Nature of Learning Behavioural Theories Behavioural Models 1. Cognitive model 2. Social cognitive model 3. Theory of Reasoned Action 4. Theory of Planned Behaviour 5. Trans- Theoretical Model 6. Health Belief Model 7. Health Promotion Model 8. Self Care Motivation Model 9. Locus Of Control 10. Sense of Coherence 11. Precede- Proceed Model 12. The Precaution Adoption Process Model 13. Behavioural Learning Model

1. Behavioral
Models in Oral
Health
Education.
Dr. Ankit Mohapatra,
Department of Public Health Dentistry

2. Contents
• Introduction
• Terminologies
• Nature of Learning
• Behavioural Theories
• Behavioural Models
1. Cognitive model
2. Social cognitive model
3. Theory of Reasoned Action
2

3. 4. Theory of Planned Behaviour
5. Trans- Theoretical Model
6. Health Belief Model
7. Health Promotion Model
8. Self Care Motivation Model
9. Locus Of Control
10. Sense of Coherence
11. Precede- Proceed Model
12. The Precaution Adoption Process Model
13. Behavioural Learning Model
3

4. • Other Models
• Conclusion
• Reference
4

5. Introduction
• Oral diseases bother mankind in spite of advances made
by us in our field.
• These diseases can be prevented or controlled by a
positive oral health behavior with emphasis on
individual's oral health.
• And to get it accomplished oral health education helps
bridge the gap between us and the community.
5

6. • Patient education is considered a hallmark of the Dental
Public Health profession.
• The fundamental needs of shelter, food, water, and safety
are health related, and the writings of the Babylonians,
Egyptians, and Old Testament Israelites indicate that
various health promotion techniques.
6

7. • Early approaches to patient education tended to focus on
health care provider to patient communication.
• During that time, the main message from health care
providers to patients was to comply with a prescribed
self-care regime.
• Public health workers in the 1950's began to discuss the
importance of individuals taking part in their own health.
Hollister MC, Anema MG. Health behavior models and oral health: a review. American
Dental Hygienists Association. 2004 Jun 1;78(3):6-14. 7

8. • President Eisenhower officially established the
Department of Health, Education and Welfare on April
11, 1953 in the USA.
• The need of effective health education targeted towards
specific beahviour of individual or group became
important.
• Understanding existing behaviour and changing the
behaviour became the goal of many health education
strategies. 8

9. Terminologies and Definition
9

10. • I AM FRIGHTNED OF THE DRILL USED BY THE
DENTIST, AND I BELIEVE IT IS A USELESS
INSTRUMENT. I WILL BETTER STAY AWAY FROM
THAT.
• I LOVE SMOKING, I BELIEVE IT MAKES ME
RELAXED, AND I WILL CONTINUE SMOKING
EVERY DAY.
10

11. Health
• Health is the complete state of physical, mental and social
wellbeing of an individual and not merely the absence of
disease or infirmity with the ability to lead a socially and
economically productive life.
- WHO (1978)
Park K. Parks textbook of Preventive and Social Medicine. 24th ed.
2016. Pg 14
11

12. Health Education
• Any planned combination of learning experiences
designed to predispose, enable and reinforce voluntary
behaviour conductive to health in individuals, groups or
communities.
P Cynthia, H Rebecca. Chapter 12, Community Oral Health.
Quintessence Publishing Co. Ltd; 2007.p.308
12

13. Oral Health Education
• A process that informs, motivates and helps persons to
adopt and maintain healthy practices and lifestyles;
advocates environmental changes as needed to facilitates
this goal; and conducts professional training and research
to the same end.
Hiremath S S. Chapter 14, Textbook of Public Health Dentistry. 3rd ed.
Elsevier;2016.p.139.
13

14. Behavior
• The way in which one acts or conducts oneself, especially
towards others or the response of an organism to a
stimulus.
14

