Patient compliance is an ongoing challenge for oral health professionals. Significant time is spent educating patients with varying results. While compliance, or lack thereof, applies to patients of all generations, Millennial patients (typically those born between 1980 and the early 2000s) present some unique challenges. To address these challenges, oral health professionals need to understand the difference between compliance and adherence, in addition to learning the generational traits of Millennial patients and their health care preferences.
The Oxford English Dictionary (OED) defines compliance as “acting in accordance with, or yielding to a desire, request, etc; consenting to act in conformity with; and acceding to; practical assent; in submission, or active obedience.”1 As such, compliance refers to patients following what is prescribed with little to no decision in their care plan. The OED defines adherence as a “steadfast commitment to a belief, practice, etc; fidelity, devotion; (later also) strict or faithful observance of (rule, promise, etc).”1 In 2001, the World Health Organization (WHO), defined adherence as “the extent to which a patient follows medical instructions.”2 The WHO, however, decided the term “medical” did not fully encompass all therapies used to treat chronic disease.2 In addition, the term “instruction” implies patients defer to clinicians’ recommendations with no participation in their own treatment plan; negating patient responsibility.2 The WHO provided an expanded definition of adherence: “the extent to which a person’s behavior … corresponds with agreed recommendations from a health care provider,” which embodies the essence of the relationship between provider and patient.2 Redefining adherence embodies a team approach to patient care using the strengths of both parties to create high-quality interactions between patient and provider.2 Adherence, rather than compliance, becomes the goal for oral health professionals’ interactions with patients.
Millennials are known for their familiarity and reliance on technology.3,4 They may prefer interaction with health care providers through electronic means rather than face to face.3,5 Typically high goal setters, Millennials may become discouraged when goals are not met or when they are reminded of what is needed to achieve such goals by authority figures.4 Additionally, this patient population may prefer regular feedback and reassurance as they work toward their goals.4 Despite a preference for working with others and an inclination to freely express their opinions, Millennials may appear indifferent or apathetic.3–5 The Millennial generation is more ethnically diverse than previous generations.3,6 This, coupled with a sincere desire to make a difference, may indicate a high level of compassion.3 In addition, Millennials are rapidly becoming more educated than all generations before them.6
THEORETICAL APPROACH TO ADHERENCE
Maslow’s Hierarchy of Needs demonstrates the theory of human motivation, beginning with the most basic needs and progressing to more complex needs.9,10 Human motivation is directly related to basic physiological needs such as food, water, sleep, and health.7,8Safety is the next highest need and includes situational and physical safety.7,8 The middle level relates to an individual’s need to be accepted by others. Esteem needs require acknowledgement, respect, and appreciation from others.7,8 Self-actualization, the uppermost level of Maslow’s Hierarchy of Needs, describes an individual’s need to reach his or her fullest potential.7,8 Interestingly, the unmet need is considered the most powerful.7
Health care providers should know Maslow’s Hierarchy is not necessarily linear in nature.7,9 For example, circumstances related to economic concerns such as lack of employment, personal or family illness, or other significant family issues may cause a downward spiral of a patient’s needs.9 Maslow’s Hierarchy of Needs can be applied to dental patients’ adherence or lack thereof.
As health care providers, dental hygienists must “meet the physical, social, and emotional needs” of patients, including Millennials, with the goal of motivation toward adherence.10 Engaging patients, developing rapport, and establishing a trusting relationship are necessary to meeting these needs.10–13 Valuing Millennials’ opinions and autonomy regarding their health care decisions may greatly improve adherence to treatment recommendations.7,10,12 While health care providers may find it difficult to surrender control of treatment planning, success and continuity of patient adherence may depend on it.12 As always, accurate diagnosis and self-care instruction are needed; however, surrendering control is related more to accepting the patient’s pace or creating a collaborative approach to self-care instruction in which the patient has the final say in what will work for him or her. Additionally, understanding personal values and beliefs significantly impacts adherence.13
HEALTH CARE PREFERENCES
Different generations have different motivators.4 Millennials have access to more information than any generation before them. These patients frequently turn to the internet for medical information, which changes the patient-provider dynamic.5,14 Providers are no longer the authority in treatment decisions.5
Technology-driven practices incorporating online evidence-based patient education can enhance patient knowledge and may improve adherence with treatment plans and self care.11 Creating an online blog is one method oral health professionals can ensure Millennials access appropriate, relevant oral and systemic health information. Using patient interactive sites enables Millennial patients to access their health information or make account payments any time. In addition, recommending technology-based self-care aids, such as the Arizona School of Dentistry and Oral Health’s Text2Floss© program, may serve to increase adherence to self-care recommendations.
A personal patient-clinician relationship has many benefits. Despite their preferences, Millennial patients may find a one-on-one relationship with health care professionals beneficial. Millennials may appreciate a collaborative approach to treatment decisions rather than the traditional hierarchy of the provider-patient relationship. This may increase adherence.15 The following suggestions can help build rapport with Millennial patients.
