Abstract
Purpose: Social Intelligence refers to interpersonal relationships and a person’s ability to recognize and influence the emotions and motivations of another person. The purpose of this study was to describe patients’ perspectives regarding the influence dental hygienists’ Social Intelligence had on their self-care. Perspectives were also compared to determine differences based on the participants’ gender, generation, and recare intervals.
Methods: This descriptive comparative study used a convenience sample consisting of patients receiving care at a university dental hygiene clinic. Participants were surveyed during the spring of 2019 following a dental hygiene care appointment which included a 15-minute oral self-care session. Data were collected using a self-designed questionnaire based on the Emotional Competence Framework. Content validity and test-retest reliability were established prior to administration. The Social Intelligence abilities of Social Awareness and Social Skills were measured by thirteen capabilities: Empathy, Service Orientation, Developing Others, Leveraging Diversity, and Political Awareness, Influence, Communication, Leadership, Change Catalyst, Conflict Management, Building Bonds, Collaboration and Teamwork. Participants rated twenty-six items on a 7-point Likert scale. Descriptive and inferential statistics were used to analyze the data.
Results: A total of 103 patients agreed to participate. Means of the Social Awareness capabilities ranged from 6.4 to 6.6 while the means for the Social Skills capabilities ranged from 6.0 to 6.55. There was a statistically significant difference between patients’ perspectives based on gender (p=0.013); female participants rated the capabilities higher than males. However, there were no significant differences between patients’ perspectives based on generation or recare interval (p=0.157 and p=0.340, respectively).
Conclusion: All thirteen Social Intelligence capabilities positively influenced the dental hygienists’ Social Intelligence from the patients’ perspectives. Perhaps practitioners and oral healthcare students could benefit from learning about these capabilities and their application to patient self-care.
- social intelligence
- social skills
- emotional intelligence
- dental hygienists
- dental hygiene education
- person-centered care
Introduction
The concepts of emotional intelligence, social intelligence, social competence, social skills and soft skills have been difficult to differentiate in the literature.1 This confusion results from using these terms synonymously, separately, or as components of one another.1 Emotional Intelligence (EI) refers to an intrapersonal relationship and a person’s ability to recognize and influence emotions and motivations within oneself2 whereas Social Intelligence (SI) refers to interpersonal relationships and one’s ability to recognize their influence on the emotions and motivations of others.3
Social Intelligence was first popularized in 2006 and two SI domains were identified, Social Awareness and Social Facility.3 Social Awareness involves a person developing an awareness of the verbal and nonverbal cues about the feelings of another person during social interaction and requires both individuals to be present and “deeply” listen to be responsive to each other. This interaction leads to connecting and developing an understanding of each other’s thoughts and feelings. Individuals who exhibit Social Awareness also understand the expectations of social situations and are able to analyze social events, resulting in appropriate responses in those situations. These attributes provide the foundation for the second domain, Social Facility. The Social Facility domain uses Social Awareness to promote beneficial interpersonal interactions such as responsiveness to nonverbal cues, effective presentation of self, and constructive influence to produce an intended outcome while demonstrating concern and compassion.3
The Emotional Competence Framework includes Personal and Social Competence (Table I).4 Personal Competence is related to Emotional Intelligence and consists of Self-Awareness, Self-Regulation and Self-Motivation. An individual’s Social Competence is related to their SI and includes Social Awareness and Social Skills paralleling the Social Awareness and Social Facility domains identified by Goleman.3 Social Awareness has been defined by the capabilities of Empathy, Service Orientation, Developing Others, Leveraging Diversity and Political Awareness4 while Social Skills were defined by Influence, Communication, Leadership, Change Catalyst, Conflict Management, Building Bonds, Collaboration and Cooperation and Team Capabilities (Table II).4 Competency can be defined as possessing the abilities that lead to outstanding performance resulting from the effective implementation behaviors to achieve goals or outcomes.5
Emotional Competence Framework4
Self-care education is an aspect of oral health care that can be related to the health care provider’s SI. Capabilities such as enhanced communication, empathy, positive influences, change catalyst, and leadership appear to be associated with effective self-care education interactions. Patient education philosophies have evolved from the era when providers assumed an authoritative role and the patient played a passive role to the more contemporary process of patient engagement and collaborative decision making regarding patients’ self-care.6 This change was based on the realization that patients’ daily health behaviors influenced their health outcomes.6 Oral self-care education emphasizes equal partnership between the patient and provider, shared decision-making and patient responsibility for managing health.6 A current meta-analysis, including sixty years of research, revealed the positive effect of patient education on improved health outcomes.7
