Background: Periodontal disease is a significant public health issue worldwide. Motivational techniques in\ncombination with financial incentives are shown to lead to effective behavior change. The current study\nsought to examine whether a brief oral health promotion program (self-management cues that were based\non self-efficacy and self-regulatory skills) in combination with an incentive (free dental treatment) would make a\ndifference in the adoption of regular dental flossing in a population of Indian periodontal disease outpatients.\nMethods: One hundred and twelve participants (n = 55 oral health promotion intervention group; n = 57 control\ngroup) were assigned to the intervention (self-management cues + incentive) or control groups, and follow-up\nassessments were performed three weeks later. Flossing frequency, behavioral intentions, and perceived self-efficacy\nserved as dependent variables. Data were analyzed with mixed models, ANCOVAs, and path analyses.\nResults: The intervention yielded effects on flossing frequency (p < 0.01) and flossing intentions (p < 0.01) at follow-up.\nWomen developed stronger intentions than men. Moreover, by path analysis a sequential mediation chain was found\nthat demonstrated an indirect effect of the intervention on flossing via self-efficacy and intentions: the intervention\npredicted changes in self-efficacy which, in turn, were associated with changes in intentions, predicting flossing\nfrequency at follow up, while controlling for baseline behavior, gender, and age.\nConclusions: Combining incentives with minimal self-management cues has been found effective in improving\ninterdental cleaning intentions and habits in periodontal disease patients, and the facilitating role of dental self-efficacy\nhas been demonstrated.
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