- Be aware of health issues specific to Millennial patients.16 Parents of Millennial patients were very involved in their children’s everyday lives.16 Overscheduling and high expectations may contribute to patients who have difficulty making their own decisions.16 Consistent pressure to comply with recommendations or treatment may alienate patients rather than encourage them to seek recommended treatment or follow self-care instructions.
- Tailor communication. Millennials may prefer more relaxed, casual communication.4 Relay information in short segments with a respectful tone, providing feedback regularly.16 Visual aids greatly enhance communication and maintain attention.16,17 Millennials may prefer online chat or email interaction with their health care providers.5,16,18 Send an electronic copy of an article relating to a question that arose during a hygiene appointment or the latest technology in the dental field. Email a thank you for scheduling treatment or the next hygiene appointment, or for referring a friend.
- Show appreciation for cultural diversity.16 Millennials are typically highly accepting of people from all cultures and backgrounds and have an expectation that others are, as well.16,17 Continuing education courses relating to cultural competency should be encouraged for all oral health professionals.16 Learning about health care beliefs specific to a patient of a different culture can cultivate a trusting relationship.
- Demonstrate patience and provide feedback.16 Millennials need to know why treatment is being recommended.16,19Taking a few extra minutes to answer questions can mean the difference between adherence or refusal of treatment recommendations. Millennials may be accustomed to immediate feedback.19 Give praise when deserved and constructive feedback when needed. Be cautious, however, of tone of voice and do not reiterate unless asked to do so.19
- Include Millennials in treatment decisions.19 Allow them to share what works and does not work for them, and attempt to tailor recommendations based on their preferences.19
Oral health professionals who recognize generational traits of Millennials may be more successful in fostering a team approach to dental care. Creating a safe environment where Millennials feel free to share knowledge and concerns regarding their oral health is the first step. Tailoring health education and motivation strategies to this patient population has potential to achieve greater adherence and, thus, improve oral health.
- Oxford English Dictionary. Oxford, United Kingdom: Oxford University Press; 2010.
- World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. Available at: who.int/chp/knowledge/publications/adherence_report/en. Accessed December 14, 2017.
- Berkowitz EN, Schewe CD. Generational cohorts hold the key to understanding patients and health care providers: Coming-of-age experiences influence health care behaviors for a lifetime. Health Mark Q. 2011;28:190–204.
- Wieck KL. Motivating an intergenerational workforce: Scenarios for success. Orthop Nurs. 2007;26:366–371.
- Cowan M. Millennial transformation for primary care. Mil Med. 2010;175:379–381.
- Patten E, Fry R. How Millennials today compare with their grandparents 50 years ago. Available at: pewresearch.org/fact-tank/2015/03/19/how-millennials-compare-with-their-grandparents. Accessed December 14, 2017.
- Maslow AH. A theory of human motivation. Psychol Rev. 1943;50:370–396.
- Kaur A. Maslow’s need hierarchy theory: Applications and criticisms. Global Journal of Management and Business Studies. 2013;3(10):1061–1064.
- Rajasakran T, Sinnappan S, Raja, SS. Purushartha: Maslow’s need hierarchy revisited. Anthropologist. 2014:18(1):199–203.
- Guglielmi CL, Stratton M, Healy GB, et al. The growing role of patient engagement: Relationship-based care in a changing health care system. Assoc Periop Reg Nurs. 2014;99:517–528
- Collins FM. Factoring patient compliance into oral care. Available at: dentalacademyofce.com/courses/2059/PDF/1103_CEDfpc-compliance_rev1.pdf. Accessed December 14, 2017.
- Dayiya P, Kamal R, Kumar, M, Bhardwaj, R. Patient compliance: Key to successful dental treatment. Asian Pac J Health Sci. 2014:1:39–41.
- Damij N, Levnajic Z, Skrt VR, Suklan J. What motivates us for work? Intricate web of factors beyond money and prestige. PLoS ONE. 2015;10:e0132641.
- Guan SA, Subrahmanyam K. Youth internet use: risks and opportunities. Curr Opin Psyc. 2009;22:351–356.
- Monaco M, Martin M. The millennial student: A new generation of learners. Athl Train Educ J. 2007;2:42–46.
- Johanson LS. Caring for patients of the millennial generation: Considerations for nurses. Nurs Forum. 2017;52:207–210.
- Mar MY, Neilson EK, Torchalla I, Werker GR, Laing A. Expoloring e-mental health preferences of Generation Y. J Tech Hum Serv. 2014:32:312–327.
- Christman T. Millennials and patient compliance: Where’s the app for that? Available at: nata.org/blog/toddc/millennials-and-patient-compliance-where’s-app. Accessed December 14, 2017.
- Williams KC, Page RA, Petrosky AR, Hernandez EH. Multi-generational marketing: descriptions, characteristics, lifestyles, and attitudes. J App Bus Econ. 2010;11:21–36.
From Dimensions of Dental Hygiene. January 2018;16(01):14,17.