title: Combining self-management cues with incentives to promote interdental cleaning among Indian periodontal disease outpatients.
abstract: BACKGROUND
  Periodontal disease is a significant public health issue worldwide. Motivational techniques in combination with financial incentives are shown to lead to effective behavior change. The current study sought to examine whether a brief oral health promotion program (self-management cues that were based on self-efficacy and self-regulatory skills) in combination with an incentive (free dental treatment) would make a difference in the adoption of regular dental flossing in a population of Indian periodontal disease outpatients.
  
  
  METHODS
  One hundred and twelve participants (n = 55 oral health promotion intervention group; n = 57 control group) were assigned to the intervention (self-management cues + incentive) or control groups, and follow-up assessments were performed three weeks later. Flossing frequency, behavioral intentions, and perceived self-efficacy served as dependent variables. Data were analyzed with mixed models, ANCOVAs, and path analyses.
  
  
  RESULTS
  The intervention yielded effects on flossing frequency (p < 0.01) and flossing intentions (p < 0.01) at follow-up. Women developed stronger intentions than men. Moreover, by path analysis a sequential mediation chain was found that demonstrated an indirect effect of the intervention on flossing via self-efficacy and intentions: the intervention predicted changes in self-efficacy which, in turn, were associated with changes in intentions, predicting flossing frequency at follow up, while controlling for baseline behavior, gender, and age.
  
  
  CONCLUSIONS
  Combining incentives with minimal self-management cues has been found effective in improving interdental cleaning intentions and habits in periodontal disease patients, and the facilitating role of dental self-efficacy has been demonstrated.
authors.affiliation: Department of Psychology, Freie Universität Berlin, Berlin, Germany.
authors.forename: Pempa
authors.initials: P
authors.lastname: Lhakhang
authors.affiliation: Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.|School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia.
authors.forename: Kyra
authors.initials: K
authors.lastname: Hamilton
authors.affiliation: Himachal Pradesh Govt. Dental College & Hospital (IGMC), Shimla, India.
authors.forename: Nayantara
authors.initials: N
authors.lastname: Sud
authors.affiliation: Department of Psychology, St. Bede's College, Himachal Pradesh University, Shimla, India.
authors.forename: Shonali
authors.initials: S
authors.lastname: Sud
authors.affiliation: Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Kroon
authors.affiliation: Department of Psychology, Freie Universität Berlin, Berlin, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Knoll
authors.affiliation: Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia. ralf.schwarzer@acu.edu.au.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schwarzer
mesh_terms: D003463:Cues; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007194:India; D008297:Male; D009042:Motivation; D009910:Oral Hygiene; D010045:Outpatients; D010510:Periodontal Diseases / Q000628:therapy*; D012648:Self Care
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