title: Comparison of three forms of teaching - a prospective randomized pilot trial for the enhancement of adherence.
abstract: OBJECTIVE
  Adherence of young adults to preventive programmes is low. The following study compares three different educational concepts to increase toothbrushing adherence in young adults.
  
  
  METHODS
  Nine vocational school classes (157 young adults) were randomly assigned to three different 60-min approaches: (I) Education by a dentist, (II) Peer-teaching and (III) 'Adherence triangle concept' uniting dentists, teachers and participants as equal partners in intervention planning combined with peer teaching. Follow-up was 1 week for approaches I and II, and 1 week, 3 and 9 months for approach III. Adherence was defined as reported change from the childhood toothbrushing technique to adult technique. Adherence was evaluated using anonymous questionnaires and by diary analysis.
  
  
  RESULTS
  After instruction, 90% of participants (approaches I-III) showed the desired behaviour in practice and theory. Reported adherence after 1 week with approach I was 28.5%, with approach II 39% and with approach III 95%. Prolonged follow-up of approach III yielded 76% after 3 months and 68% after 9 months. Adherence using approach III was significantly higher (P ≤ 0.001) than using approach I and II after 1 week. Adherence rates with approach III after 9 months were still higher than those of approaches I and II after 1 week.
  
  
  CONCLUSIONS
  The 'adherence triangle' concept enhanced reported adherence significantly in comparison with previous studies and the one-dimensional concepts of approaches I and II. The tools of the adherence triangle concept seem worthwhile to be considered when planning new preventive action.
authors.affiliation: Department of Biology Teaching, State Teacher Training Center, Köln, Germany. drcreinhar@aol.com
authors.forename: C H
authors.initials: CH
authors.lastname: Reinhardt
authors.forename: M J
authors.initials: MJ
authors.lastname: Noack
authors.forename: G
authors.initials: G
authors.lastname: Wassmer
authors.forename: J
authors.initials: J
authors.lastname: Dumit
authors.forename: A
authors.initials: A
authors.lastname: Rolfs
authors.forename: K
authors.initials: K
authors.lastname: Klein
mesh_terms: D001294:Attitude to Health; D003726:Dental Assistants; D003812:Dentist-Patient Relations; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008499:Medical Records; D009042:Motivation; D009909:Oral Health; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic; D010358:Patient Participation; D010379:Peer Group; D010865:Pilot Projects; D011369:Professional-Patient Relations; D011446:Prospective Studies; D057566:Self Report; D012923:Social Class; D013663:Teaching / Q000379:methods*; D014099:Toothbrushing; D055815:Young Adult