Background on Supportive Relationships
What are supportive relationship strategies?
- Supportive relationships interventions are programs or activities designed to increase social support for prevention of oral diseases and illnesses (e.g., cavities, gum disease, and oral cancer) through involvement with individuals, organizations and communities.
- These interventions may focus on increasing the information individuals have about oral health (e.g., brushing teeth, using fluoride, flossing, visiting oral health professionals regularly, avoiding tobacco, minimizing use of sugar and alcohol, receiving oral cancer screening, and using protective head and mouth gear during athletic events) [informational support], provide a venue for sharing experiences and feelings [emotional and appraisal support], or provide tangible support (e.g., how often to use fluoride, locations of dental care facilities, proper brushing and flossing techniques).
- In addition, such interventions provide opportunities to identify and address challenges collectively rather than individually (e.g., collective problem solving or advocacy).
- Supportive relationships interventions may help to change oral care habits in order to prevent a disease or health condition from occurring (primary prevention) or work with those who have already developed an oral disease or illness in order to decrease the negative effects of that condition through changing oral care habits (secondary prevention).
How do supportive relationships impact oral health related behaviors?
- Supportive relationships interventions are successful for many reasons, such as: individuals can ask questions or clarify what they have been told, those providing support can also provide referrals and resources to assist the individual, and longer-term relationships can help to sustain behavior change over time, among others.
How can I use supportive relationship strategies in an oral health intervention?
- Supportive relationship intervention strategies may be designed to discuss challenges, benefits and advice for improving oral health. Supportive relationships may be provided in the form of face-to-face interactions, telephone calls, or through interactive web-based systems. These interventions may include specific information as part of each call or face-to-face session, or may be more open ended and responsive to the specific needs of the individual.
Why is it important to considering tailoring in supportive relationship strategies?
- These interventions can be very successful when the support is tailored to the individual’s needs.
- In order to provide tailored advice to the individual, the person providing the support has to determine the specific challenges the individual is facing. Supportive relationships interventions may include an assessment of the individual’s health, oral care habits and related behaviors (e.g., tobacco use, sugar intake) as well as a discussion of challenges, benefits and advice for maintaining certain types of oral care habits over time.
- Supportive relationship interventions work best when the advice also takes into account the person’s gender, age, language, race or ethnicity, and other cultural factors.
What is “readiness to change” and how does it relate to supportive relationships?
- Supportive relationships interventions can be very successful when the support is tailored to individuals’ readiness to change. The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions to help them improve their oral care habits depending on their readiness. For example, individuals who are not really thinking about flossing may need information on the harmful effects of poor oral care habits whereas individuals who are ready to floss may need training on how to floss to achieve the best results. Supportive relationships may be particularly important when people are ready to improve oral care habits (i.e., supportive relationships can help to reinforce these decisions).
How do supportive relationship strategies deal with relapse?
- Often, people improve their oral care habits and then relapse, or go back to previous patterns. Supportive relationships, therefore, include information to help individuals recognize that this is not unusual and to work with individuals to develop strategies to help prevent relapse in the future (see Relapse Prevention Theory).
- It can be helpful to recognize that changes in oral care habits may happen in small steps. For example, increasing tooth brushing may be the first step, followed by increases in flossing, use of fluoride, and changes to other lifestyle behaviors (e.g., tobacco use, sugar and alcohol intake, wearing protective head or face gear during athletic events). Every individual will have preferences for what steps may be the easiest to take first, and these preferences may depend to a large extent on the support of others for these changes (e.g., family, roommates, friends, co-workers).
How have supportive relationships been used in past oral health interventions?
- Increase oral health professional support for changing oral care habits. For example, a dental hygienist can provide support to a mother of young children to decrease the amount of sugar her children consume and to improve their teeth brushing routines. Health care provider support may be offered through face-to-face interactions, letters, or telephone calls. These support efforts may be initiated by the health care provider or the client (e.g., counseling during an office visit).
- Increase school-based support for changing oral care habits. For example, peer educators can be trained to provide support through school-based activities such as athletic programs; teachers, school nurses and coaches can be trained to provide formal structured support (e.g., class sessions covering these topics) or less formal support (e.g., advice or encouragement) and family members can be encouraged to provide support through letters, newsletters or videos sent home with the students. These cues to action (see Health Belief Model) can describe or illustrate the challenges in changing oral care habits and instigate discussion between school representatives, family members and students about these struggles. Schools could include tooth brushing time after meals or break time at school.
- Increase worksite support for changing oral care habits. For example, worksites can be considered a mini-community with interventions that provide tangible support (e.g., co-workers can encourage proper tooth brushing, visiting the dentist or decreasing tobacco use), informational support (e.g., classes to improve tooth brushing or use of dental floss) and emotional and appraisal support (e.g., buddy systems, lay health advisors or team contests). Some worksite interventions have been offered by management, while others have been developed jointly through labor and management negotiations. Worksite support could include lower premiums or some type of incentive for those non-smokers or for those in smoking cessation programs.
- Increase support from faith-based organizations for changing oral care habits. To date, faith-based organizations have not been the focus of many oral health interventions, if any. Yet, faith-based organizations may, for example, help people recognize that proper oral care habits are part of the divine message through connections between the spiritual and physical being. Through health ministry and membership in the faith community, these organizations can also increase knowledge and skills about the health risks of poor oral care habits (e.g., cavities, oral cancer) or the health benefits of good oral care habits (e.g., looking and feeling better); offer oral health classes (see Group Education); include health messages as part of sermons and share testimonials from congregation members. Ministers, faith community nurses (e.g., parish nurses) and members can pray with fellow members, find resources for them, comfort them, and help to nurture them. Faith-based organizations are an ideal setting because people look to them for social support and interaction. Faith-based organizations can incorporate oral care habits as part of their mission and serve as centers of daily life, social structure and community life.
- Increase community support for changing oral care habits. For example, informational, emotional and appraisal support can be provided through telephone hot lines (e.g., program initiated calls to individuals, a call line that is made available for people to call, cards with numbers to call for oral health support). Individuals staffing these lines may be oral health personnel (e.g., dental hygienists), health educators or trained lay health advisors. Other examples of community support include the use of community role models who can speak to community members about the risks of certain oral care habits and the benefits of change.
- Increase other health care professionals support for promoting positive oral health messages. For example, other health care professionals can promote good oral health for patients by promoting dental visits, smoking cessation, etc.; pediatricians can advise moms not to share saliva for disease transmission, to not smoke with children nearby, and to take the newborn to the dentist by one year or sooner.