The evolution of patient education inspired the development of the Client Self-Care Commitment Model that provides a framework to guide practitioners’ interactions with clients during self-care education.8 The Client Self-Care Commitment Model has a basis in medical anthropology, taking into consideration an individual’s cultural perspective of illness, as well as the Empowerment Model from psychology. Interactions are based on collaborative partnerships empowering clients to make decisions about self-care and build relationships that are based on trust and respect. The client has the role of co-therapist and active participant in making decisions about health choices. The provider’s role as facilitator helps clients make informed decisions and respects their self-care choices leading to an individualized action plan addressing the client’s needs for disease prevention, control, and management.8-11
The Institute of Medicine addressed patients’ needs, values, and beliefs as core elements of patient-centered care in 2001.12 Patient-centered care “encompasses qualities of compassion, empathy and responsiveness to the needs, values and expressed preferences of the individual patient,”12 emphasizing the importance of the healthcare provider’s social abilities to engage in this approach. Patient-centered care has evolved into person-centered care focusing on the person as a unique individual instead of a patient with a disease or condition.13 Patient-centered care and person-centered care are similar because each includes empathy and emotional support; respect for beliefs, values and dignity; and engagement to listen and understand patient needs and preferences. Also, both approaches include: partnership relationships; two-way communication; shared decision-making; holistic focus on the person’s biological, psychological, and social context; individualized care; and interprofessional care coordination. However, a difference was found, patient-centered care focused on the patient’s ability to function, while person-centered care focused on well-being and a meaningful life. Person-centered care embodies many of the SI concepts such as effective communication, empathy, developing others, building bonds and collaboration.
Person-centered care and SI both relate to relationships. Emotions influence social interaction, development of relationships, and performance at work.15 Beach et al. found that individuals from diverse racial/ethnic groups want to be treated as a person and an equal.16 Relationships built on respect embraced patient autonomy, dignity, integrity, and vulnerability.16 Similarly, person-centered actions were found to support respect, mutual trust, holistic focus and the provision of empathetic and quality care.17 Additionally, communication was important in informing persons of care alternatives based on needs using understandable wording.17 To support person-centered care and building relationships, providers must first understand the personal context including factors such as gender and culture, surrounding an individual’s lifestyle and health decisions.18
Oral healthcare professionals must be empathetic and sensitive to persons’ emotional perspectives, which have been found to present as anxiety and shame about their poor oral condition.19 When providers allowed patients to communicate about anxiety, this emotion was reduced.19 When providers evoked feelings of guilt and shame about self-care, patients’ attitudes were negative.20 Also, negative attitudes occurred when patients felt helpless in the dental chair and providers did not attend to their needs, such as resting or stopping when care was painful.20 In comparison, positive communication was identified by patients when providers acknowledged anxiety and discomfort during care.21 Furthermore, positive experiences were found when persons’ efforts were validated during self-care and communication was nonjudgmental to prevent guilt, shame or embarrassment.21
Social Intelligence is not specifically noted in the Commission on Dental Accreditation (CODA) Standards, however related concepts are included such as patient-centered care, communication skills and cultural competency.22-24 Dental students must be competent in patient-centered approaches for promoting, improving, and maintaining oral health22 and dental hygiene students must be competent in the process of care which includes patient-centered treatment to enhance oral health.23 Dental hygiene programs must have a quality assurance plan that includes patient-centered standards of care23 and dental therapy education is required to have high standards of care that are patient-centered.24 Dental hygiene graduates must be “competent in managing a diverse patient population and have the interpersonal and communications skills to function successfully in a multicultural work environment.”23 While SI is not directly addressed, concepts of SI are reflected in some of these standards.