15. Behavioral Science
• Behavioral Science is the science of the study of human
behavior at the level of their own self, other individuals,
family and community members, and the resulting
reaction on the dental health programme.
Hiremath S S. Chapter 9, Textbook of Public Health Dentistry. 3rd ed.
Elsevier;2016.p.93.
15

16. Health Behaviour
• It is “those personal attributes such a beliefs,
expectations, motives, values, perceptions and other
cognitive elements; personality characteristics, including
affective and emotional states of traits; and overt
behaviour patterns, actions and habits that relate to health
maintenance, to health restoration and to health
improvement.” – Gochmann 1988
P Cynthia, H Rebecca. Chapter 12, Community Oral Health.
Quintessence Publishing Co. Ltd; 2007.p.308
16

17. • Learning- A process of acquiring knowledge or skills
through study, instruction or experience.
Basically three domains govern the nature of learning-
1. Cognitive Domain
2. Affective Domain
3. Psychomotor Domain
17

18. • The overall goal of patient education is to provide
patients the information they need to make informed life
style choices and options for professional services.
• An early breakthrough in health education came in the
1950's with the introduction of the Health Belief Model.
• Other theories have since followed and applied to both
acute and chronic health conditions.
18

19. • Concepts is something which cannot be proven, they
can only be supported or disproven through observation
and experimentation.
• Theory is a generalized thinking or conclusion of
something which is a consequence of an analysis proven
scientifically with evidence.
19

20. Theories most often associated with oral health education
are-
1. Behavioural Theory
2. Social Learning Theory
3. Cognitive Theory
4. Humanist Theory
5. Developmental Theory
6. Critical Theory
7. Salutogenic Theory
8. Expectancy Value Theory 20

21. Behavioural Theory
• Goal – Behavioural Changes
• Method- Identify target behaviour and reinforce (increase
or decrease in behaviour)
• Approach gives the educator control over feedback
system also when learner has cognitive limitations.
• Ex- Incentives and Punishment from point of maintaining
oral hygiene.
21

22. Social Learning Theory
• Goal- Changing expectations, values and beliefs in
oneself
• Method- Information, Case presentation
• Approach helps individual get motivated to change
behaviours.
• Ex- Oral Health Education for cessation of smoking.
22

23. Cognitive Theory
• Goal- Changing Thought patterns
• Method- Information provided in repetition and
reinforced.
• Approach helps in change in thought pattern leading to
change in behaviour
• Ex- Convincing an individual to maintain oral hygiene.
23

24. Humanist Theory
• Goal- Development of self- expression.
• Method- Group discussions
• Approach helps create awareness in an individual to
improve health.
• Ex- Oral health discussion leading to a self-determined
lifestyle.
24

25. Developmental Theory
• Goal- Learning according to level of development
• Method- Opportunity of to learn according to the
readiness of the learner.
• Approach helps in learning and understanding according
to level of develoment.
• Ex- School based Oral Health Education and community
based Oral Health Education.
25

26. Critical Theory
• Goal- Continue the process of learning
• Method- Providing Knowledge via interactions and
question answer session.
• Approach helps in change in thinking and beahviour.
• Ex- Tobacco and its impact on oral and general health.
26

27. Salutogenic Theory
• Goal- Over come difficulties and cope with life stressors.
• Method- Four A's - Avoid, Alter, Adapt & Accept
• Approach helps in a happier, healthier, and more
productive life style.
• Ex- Better the ability to manage stress leads to regular
dental check-ups and good oral hygiene an healthier
dietary habits.
Elyasi M, et.al. Impact of Sense of Coherence on Oral Health Behaviors: A Systematic Review.
PLoS ONE . 201510(8): e0133918. 27

28. Expectancy Value Theory
• Goal- Reinforcements, but by value of expectancy.
• Method- Social skills training
• Approach helps in judgment of the likelihood of getting
the desired reinforcement.
• Ex- People with high general expectancy believe that
they can control their behaviour for the desired
reinforcement.
Rotter J. Locus of Control. 1954.
28

