Measuring Readiness to Change Dental Avoidance: "Contemplation Ladder" Pilot Results

Objectives: Dental avoidance may be modifiable by Motivational Interviewing (MI). MI tailors interventions to match each patient's readiness to change behavior. It would be desirable to develop a simple scale to assess a patient's readiness to change dental avoidance.

Methods: A “Contemplation Ladder” previously validated to assess readiness to cease cigarette smoking was modified to assess readiness to go to a dentist. In one sample, 85 adolescents completed the Dental Neglect Scale (DNS) and, if they did not go to the dentist, the modified Ladder. In a second sample, 18 adolescents and young adults (aged < 26) with high levels of caries (indicating that they had not been to a dentist despite obvious need) completed the modified Ladder and were followed for three months to determine if they had sought out dental care.

Results: In the first sample, adolescents who do not go to the dentist had higher DNS scores compared with peers who do go (t = 3.54, df = 83, p = 0.001). Non-attendees who most strongly endorsed the DNS item “I consider my dental health to be important” also chose Ladder options more indicative of readiness to go to a dentist ( r = 0.513, p = 0.017). In the second sample, those who endorsed a higher Ladder option of readiness to go to a dentist were more likely to have actually decided to go to a dentist by the three month follow-up, in a trend which approached significance (t = 2.069, df = 4.47, p = 0.05).

Conclusions: According to these pilot findings, the modified Ladder appears to have construct and criterion validity, and should be tested in larger samples.

Supported by NIH/NIDCR grants DE016952, T32DE07132, & U54 DE14254.