Literature is lacking in SI and its relationship to oral health care provider-patient relationships. Research has reported that women have higher EI and SI than men25-27 and age groups are purported to have different characteristics.28 The purpose of this study was to describe patients’ perspectives regarding the influence dental hygienists’ Social Intelligence had on their self-care. Self-care education was viewed as the aspect of care that influences a person’s oral health the most and the time period during care when the patient and provider interact the most. Social Intelligence was the variable studied and was operationally defined by Social Awareness and Social Skills, which were termed abilities, as well as the thirteen behaviors identified previously, which were termed capabilities. Three null hypotheses were tested to compare patients’ perspectives to determine differences about the influence dental hygienists’ SI had on self-care based on the participants’ gender, generations, and recare intervals.
Methods
This descriptive comparative study was approved by the Idaho State University Human Subjects Committee via an expedited review (IRB-FY2019-131). A 38-item questionnaire was designed by the researchers using the Emotional Competence Framework.19 The questionnaire included the informed consent, nine demographic questions, and three general statements or questions about self-care. Each of the thirteen capabilities of SI, such as Service Orientation, were measured by two statements; therefore, there were 26 items about the SI capabilities. Ten items measured the five Social Awareness capabilities, and sixteen items measured the eight Social Skills capabilities. Participants rated each item on their level of agreement or disagreement with the dental hygienists’ SI that influenced their commitment to self-care on a Likert scale ranging from 1-7: 1 Strongly disagree, 2 Disagree, 3 More or less disagree, 4 Neutral, 5 More or less agree, 6 Agree, 7 Strongly Agree.
Content validity of the questionnaire was confirmed through an Item Content Validity Index (I-CVI) using ten experts: five faculty with expertise in research methodology and five patients. Experts rated each item on a scale from 1-4 (not relevant to highly relevant) and provided feedback. The I-CVI was calculated as the number of experts who rated the item as a 3 or 4 divided by the total number of experts,29 and a quotient of 0.08 was considered relevant. Items receiving a score less than this quotient (n=4) were rewritten for clarity. Reliability was established through a test-retest approach with eleven participants who met the study’s inclusion criteria and who completed the questionnaire twice with one week in between testing. The percent agreement was computed for each question; one question was rewritten due to less than 0.80 agreement.
The nonprobability convenience sample consisted of patients receiving care at a dental hygiene student clinic during the Spring of 2019. The inclusion criteria were individuals aged 18 years and older who had completed at least one fifteen-minute self-care education session with a student clinician. Dental hygiene students, faculty, and staff of the dental hygiene program were not eligible to participate. Participants completed the questionnaire in the reception area and were asked to base their responses on all previous experiences with dental hygienists.
Participants chose the method of questionnaire completeion: paper, a tablet or smartphone. A QR code established a link for handheld devices to the survey developed via an online platform (Qualtrics; Provo, UT, USA) The data from the paper questionnaires were entered into the online survey tool. Participants were incentivized through a drawing for one of two $50 Visa cash cards.
Descriptive statistics, including mean, median and mode, were computed for each of the twenty-six capability items. An average mean was computed using the mean of the two items that measured each capability. Inferential statistics were used to analyze hypotheses (p<0.05). The Mann-Whitney U test analyzed the null hypothesis that stated there was no statistically significant difference in patients’ perspectives about the influence dental hygienists’ SI had on self-care based on gender. The Kruskal-Wallis H test analyzed the two null hypotheses that stated there is no statistically significant difference in patients’ perspectives about the influence dental hygienists’ SI had on self-care based on generations or recare intervals. Both tests were used because the assumption of normal distribution was not met.