29. Behavioural Models
• Changing and promoting health behaviour involves
specifying and targeting beliefs, attitudes, intentions and
context related barriers which prevent behaviour changes.
• Theories provide information about interventions, how
they work and allow for replications.
29

30. Model
• Model is an evidence-based or structure
representation of something that provides us with a
simplified understanding of a phenomenon.
30

31. Cognitive Model
• Cognitive model is based on the assumptions that
knowledge helps change behaviour.
• The important part of this model is attitude.
Knowledge Attitude Behaviour
31

32. Also health educators effort and resultant behaviour
change is influenced by many factors such as:
1. Socio-demographic
factors
2. Values, beliefs
3. Readiness to change
4. Education
5. Cultural norms
6. Cultural values
7. Needs
8. family, peers
9. Expectations
10. Environment
11. Method of
education delivery
32

33. Young’s Dynamic Model
Learner’s goals
for educator
Other Goals for
learner
Learner’s
dental goals
Dental
educator
Learner
Desired
outcome
Influences
33

34. Limitations
• As effort of education and consequent change in
behaviour are not a continuous process and to get the
desired behavioural change attitude needs to be changed,
which is very difficult task.
34

35. Application
• This model can be used in Smoking cessation
programmes in a community at large.
• A study conducted by Catherine M Sykes and David F
Marks (2001) reported that Cognitive Behavioural
Therapy based on this model had the potential to reduce
the prevalence of smoking among lower SES smokers.
Skyes CM, Marks DF. Effectiveness of a cognitive behaviour therapy self-help
programme for smokers in London, UK. Health Promot Int. 2001;16(3):255-60
35

36. Social Cognitive Theory
Of Learning
by Bandura, 1986.
36

37. • Social cognitive learning theory highlights the idea that
much of human learning occurs in a social environment.
• By observing others, people acquire knowledge of rules,
skills, strategies, beliefs, and attitudes.
37

38. Assumptions
1. People learn by observing others: Modeling
2. Learning is internal.
3. Learning is goal-directed behavior.
4. There are ways to reinforce behaviors:
38

39. • Individuals also learn about the usefulness and
appropriateness of behaviors by observing models and
the consequences of modelled behaviors and they act in
accordance with their beliefs concerning the expected
outcomes of actions.
39

40. 40

41. Limitations
• No big picture of the person
• Too much focus on situations
• Ignore biological factors
• Mechanical -- No free will
41

42. Application
• This model can be used for development of an
appropriate oral health education for a target population
as social environment positively influences an individuals
oral health behaviour.
• A study conducted by Okada M et.al. (2002) reported that
parents oral health behaviour significantly affected the
child’s oral health behaviour and dental caries.
Okada, M., et.al. Influence of parents’ oral health behaviour on oral health
status of their school children: an exploratory study employing a causal
modelling technique. Int J Paediatr Dent. 12: 101–108. 42

43. Theory of Reasoned Action
By Fishbein and Ajzen
43

44. Assumptions
• Human behavior is under the voluntary control of the
individual.
• People think about the consequences and implications of
their actions, then decide whether or not to do something.
• The greater the intention to perform the more likely it is
that the result will be the desired behaviour.
44

45. Components
• Attitudes toward a specific action
– What will happen if I engage in this behavior?
– Is this outcome desirable or undesirable?
• Subjective norms regarding that action
– Normative beliefs: others expectations
– Motivation to comply: do I want to do what they tell
me? How much? Why?
45

46. Beliefs and
Evaluations of
Behavioral
Outcomes
Attitude
Toward
The Behavior
Behavioral
Intention
Behavior
Normative
Beliefs
Subjective
Norms
46

47. Limitations
• Demographic factors are not included as the have direct
influence on any model.
• People with less self determination are left out.
47

