The impact of oral health risk indicator labels on prevention uptake

Objectives: Informing patients about their disease risk may initiate behaviour change. Proposed changes in NHS dentistry (England) include the use of red, amber and green (RAG) oral health risk indicators for patients as part of a mandatory oral health assessment. These labels might have several different effects, including impacts on how patients engage with services as well as personal (home based) preventive interventions. This study aims to investigate the impact of oral health risk labelling (RAG) on patients’ understanding of risk and their motivation towards preventive behaviours.

Methods: Semi-structured qualitative interviews were conducted with patients (11 Males & 9 Females, range: 22-83 yrs, avg: 40yrs) attending Newcastle Dental Hospital who had been given results of a RAG assessment. A focussed topic guide covered: Previous dental experiences, experience, emotional response and views on the presentation of RAG and intention to change behaviour. Interviews were recorded, transcribed and analysed using thematic analysis.

Results: Findings suggest a range of different understandings of the risk assessment, attitudes towards risk reduction behaviours, and preferences for presentation of risk information. The colour system was seen as a series of “stages”. Patient responses towards their oral health behaviour on receiving risk information included statements of intent and feelings of empowerment. – Aesthetics and a desire to change oral health emerged as their main motivating factors. The concept of shared responsibility emerged as an important aspect, with expectations of oral health care providers and of themselves differing between patients.
Conclusions: The data provides an insight into patients’ explicit understanding of the RAG score assigned to their risk. The RAG system has the potnetial to eilicit emotional responses which can create an intention to change behaviour, but with mixed views on responsibility. Nevertheless, the evidence suggests that improved understanding of risk can help improve patient engagement in preventive behaviour.