title: Attending and avoiding dental appointments: Do "bright" and "dark" motivational paths have a role?
abstract: OBJECTIVE
  The aim of this study was to test a self-determination theory (SDT) process model of the "bright" and the "dark" motivational pathways through dental attendance or avoidance to oral health.
  
  
  METHODS
  A cross-sectional study was conducted among 322 students from all study disciplines at the University of Oslo. Participants responded to a survey with validated questionnaires. Structural equation modelling was used to test the SDT model, and a bootstrapping procedure was used to test the indirect links in the model.
  
  
  RESULTS
  Along the "bright" path: Autonomy support at the dental clinic was positively associated with need satisfaction in treatment, which was positively associated with autonomous motivation for dental treatment and reappraisal of dental anxiety. Further, autonomous motivation was positively related to dental attendance, which in turn predicted oral health. Also, both autonomous motivation and reappraisal of anxiety were negatively related to avoiding dental appointments. Along the "dark" path: Conditional regard at the dental clinic positively predicted need frustration in treatment, which positively predicted dental anxiety. In turn, dental anxiety positively predicted avoiding appointments, along with the negative predictions by autonomy and anxiety reappraisal. Finally, oral health was negatively predicted by avoiding appointments. A bootstrapping procedure indicated that all indirect links in the model were supported. A SEM fit the data very well.
  
  
  CONCLUSIONS
  Because of the high level of explained variances for dental attendance (42%) and avoiding dental appointments (52%), promoting autonomy support and avoiding conditional regard at the dental clinic may be important for patients' oral health.
authors.affiliation: University of Oslo, Oslo, Norway.
authors.forename: A E
authors.identifier: http://orcid.org/0000-0001-5506-4704
authors.initials: AE
authors.lastname: Münster Halvari
authors.affiliation: University College of South-East Norway, Hønefoss, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Halvari
authors.affiliation: University College of South-East Norway, Hønefoss, Norway.|University of Rochester, Rochester, NY, USA.|Australian Catholic University, Strathfield, NSW, Australia.
authors.forename: E L
authors.initials: EL
authors.lastname: Deci
mesh_terms: D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009664:Norway; D010349:Patient Compliance; D026684:Personal Autonomy; D011795:Surveys and Questionnaires
keywords: Self-determined motivation; avoiding dental appointments; dental anxiety; dental attendance; oral health; reappraisal of dental anxiety