48. Applications
• It can be used effectively in Oral Hygiene Practice
education, as this model predicts the behaviour that is in
control of an individual and whose intentions remain
stable.
• A review by Swetha HL, et.al.(2014) reported that very
few actions produce healthy outcomes without ample
knowledge and intention to practice a healthy behaviour.
Swetha HL, et.al. Behavioural Health Models-A Niche to Create Positive Health
Outcome. IJOCR. 2015. 3(1): 86-91 48

49. Theory of Planned Behavior
Ajzen 1988
49

50. • Due to the limitation of self-determination in Theory of
Reasoned Action Ajzen developed this theory.
• This theory considers the relation between intention and
behaviour.
50

51. Components
• Attitudes
• Subjective norms
• Perceived Behavioural Control – an individual's
perceived ease or difficulty of performing the particular
behaviour.
51

52. Assumption
• Individuals will have intention of executing the behaviour
when they have a positive attitude.
• Believe that others think it is worthwhile for them to
perform
• And have confidence that they can perform the desired
behaviour with ease.
52

53. 53

54. Limitations
• Demographics and personality still not in the model.
• Perceived behavioral control is hard to measure.
• Assumption that perceived behavioral control predicts
actual behavioral control.
54

55. Application
• The model can be best used to find out positive attitude
and knowledge of participants towards an education.
• A study by Ebrahimpour et.al.(2016) reported that
positive attitude and knowledge of participants in a face
to face lecture based oral health education is better than
an education printed on leaflets and administered.
Ebrahimipour, Sediqe et al. “Effect of Education Based on the Theory of Planned Behavior
on Adoption of Oral Health Behaviors of Pregnant Women Referred to Health Centers of
Birjand in 2016.” J Int Soc Prev Community Dent. 2016 Nov-Dec; 6(6): 584–589.
55

56. Uses for TRA/TPB
• TRA works best when applied to behaviors that are under
the person’s control (or they think they are)
• TPB works best when the behavior is not perceived to be
under the person’s control.
56

57. The Trans-theoretical
Model
by Prochaska, Norcross & DiClemente
57

58. • This model describes common stages of change through
which individuals go when trying to change health related
behaviours.
• It draws on fields of psychotherapy and behaviour
change.
• It helps us understand behaviour change
58

59. • Model consists of four core constructs:
1. Stages of Change (6 stages)
2. Processes of Change (10 processes)
3. Decisional Balance (Pros/Cons)
4. Self-Efficacy (Confidence/Temptation)
59

60. 60

61. Termination/advocacy
• This stage was added to the model by researchers seeking
to build on the initial work of Prochaska and DiClemente.
• This ‘new’ stage is the continuing part of any behaviour
change including the understanding that going back to old
behaviours would ‘feel weird’ and that former problem
behaviours are no longer perceived as desirable.
61

62. • This stage also has a element of advocacy where people
spread the word to peers, family members, neighbors and
community.
62

63. Processes of Change
• These are changes that mediate progression between
stages of change.
63

64. Decisional Balance
• It is a tabular method for representing the pros and cons
of different choices and for helping someone decide what
to do in a certain circumstance.
• Pros should be higher than cons in order to move into the
action stage and beyond
64

65. Self-Efficacy (Confidence)
• Confidence that one can engage in healthy behaviours
across different challenging situations.
65

66. Application
• To improve compliance of patients needing periodontal
therapy.
• To assess the readiness of change of a patient towards
oral hygiene advice and interventions.
• It is the best recommended model for use in smoking
cessation studies.
Ayşe K, Kafiye E. The transtheoretical model use for smoking cessation.
European Journal of Research on Education, 2014, Special Issue:
Contemporary Studies in Social Science, 130-134 66

67. Limitations
• TTM aims to produce individual change and not
structural change, so interventions are usually limited to
the individual level.
• TTM interventions usually target people with change
potential, model does not acknowledge that people with
lower change potential are often socially or economically
disadvantaged.
67

