Patient-Centred Communication during Consultations in Primary Dental Care: An Evaluation of the Health Coaching Intervention for Oral Health Promotion in Malawi.

Background: Efforts to reduce oral health inequalities in Malawi may require significant strategic reforms. In Sub-Saharan Africa, including Malawi, reliance on restorative dental methods alone is insufficient due to the high burden of oral disease. Therefore, there is a pressing need for the adoption of novel, patient-centred behaviour change communication frameworks based oral health promotion models that empower individuals through education and support self-care. Purpose: This PhD study aimed to test a communication intervention health coaching (HC), delivered to oral health professionals (OHPs) in primary dental care settings in Malawi. The objective was to evaluate its impact on patient-centred communication during dental consultations. Methods: The research adopted a three-phase design. Phase I involved a literature review; Phase II was a scoping review; and Phase III was an intervention study using a convergent mixed-methods design. • Scoping Review: This phase aimed to explore and map the characteristics of health coaching-based interventions used in oral health promotion. • Intervention Study: This phase evaluated the efficacy of a health coaching training programme provided to OHPs. The programme’s impact was assessed through observations and interviews conducted at baseline and follow-up, focusing on patient-centred behaviour change communication during dental consultations. Results: • The scoping review identified key characteristics of effective health coaching-based interventions, including: (i) training of OHPs, (ii) patient engagement using positive and non-critical communication, (iii) brief but routine HC-based interactions, (iv) integration of HC techniques with traditional health education, and (v) cost-effectiveness considerations. • The intervention study found that the HC intervention may positively influence patient-centred communication behaviours among OHPs. Quantitative analysis showed improvements in behaviours associated with three of the "4H" communication habits: H1 (investing in the beginning), H2 (eliciting the patient’s perspective), and H4 (investing in the end). Qualitative data further illuminated these findings, particularly demonstrating increased empathetic engagement (H3). Additionally, OHPs spent more time with patients during follow-up consultations, indicating improved consultation quality. However, further work is required to investigate whether Health Coaching could have a role to play in promoting oral health promotion in community and primary care settings in Malawi as this study presented with multiple limitations. Conclusion: Whilst there are major limitations in this PhD project, however, compared to traditional health education, health coaching-based interventions appear to be a promising approach for enhancing patient-centred behaviour change communication in primary dental care in Malawi. This approach has the potential to support long-term oral health improvements. It is recommended that future research involving larger sample sizes with fewer limitations and broader settings should validate and expand our findings.