted with each patient’s dental care provider. Interviews were audio taped and transcribed. Results: The results show both patients and providers perceived the interaction during consultation positively. The majority of patients were able to accurately recall information they received from their dentists and made sense of new information through the lens of their previous experiences. Four additional factors that explain patients’ adherence with health advice were also found in addition to the previous studies. Conclusions: Successful dentist-patient interaction could be thought of as a match between what dentists think patients need to know, what patients think they want/need to know, and what patients actually know. Thus, some barriers that can keep dentists and patients from reaching information equilibrium are discussed. The study concludes by offering practical and theoretical implications.