68. The Health Belief Model
By M. Rosenstock, M Hockbaum
68

69. • The Health Belief Model (HBM) is an intrapersonal
(within the individual, knowledge and beliefs) theory
used in health promotion to design intervention and
prevention programs.
• It was designed in the 1950’s and continues to be one of
the most popular and widely used theories in intervention
science.
69

70. Assumption
• The HBM assumes that behaviour change occurs with the
existence of three ideas at the same time:
1. Perceived seriousness- An individual perceives the
severity of the consequences should they develop a
health problem or seek treatment. More serious better
the action.
70

71. 2. Perceived Susceptibility- That person understands he or
she may be vulnerable to a disease or negative health
outcome.
3. Cues to Action- The person is made aware of a
potential health problem after receiving information and
advice regarding health.
71

72. 4. Perceived benefits and barriers- Lastly the individual
must realize that behavior change can be beneficial and
the benefits of that change will outweigh any costs of
doing so.
72

73. Application
• To assess if parents belief and disease prevention
behaviours influence brushing and flossing or oral
hygiene behaviours in their child.
• Also to increase the likelihood of patient taking
preventive oral health behaviour after an oral health
education.
Solhi M, Zadeh DS, Seraj B, Zadeh SF. The application of the health belief model
in oral health education. Iranian journal of public health. 2010;39(4):114.
73

74. Limitations
• Research has not supported HBM to be a descriptive
rather than predictive model.
• This model might help in changing beliefs but may not be
sufficient for behavior change.
Carpenter CJ. A meta-analysis of the effectiveness of health belief model
variables in predicting behavior. Health communication. 2010 Nov
30;25(8):661-9.
74

75. The Health Promotion Model
(HPM)
by Nola J Pender (1982; revised, 1996)
75

76. • It describes the multi dimensional nature of persons as
they interact within their environment to pursue health.
• The model focuses on following three areas:
Cognitive perceptual factors- Individuals perception and
importance of health, perceived health status, self efficacy,
benefits and barriers to health behaviours
Modifying factors- demographic, body weight, body fat,
behavioural and environmental factors
Factors affecting cues to action- Internal and external
cues such as desire to feel well, mass media promotion
campaign and etc.
76

77. Assumption
• Individuals seeking to regulate their own behaviour.
• Individuals in all their biopsychosocial complexity
interact with environment, progressively transforming
environment and being transformed over time.
• Health professionals as a part of the interpersonal
environment, exerting an influence on person throughout
their life span.
77

78. Limitations
• Model does not outline specific ways to assess the patient
to determine likelihood of action towards a behaviour.
Jacqueline M. Ripollone. Health Promotion Theory: A Critique
With a Focus on Use in Adolescents. University of Virginia.
78

79. Self-Care Motivation Model
• It is a whole person approach to motivating self care
based on values, awareness, choice and action.
• It addresses the elements common to all individuals with
specific intention to address non compliance issue in
behaviour and lifestyle that result in negative health
consequences.
79

80. • Making a choice is greatly based on personal awareness
of physical, mental and emotional feedback leading to
cognitive self-regulation.
80

81. Application
• This model is best applied in smoking cessation
counseling, where motivating the individual at his
maintenance phase in Stage of Change is very important.
• Also this model is best used to promote oral health and
hygiene behaviour change among school children and
promote compliance towards health practices.
81
Horowitz LG, Dillenberg J, Rattray J. Self‐care Motivation: A Model for
Primary Preventive Oral Health Behavior Change. Journal of School Health.
1987 Mar 1;57(3):114-8.

