Dental hygienist, writer and speaker Linda Douglas, who lives in Canada, ponders the value of dental hygienists conducting research in their practice.

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Roles of the dental hygienist

The key responsibilities of dental hygienists1 include health promotion, education, clinical therapy, research, change agent, and administration. We are familiar with some of these roles, especially clinical therapist and educator. The roles of researcher and change agent are not as widely fulfilled, yet they are vital to advance the profession and improve the health of the public. Most hygienists underestimate their abilities regarding these aspects of the profession, when in fact they are far more capable than they realise.

I had pondered the possible value of dental hygienists conducting research in their practice for some time; partly due to my inquisitive nature, and also because I had read about concerns regarding the paucity of research by dental hygienists.

In 2007 I attended a workshop on dental hygiene research at the International Federation of Dental Hygienists'2 symposium, where I asked a well-known dental hygiene educator about the possibility of hygienists in clinical practice conducting research; she replied: 'You need a Master's degree to conduct research, and there are few hygienists with Master's degrees'.This was rather disappointing to hear, but another speaker, Dr Ken Eaton, was quite encouraging; he mentioned the Faculty of General Dental Practice3 in the United Kingdom, which was committed to supporting general dentists who want to conduct research. That's when I realised it was possible for the clinical dental hygienist to do research as well. This became a reality in 2012, when I commenced my studies at O'Hehir University4 for a Bachelor of Science degree in oral health promotion. I was introduced to these three significant concepts: reflective practice,5 action research6 and health behaviour change.7

What is reflective practice?

Reflective practice is the ability to reflect on our actions in order to engage in the process of continuous learning. Action research questions stem from reflections on our work with the aim to improve outcomes.

Action research is 'research in action'

Researchers generate new ideas and knowledge. There are various types of research methodology: the types most familiar to us from reading research journals come under the umbrella of basic research. Basic research differs from action research in that it does not necessarily have any immediate application. The aim of basic research is to amass knowledge and better understand some phenomenon. For example: a research study to increase understanding of the pathophysiology of a particular disease is basic research.

Action research differs from basic research in that it is a form of applied research: its purpose is to solve problems and improve practice. It is reflective, dynamic and responsive;8 so, if an action is not successful, we try another until we find one which works. Action research is conducted by the practitioner, and it is participatory:9 instead of having subjects on whom we conduct research, we have participants in our research; the researcher also participates through their actions.

Any practitioner can do action research because it is conducted in the workplace without disrupting the workflow.

Any practitioner can do action research because it is conducted in the workplace without disrupting the workflow. The action researcher is a practitioner-researcher who improves their practice, and generates knowledge by describing how they have improved it;10 therefore, research is not just the domain of those in academia. We don't have to wait for others to conduct research and provide us with new knowledge: we can create new knowledge,11 transfer it into our practice, and share it with others. Action research empowers the practitioner, benefits patients and often has a positive ripple effect on the entire workplace in terms of elevating practice standards, and boosting morale.

There are differing perspectives on action research in various professions, such as nursing, social work and education; it is also evolving to suit the needs of the dental team. The dental team needs more focus on action research that improves oral health by facilitating health behaviour change, in addition to implementing novel clinical therapies and oral hygiene aids.

The importance of health behaviour change

Changing health behaviours is notoriously difficult. Some prime examples include how we have all been educated on the health benefits of regular exercise, but numerous individuals are sedentary. Almost everyone knows smoking is the leading preventable cause of death12,13in Britain and the United States of America, yet many people continue to smoke. Most of us are also aware that consuming sugar increases risk of diabetes,14 caries15 and inflammatory diseases such as periodontal disease,16 but such awareness frequently fails to deter the behaviour. These examples clearly demonstrate that knowledge alone is not an effective motivator for changing health behaviour.

Although genetics17 plays a part in susceptibility of some individuals to certain oral diseases such as periodontal disease,18 most oral disease is related to behaviours19 such as poor nutrition,20sugar consumption,21 smoking,22 and failure to achieve effective daily biofilm removal or disruption.23 We know it is possible despite genetic risk factors to achieve and maintain a healthy periodontium with effective daily self-care and clinical therapies.

We can educate our patients about oral disease, and instruct them in the use of the products we recommend; however, there is one fundamental truth: the only oral hygiene aids thatwork, are the ones they actually use. We only see our patients for an hour every three or six months, so their daily self-care is more significant than what happens in our chair. Consequently, changing oral health behaviour is a crucial factor in improvement and lasting maintenance of oral health.

Our patients are experts too! The benefits of listening instead of instructing

While we are experts in clinical therapies and oral health counselling, our patients are experts on their lives, their capabilities, what they value, and what they want. Listening to our patients rather than just educating them is the key to finding what motivates them. By utilising motivational interviewing techniques such as asking open-ended questions and actively listening to our patients, we facilitate their autonomy, and develop a rapport. These conversations tell us how much they value their oral health, and the extent of their knowledge about their oral health issues: then we can offer to add to their knowledge by sharing further information. Asking permission to share information enhances their receptiveness to our message.

Once our patients become aware of the incongruence between what they value (such as a nice smile, and healthy mouth) and their current health behaviours and they are ready to change, they can tell us what their goals are. We then collaborate to help them decide what they are prepared to do to achieve their goals. They can also choose solutions to address any barriers and ensure their environment is conducive to successful change, such as ridding their home of sugary foods and drinks, or using smartphone apps as reminders. This active involvement of our patients in the decision-making process enhances their self-efficacy, and improves their chances of success.

Health behaviour change requires a personalised approach, therefore implementing appropriate health behaviour change methods is vital to any action research project that aims to improve oral health outcomes.

I am a firm believer in education, and I am amazed at the opportunities I have had so recently to support patients, colleagues and students.

You can do it!

Most dental hygienists initially find the prospect of conducting research quite daunting; nevertheless, we are all practitioner-researchers. We conduct action research day-to-day every time we reflect on a problem in our practice and implement new improvement strategies. This 'research in action' is really action research, only we don't always formalise it and write it up in a paper. Successfully conducting our own research and communicating an account of the process and outcome instigates changes which benefit the wider community beyond our own practice: this is the essence of health promotion.24

The following are abstracts of two action research papers by dental hygienists who recently graduated with their Bachelor of Science degree in Oral Health Promotion.