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CLINICALFEATURE
setting efforts. In the proper conditions, intentions can lead to
higher performance.
Applications to Dentistry: Try to set specific goals for the patient,
for example, to wear the headgear for how many hours, rather
than just using the vague term ‘try your best’.
Reinforcement theory
Reinforcement theory is counter to goal-setting theory. It
proposes that behavior is a function of its consequences. While
goal-setting theory proposes that an individual’s purpose directs
his or her behavior, reinforcement theory argues that behavior is
externally caused. Reinforcement theory ignores factors such as
goals, expectations, and needs; it focuses on what happens
when a person takes an action. The concept of reinforcement
can be used to explain motivation. According to Skinner 7 people
will most likely engage in a desired behavior if they are rewarded
for doing so. These rewards are most effective if they
immediately follow a desired response. Behavior that is not
rewarded or is punished is less likely to be repeated. The
emphasis is on positive reinforcement, not punishment, people
should ignore, not punish, unfavorable behavior. Even though
punishment eliminates undesired behavior faster than no
reinforcement does, its effect is often only temporary and may
later have unpleasant side effects including dysfunctional
behavior such as conflicts, absenteeism, and withdrawal.
Applications to Dentistry: Patient should be immediately praised
(positive reinforcement) every time when a good response (e.g.
good oral hygiene) is encountered.
Equity Theory
Being human, one tends to compare oneself with others. If
someone offered one US$10,000 a month on one’s first job after
graduating from a dental school, one would probably jump at the
offer and report to work enthusiastic, ready to tackle whatever
needed to be done, and certainly satisfied with one’s pay. How
would one react, though, if one
found out a month into the job that
a coworker, your classmate with
comparable school results and
with comparable work experience
— was getting US$11,000 a
month? One would probably be
upset! Even though in absolute
terms, US$10,000 is a lot of
money for a new graduate to make
(and one knows it!), that suddenly
is not the issue. One sees the
issue now as relative rewards and
what one believes is fair — what is
equitable. The term equity is
related to the concept of fairness
and equal treatment compared
with others who behave in similar
Fig. 1 Expectancy theory of motivation
ways. Equity theory was developed by J. Stacey Adams 8 , it is the
theory that a person compares his/her work’s input-outcomes
ratio with that of relevant others and then corrects any inequity.
Equity theory recognizes that individuals are concerned with their
absolute rewards as well as the relationship of those rewards to
what others receive. When people perceive an inequity, they will
tend to correct the situation 9 . They may distort either their own or
others’ inputs or outcomes; behave in some way to induce others
to change their inputs or outcomes; behave in some way to
change their own inputs or outcomes; the result might be lower
productivity, reduced quality of output, increased absenteeism or
withdrawal from work.
Applications to Dentistry: Patients like to compare themselves
with one another. Inequity may be one of the sources of
dissatisfaction or complaint even the actual services provided are
satisfactory. Conversely, favorable comparisons may significantly
motivate patients.
Expectancy Theory
Last but not the least, the most comprehensive and widely
accepted explanation of motivation to date is Victor Vroom’s
expectancy theory 10 . Although the theory has its critics, most
research evidence supports it 11 . This is the theory that an
individual tends to act in a certain way based on the expectation
that the act will be followed by a given outcome and on the
attractiveness of that outcome to the individual. Three
relationships are important to this theory. Effort-performance
linkage (expectancy) is the probability perceived by the individual
that exerting a given amount of effort will lead to a certain level of
performance. Performance-reward linkage (instrumentality) is the
degree to which an individual believes 1that performing at a
particular level is instrumental in, or will lead to, the attainment of
a desired outcome. Attractiveness of the reward (valence) is the
importance that the individual places on the potential outcome or
reward that can be achieved on the work. The explanation of this
theory can be summed up in the following questions: What
28 Dental Asia • May / June 2008