The Premack principle, self-monitoring, and the maintenance of preventive dental health behaviour
Creators: name: Ramer, Donald Gordon
Publisher: name: University of British Columbia
Year: 2010

description: Preventive dental programs designed to reduce the incidence of gingivitis and periodontal disease have met with only limited success. The advent of behavioural technology offered a possible application to this problem. The present study examined the effects of two behavioural techniques, the Premack Principle and self-monitoring, on the maintenance of preventive dental health behaviour. Experiment 1 attempted to determine the validity of the Premack Principle using both toothbrushing and flossing as instrumental and contingent responses. Twelve female students of a dental assisting instructional program were exposed to various baseline and contingency conditions of brushing and flossing, daily for 11 weeks, according to a single-subject reversal design. When access to the contingent response was prevented, six of the twelve subjects showed a reliable increase in instrumental responding. Compared to baseline performance, six of seven subjects and four of twelve subjects evidenced reinforcement effects due to a contingency which allowed unlimited and. limited access, respectively, to the contingent response. However, increases in instrumental responding observed during these conditions failed to surpass those observed when access to contingent responding was prevented, in all but three subjects. These results would suggest that many observed increases in instrumental responding which are often cited as evidence supporting the Premack Principle may be due in fact simply to the unavailability of the contingent response. Additional theoretical implications of these findings were discussed. Experiment 2 factorially compared two levels of the Premack Principle (contingency vs. no contingency between flossing and brushing) with three levels of self-monitoring (no SM, SM-frequency, and SM-frequency plus evaluation). Ninety first and second year university student volunteers were assigned to one of six treatment groups. Instruction in brushing and flossing technique as well as application of the appropriate experimental manipulation was provided in two instructional sessions. Subjects' oral hygiene was assessed according to a gingival index and a plaque index before, one month following, and seven months following instruction.. Repeated measures analysis of variance revealed only a significant Assessment effect. All treatment groups showed an equivalent large degree of improvement in oral hygiene from pre- to one month postinstruction. Improved plaque scores were maintained over the six-month follow-up period; gingival scores, however, were not. A no-treatment control group differed from the six treatment groups only at the one-month postinstructional assessment. These results show.that instructions to implement a contingency between flossing and brushing, and different levels of self-monitoring, failed to augment the short-term gains in oral hygiene produced by instruction in brushing and flossing technique per se. None of the experimental components differentially contributed to maintenance. A third and final experiment examined the effect of the Premack Principle on the maintenance of.effective brushing and flossing within a private dental clinic. Thirty dental patients were alternately assigned to an experimental Premack Principle group or a control group. Subjects of both groups received two sessions of individualized instruction in oral hygiene techniques. Repeated measures analysis of variance showed only a significant Assessment effect, from pre-to three months postinstruction, only for plaque, but not gingival, scores. Instructions to impose a contingency between flossing and brushing failed to produce an effect. The results of this study demonstrated that neither self-monitoring nor instructions to impose a contingency between flossing and brushing contributed to the maintenance of effective oral hygiene behaviour. Self-management programs must become more concerned with the issue of maintenance, particularly following cessation of experimental or therapeutic contact. Implications for maintenance strategies were discussed.