82. Locus Of Control
By Wallston & Kaplan in 1970s
82

83. • It deals with perception of personal control over health
issues.
83

84. Application
• LOC has been found to be predictive for children's dental
health and also assessing an individuals oral health
beahviours.
• A study reported children whose mothers had more
external LOC were at higher risk for developing dental
caries.
Reisine S, Litt M. Social and psychological theories and their use
for dental practice. Int Dent J 1993;433Suppl 1:279-287.
84

85. Limitations
• Model had a problematic approach because healthy
people respond differently to the questions on the scales
than do chronically ill individuals.
85

86. Sense of Coherence
By Antonovsky
86

87. • Sense of coherence (SOC) is the main constituent of the
Salutogenic theory.
• It evaluates the individual’s capability to use existing
resources in order to overcome difficulties and cope with
life stressors to perform healthy behaviour and stay well.
• It views health as a continuum
ease → dis-ease
87

88. • Stressor may come from external or internal sources such
as illness, heredity, job stress, or lack of personal control.
• SOC is a method of seeing the world and one's place in it.
88
Hollister MC, Anema MG. Health behavior models and oral health: a
review. American Dental Hygienists Association. 2004 Jun 1;78(3):6-.

89. Components
• Comprehensibility: Extent to which one perceives stimuli
as ordered, consistent, etc.
• Manageability: Extent to which one perceives resources
available as adequate to meet demands.
• Meaningfulness: Extent to which one feels life makes
sense, some demands worth investing in, challenges are
welcomed.
89

90. Application
• It is extensively used in forming strategies which aim at
oral health lifestyle modification.
• A study by Senjam Suraj & Amarjeet Singh (2011),
reported that students with higher SOC had a higher
Health Promoting Lifestyle Profile(HPLP).
90
Suraj S, Singh A. Study of sense of coherence health promoting behavior in
north Indian students. The Indian journal of medical research. 2011
Nov;134(5):645.

91. Precede- Proceed Model
By Greenand Kreuter 1991
91

92. • It is a framework or model of delivering health education
programmes and also evaluate interventions.
• It gives a view on necessary steps next to health
education with guidance on how to initiate and
implement a programme at national and international
level.
92

93. The Precaution Adoption
Process Model
• Similar to Stage of Change Model except that it focuses
on educating about health hazards and engaging them in
behavioural change.
• One important point in this model is that a person doesn't
cycle back to the previous stage as in SCM.
93

94. Application
• This model is used mostly for educating groups or
community at large regarding health hazards and also
engage them to change behaviour.
94

95. Behavioral learning model
• Goal – Change behaviour of learning
• Method – activities with appropriate skills, behavior and
knowledge with a hope of a desired attitude.
Example – School oral health programs focused on
involving students in learning oral hygiene techniques
rather than educator demonstration.
95

96. Other Models
Ecological Models
• Social Ecological Models
• Life Course Health Development Theory
Planning Models
• Health-Promoting Self-Care System Model
• A Stage Planning Program Model for Health Education/
Health Promotion Activity 96

97. Communication Models
• Diffusion Of Innovation Model
• Weick’s Health Communication Theory
Evaluation Model
• Precede Proceed Model
• RE-AIM Framework
97

98. Conclusion
• Improving the health of individuals and communities was
a concern of the earliest civilizations and it remains a
concern today.
• Indeed, health education and promotion has evolved into
a profession, and certification indicating adequacy of
training.
98

99. • Models and theories provide a means of describing
relationships between factors such as knowledge,
attitudes, beliefs, and health behaviour in a scientifically
tested manner.
• Theories and models offer structure to design, derive and
evaluate health education interventions.
99

100. • Success of models and theory based approaches to
behavioural change should be specified and identified.
• There is no single theory to guide health education
intervention, so a model developed using many theories
would work better.
100

101. • Behavioural change models play an important role in
health education interventions and encourage people to
change health damaging behaviours and adopt health
promoting behaviours.
101

