There is no question, most people floss less than recommended and, in some cases, not at all. Emerging research indicates that self-regulatory and automatic factors play a role in oral hygiene behaviors. A study published in 2018 in the journal Psychology, Health & Medicine investigated “the role of normative support, behavioral automaticity, and action control in predicting dental flossing behavior.”1
For clarification the authors included a definition for automatic action, “a process by which, as a consequence of repeated action in stable contexts, learned cue-response associations are formed so that cues automatically trigger behavior.” This allows for minimal mental effort to perform a behavior, in this case flossing. This eliminated the need to consciously remind oneself to complete a task.
The study included a sample size of 629 participants (women = 485 and men = 135). The participants were followed, and data was collected for a 5-month period. Participants completed a baseline questionnaire and a two week follow up phone interview. Participants were assessed on normative support (friends and family flossing habits), action control (intent and effort to floss), behavior automaticity (is flossing automatic or need conscious effort), and past and follow-up behavior (flossing habits of the past and present).
The study results showed normative support (perceiving friends use dental floss) is important in the acquisition of flossing habits. This is consistent with prior studies that show social influence plays a large role in how young adults decide to behave. The authors go on to state social perceptions may play a role in cues to automatic action. Automaticity is helpful in enabling behavior to persist even when self-regulatory is depleted.
However, people with high action control do not need automaticity as these individuals consciously monitor their behavior. This study indicates only automaticity or action control are necessary to successfully implement dental flossing. Effects of normative support are associated with the value of the action control. This leads to two options for successfully implementing dental flossing, 1) instructing patients to engage in behavioral monitoring or 2) promote repetition, such as flossing in the same location or at a particular time of day.
An example of this type of guidance would be encouraging patients to make a commitment to floss on a particular day at a particular time, then add a day every few weeks. This type of goal setting encourages automaticity and action control in hopes that one or the other will develop into a successful flossing habit.
The authors conclude by stating, “while mediation analysis makes causal assumptions, in the current study causality cannot be proven; thus, causal interpretations should be made carefully. Overall, the current study extends previous research to further elucidate the self-regulatory and automatic mechanisms that govern oral hygiene behavior.”
Have you found a successful mediation technique that encourages changes in oral hygiene habits? Would you consider implementing one that reflects the findings in this study? Can you recognize automaticity or action control in your own oral hygiene habits?
- Hamilton K, Orbell S, Bonham M, Kroon J, Schwarzer R. Dental flossing and automaticity: a longitudinal moderated mediation analysis. Psychol Health Med. 2018;23(5):619-627. doi:10.1080/13548506.2017.1381339
