The hidden factors behind oral health behaviours

Dental Tribune International

Thu. 11. July 2024

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The final day of this year’s International Symposium on Dental Hygiene (ISDH), will start with a fascinating plenary session featuring Prof. Nam-Hee Kim of the Department of Dental Hygiene at Yonsei University. Based on her research interests in the social, economic and political factors underlying oral health outcomes, Prof. Kim’s talk will elaborate upon several specific clinical and public health strategies that can help mitigate a range of entrenched patient habits. In this interview with Dental Tribune International, she shares some insights into her presentation and ongoing research.

Prof. Kim's research portfolio had helped to cast new light on how people's oral health decisions are powerfully shaped by a range of often overlooked factors. (Image: IFDH)

Your current research explores the intersection of behavioural economics and public oral health. What is the significance of this connection, and what outcomes can research in this area yield for patients and public health in general?
Behavioural economics in the context of oral health provides valuable insights into how individuals make health-related decisions. By understanding the cognitive biases and decision-making processes that influence behaviours, we can design interventions and public health policies that are more effective. This research can lead to improved patient outcomes by encouraging preventive behaviours and better adherence to dental care recommendations, ultimately reducing the incidence of oral disease and promoting overall public health.

According to your current understanding, what are some of the psychosocial and behavioural factors that prevent people from maintaining healthy dental care practices, and how might these be redressed?
Several psychosocial and behavioural factors hinder individuals from maintaining healthy dental care practices. One significant factor is explained by the dual process theory, according to which people have two systems of thinking: System 1, which is fast, impulsive and emotional; and System 2, which is slow, deliberative and logical. Often, immediate desires and comfort drive System 1, leading to decisions like skipping brushing owing to tiredness, despite knowing the long-term benefits of oral hygiene. Present-biased preferences also play a role, immediate rewards being favoured over long-term benefits, making it difficult for individuals to maintain healthy practices consistently. For instance, people may choose to indulge in sugary snacks now, even though they know it will harm their oral health in the future. Additionally, emotional states and commercial advertising may compound these biases, making unhealthy choices more appealing. To address these issues, we can implement strategies like simplifying health messages, using emotional and visual appeals in our communication and creating supportive environments that make healthy choices more convenient and attractive.

Your paper sheds light on what you call the gap between knowledge and action in oral health. What is the nature of this gap, and how might it be closed?
The gap between knowledge and action in oral health refers to the discrepancy between what people know about maintaining good oral health and their actual behaviours. This gap exists because, even though individuals may understand the importance of oral hygiene practices like brushing, flossing and regular dental visits, they often fail to act accordingly owing to their cognitive biases and emotional factors. For example, people may intend to maintain good oral hygiene (System 2 thinking), but when they are tired or stressed, they may opt for immediate comfort, such as going to bed without brushing their teeth (System 1 thinking). To close this gap, we need to redesign interventions to make healthy behaviours easier and more automatic. This can be achieved by using behavioural cues to create habits, by making healthy choices the default option, by leveraging social norms to influence behaviour and by employing frameworks like CAN (convenient, attractive, normative). By integrating these strategies, we can help individuals consistently follow through with healthy oral practices and achieve better health outcomes.

Editorial note:

Prof. Kim’s presentation, titled “A behavioural economic approach to dental hygiene: redesigning oral health interventions,” will take place on 13 July at 9:00 a.m. in the Auditorium.