Results
A total of 103 clinic patients agreed to participate. Most respondents were White (82%, n=84), identified as female (60%, n=63) and were between the ages of 18-21 (36%, n=37). Nearly half (44%, n=45) received care from a dental hygienist twice a year. Sample demographics are shown in Table III. Regarding the general self-care items, 99% (n=102) of participants indicated that interactions with a dental hygienist influenced commitment to improving self-care and 86% (n=89) wanted to partner with dental hygienists to plan self-care. Most participants (96%, n=98) felt it was their personal responsibility to commit to self-care.
Demographic data* (n=103)
Social Awareness
Results of the descriptive analysis of Social Awareness are presented in rank order in Table IV. Participants agreed to strongly agreed that the dental hygienists’ Service Orientation influenced self-care (average mean=6.6); while Empathy, Developing Others, and Political Awareness were scored similarly (average means=6.45); Leveraging Diversity was the least influential capability (average mean=6.0). Mean scores regarding statements about the SI capabilities were between 6.3 to 6.7, and the range of scores were between 3-7 (disagree to strongly agree). Respondents’ perspectives were positive about the Service Orientation statement referring to offering appropriate help for improving oral self-care (mean=6.7) and favorable towards the Empathy statement of sensing feelings and perspectives (mean=6.3). Likewise, the statement about Leveraging Diversity in relation to respecting personal background related to age, gender, culture, etc. was also rated positive (mean=6.3).
Rank - order results for average means for Social Awareness*
Social Skills
Results of the descriptive analysis of Social Skills are presented in rank order in Table V. Leadership and Influence (average mean=6.55), were the most positive capabilities followed by Collaboration and Cooperation (average mean=6.45). Participants agreed to strongly agreed that Teamwork and Building Bonds (average mean=6.4) and Change Catalyst (average mean=6.35) influenced self-care. Communication (average mean=6.15) and Conflict Management (average mean=6.0) were also rated as influential capabilities.
Rank - order results for average means for Social Skills*
The mean scores for the statements about the Social Skills capabilities were between 6.0 to 6.6 and the range of scores were between 1-7 (strongly disagree to strongly agree). Respondents’ perspectives were positive about the following statements: guides me to improve my oral self-care (Leadership), has a positive outlook about my oral self-care (Influence), helps me feel capable of achieving my oral self-care goals (Teamwork) and creates trust by being honest in conversations with me (Building Bonds) (mean=6.6). Perspectives were favorable regarding the statements about negotiates solutions in our differences about oral self-care and tactfully brings disagreements about my oral health into the open (Conflict Management) (means=6.0).
The analysis of the null hypothesis that stated there was no statistically significant difference in patients’ perspectives about the influence dental hygienists’ SI had on self-care based on gender was statistically significant (p=0.013). Female perspectives regarding the influence dental hygienists’ SI had on self-care were ranked higher than the male perspectives. The analysis of the two null hypotheses that stated there was no statistically significant difference in patients’ perspectives about the influence dental hygienists’ SI had on self-care based on generations (p=0.157) and recare intervals (p=0.340) were not statistically significant. Therefore, generational categories based on age of participants and recare intervals based on months between care did not make a difference in responses.
Discussion
Patients’ perspectives about the influence dental hygienists’ SI had on the social aspects of interaction during self-care education were found to be very positive. From the patients’ perspectives, commitment to self-care was the individual person’s responsibility. Most participants believed that dental hygienists influenced their commitment to improve self-care and wanted to act as a partner with their provider to plan oral self-care strategies. These findings support the importance of collaborative partnerships and the desire of clients/patients to play an active role in making decisions regarding health care choices as outlined in the Client Self-Care Commitment Model.8 Dental hygienists must be responsive to client/patient preferences and promote a shared responsibility for self-care and oral health outcomes. Individuals who value partnering with health care professionals to achieve self-care goals is encouraging and research into further developing this partnership is warranted.