102. Refernces
• P Cynthia, H Rebecca. Chapter 12, Community Oral Health.
Quintessence Publishing Co. Ltd; 2007.
• Hiremath S S. Chapter 14, Textbook of Public Health Dentistry. 3rd
ed. Elsevier;2016.
• Park K. Parks textbook of Preventive and Social Medicine. 24th ed.
2016.
• Antonovsky A. Unraveling the Mystery of Health: How People
Manage Stress and Stay Well. 1st ed. San Francisco, CA: Jossey-
Bass; 1987. 102

103. • Nola J. Pender. Health Promotion Model. 2011.
http://currentnursing.com/nursing_theory/health_promotion_model.h
tml. Assessed on 20th Aug 2017.
• Elyasi M, Abreu LG, Badri P, Saltaji H, Flores-Mir C, Amin M.
Impact of sense of coherence on oral health behaviors: A Systematic
Review. PloS one. 2015 Aug 14;10(8):e0133918.
• Horowitz LG. The Self‐Care Motivation Model: Theory and Practice
in Healthy Human Development. Journal of school health. 1985 Feb
1;55(2):57-61.
103

104. • Hollister MC, Anema MG. Health behavior models and oral health: a
review. American Dental Hygienists Association. 2004 Jun 1;78(3):6-14.
• Social Cognitive Theory Albert Bandura Stanford University.
• Prochaska JO, Redding CA, Evers KE. In Health behavior and
education. San Francisco: Jossey Bass; 1997.
• Gil KM, Schrop SL, Kline SC, Kimble EA, et.al. Stages of change
analysis of smokers attending clinics for the medically underserved. J
Fam Pract 2002;5112:1081.
104

105. • Watt RG. Emerging theories into the social determinants of health:
Implications for oral health promotion. Community Dent Oral
Epidemiol. 2002; 30: 241–247.
• Glanz, K., and Rimer, B. K. Theory at a Glance: A Guide to Health
Promotion Practice. Bethesda, Md.: National Cancer Institute, 1995.
• Mahat G, Bowen F. Parental knowledge about urban preschool
children's oral health risk. Pediatric Nursing. 2017;43(1):30.
105

106. • Okada M, et.al. Influence of parents’ oral health behaviour on oral
health status of their school children: an exploratory study employing
a causal modelling technique. Int J Paediatr Dent. 2002. 12:101–
108.
• Skyes CM, Marks DF. Effectiveness of a cognitive behaviour therapy
self-help programme for smokers in London, UK. Health Promot Int.
2001;16(3):255-60
• Swetha HL, et.al. Behavioural Health Models-A Niche to Create
Positive Health Outcome. IJOCR. 2015. 3(1): 86-91
106

107. • Ayşe K, Kafiye E. The transtheoretical model use for smoking cessation.
European Journal of Research on Education, 2014, Special Issue:
Contemporary Studies in Social Science, 130-134.
• Emani S, Thomas R, Shah R, Mehta DS. Application of transtheoretical
model to assess the compliance of chronic periodontitis patients to
periodontal therapy. Contemporary clinical dentistry. 2016 Apr;7(2):176.
• Wade KJ, Coates DE, Gauld RD, Livingstone V, Cullinan MP. Oral
hygiene behaviours and readiness to change using the TransTheoretical
Model (TTM). New Zealand Dental Journal. 2013 Jun 1;109(2).
107

108. • Solhi M, Zadeh DS, Seraj B, Zadeh SF. The application of the health
belief model in oral health education. Iranian journal of public health.
2010;39(4):114.
• Detels R, McEwen J, Beaglehole R, Tanaka Heizo. Oxford Textbook
Of Public Health. 4th ed.
• Horowitz LG, Dillenberg J, Rattray J. Self‐care Motivation: A Model
for Primary Preventive Oral Health Behavior Change. Journal of
School Health. 1987 Mar 1;57(3):114-8.
108

109. • Suraj S, Singh A. Study of sense of coherence health promoting
behavior in north Indian students. The Indian journal of medical
research. 2011 Nov;134(5):645.
109

110. Thank You