Social Awareness
All five of the Social Awareness capabilities positively influenced self-care. Service Orientation and Empathy align with a person-centered approach to care.14 Individuals participating in self-care education seem to desire a practitioner with a service orientation who understands their needs, matches their needs to services, seeks ways to enhance satisfaction and loyalty, offers appropriate assistance, and acts as a trusted advisor.4 The Client Self-Care Commitment Model supports this capability as the provider helps clients make decisions and respects their self-care choices.8
Empathy is another influential social capability that involves attentiveness to emotional cues, listening well, showing sensitivity, understanding others’ perspectives, and helping based on others’ needs and feelings.4 Attending to verbal and nonverbal emotional cues is a key aspect of building Social Awareness.3 Empathy has also been identified as an important aspect of providing person-centered care17 and a CODA standard for dental therapy states that students need to develop core professional attributes, such as altruism, empathy, and social accountability, to provide effective care in a diverse society exhibiting many characteristics.24
Participants were influenced by practitioners who demonstrated Develop Others by acknowledging and rewarding strengths, accomplishments, and development.4 Individuals possessing these traits offer useful feedback, identify needs, mentor, coach, and provide opportunities that challenge and grow others.4 Dental hygienists provide individualized information on oral cancer, caries and periodontal diseases to enhance persons’ self-care knowledge. Clients benefit from practitioners providing feedback about plaque biofilm removal skills and other oral disease self-management abilities. Political Awareness was also rated highly by participants. Practitioners who exhibit this capability understand what shapes clients’ views and actions, and accurately assess situations and external realities.4 This trait has also been supported by the literature of Beach et al. who emphasized the importance of respect16 and Lee et al. who identified the importance of personal context.18
Developing Social Awareness by Leveraging Diversity includes respecting and relating to those with varied backgrounds by welcoming diversity as an opportunity and creating an environment where others can thrive, while not introducing bias or intolerance.4 This capability might have been ranked higher in this study if the sample reflected more cultural/ethnic diversity. Respect for individual beliefs, values, and dignity are aspects of person-centered care;14 respect for patient autonomy, dignity, integrity and vulnerability helps to build relationships.16 Diversity and inclusion for disparate populations based on racial, ethnic, geographic, or socioeconomic factors are included in accreditation standards.22.23 Educational programs are expected to develop experiences for students to provide care to diverse populations. The traits Political Awareness and Leveraging Diversity also relate to the accreditation standards stating that cultural competency is crucial in the practice of clinical dental sciences.22-24 The standards define cultural competence as “having the ability to provide care to patients with diverse backgrounds, values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.”22 Experiences for cultural competency include the development of skills for effective provider-patient communication and stress the importance of providers’ understanding the relationship between diversity of culture, values, beliefs, behavior and language and the needs of patients.22
Social Skills
Participants in this study might have ranked the Social Awareness capabilities slightly higher than the Social Skills capabilities based on their perspectives that awareness capabilities were the most critical during self-care education. Another explanation, based on Goleman, is that Social Awareness capabilities are necessary to implement Social Skills capabilities that deal with effectively interacting with others.3 The Social Skills ability encompassed eight capabilities that were all perceived to be important. Clients who participated in self-care education seem to be influenced by the provider’s Leadership, represented by articulating and arousing enthusiasm for a shared vision and guiding the performance of others through accountability.4 Stepping forward and leading is required,4 and all oral health care providers are responsible for these actions while providing care, particularly when guiding and inspiring persons to improve self-care.
Individuals’ who Influence are persuasive and fine-tune presentations to appeal to individuals.4 Practitioners might think of strategies to influence individual patient’s self-care based on the individual’s needs and desires without violating the patient’s autonomy. Self-care messages should be tailored to each person for the purpose of influencing and streamlining communication.
Respondents indicated that Collaboration and Cooperation, Teamwork and Building Bonds positively influenced self-care. These capabilities complement three aspects of person-centered care: building partnership relationships, sharing in decision-making and focusing on holistic care through interprofessional collaboration.14 Collaboration and Cooperation is demonstrated by balancing tasks and relationships, nurturing opportunities to collaborate, sharing information and resources, and promoting a friendly, cooperative environment.4 A CODA standard for dental therapy programs underscores the importance of Collaboration and Cooperation by stating that programs should foster an environment of “collaboration, mutual respect, cooperation, and harmonious relationships.”24 Individuals who exhibit the Teamwork model respect, cooperation, and helpfulness.4 Teamwork also encompasses shared credit, building commitment, and inspiring active and enthusiastic participation.4 The Client Self-Care Commitment Model supports Teamwork and Collaboration and Cooperation in that an individualized action plan addressing the client’s needs for disease prevention, control, and management is developed collaboratively.8 Building Bonds is essential for building rapport and keeping others informed as well as cultivating personal friendships.4
Practitioners who demonstrate Communication are effective in compromise, register emotional cues, facilitate open communication and deal with difficult issues frankly.4 Respondents rated Communication lower than most capabilities; 7th out of 8 for the Social Skills capabilities. This might indicate that participants were reticent to share information about self-care due to feelings of embarrassment when engaged in self-care education. Another explanation might be that practitioners were not adept at encouraging the patient to share information or did not seek to understand the patient’s point of view. Perhaps dental hygiene student clinicians are lacking the expertise to elicit this information. However, participants were asked to consider all interactions with previous dental hygienists when answering the questionnaire and responses were not limited to experiences with student clinicians. While seasoned practitioners have this expertise, they are often challenged with time restraints. adversely affecting the ability to take the time to elicit information for understanding the patient perspective.
Practitioners who exhibit Conflict Management can “handle difficult people and tense situations with diplomacy and tact,” encourage open discussion, and arrange win-win solutions.4 It is not surprising that conflict management was ranked lower than other capabilities by the participants. Clients or patients generally do not want to engage in conflict with their health care providers, as evidenced by Öhrn et al.,20 who reported that patients’ satisfaction decreased when feelings of shame, guilt, fear or helplessness were evoked. These findings were also supported by Fico and Lagoe’s findings on the negative effect of feelings of shame or guilt on successful interactions.21 However, resolution of conflict relating to differing viewpoints on self-care strategies is needed for creating win-win solutions for patients and providers.
Patient perspectives regarding the positive influence of dental hygienists’ SI on self-care education might lead professional programs to consider including education in SI for their graduates. Social Intelligence could enhance person-centered care, specifically oral self-care education. Educators could use the definitions of the capabilities when teaching students about effective communication, cultural competence, person-centered care and principles of self-care.
The variable of gender made a difference in participants’ perspectives, female participants indicated that dental hygienists’ SI had a greater influence on their self-care than the male participants. This finding is reflected in previous studies showing that women’s EI and SI is higher than men’s.25-27 Future investigations focusing on gender might be valuable to gain insight into similarities and differences related to SI. Results from this study did not indicate any difference in perspectives on the influence of SI regard to the participants’ generation. Also, the frequency of interacting with dental hygienists about self-care education did not make a difference in the participants’ perspectives. Both generations and recare intervals could be studied further with larger samples in a wider range of environments.
A limitation of this study was the convenience sample, limiting the generalizability of results to patients in varied oral care settings and geographic locations. Questionnaires have inherent systematic error.30 A risk of systematic error in this study was basing answers on the most recent interaction with a dental hygiene student. However, participants were directed to consider all interactions with dental hygienists or dental hygiene students, both past and present.
Suggestions for further research include replicating this study with diverse patient populations outside of educational settings. Additionally, studying the SI of oral health care students and the relationship of SI to patient care outcomes might aid in enhancing patient and practitioner satisfaction. A better understanding of the patients’ perspectives related to SI might increase health care students’ and practitioners’ delivery of person-centered care.
Conclusion
Within the context of this study, patients’ perspectives regarding the influence dental hygienists’ SI had on self-care education were positive. Ratings of all thirteen SI capabilities were very high. Capabilities related to Social Awareness were ranked somewhat higher than Social Skills capabilities. Gender seemed to influence patients’ perspectives, with female participants rating SI higher than male participants. Practitioners and educators might consider building SI concepts into dental hygiene care and learning experiences for students.
Footnotes
The manuscript supports the NDHRA priority area, Client level: Oral health care (Health promotion: treatments, behaviors, products).
- Received January 19, 2022.
- Accepted June 3, 2022.
- Copyright © 2022 The American Dental Hygienists’ Association
