Reinforcement Motivation Research Articles

The Mechanism of the Nucleus Accumbens-Ventral Pallidum Pathway Mediated by Drug Withdrawal-Induced High-Seeking Motivation in Cocaine Addiction.

The reinforcement of drug-seeking motivation following drug withdrawal is recognized as a significant factor contributing to relapse. The ventral pallidum (VP) plays a crucial role in encoding and translating motivational aspects of reward. However, current research lacks a clear understanding of how the VP mediates drug-seeking motivation and the feedback modulation between the VP and the nucleus accumbens (NAc) following drug withdrawal. Therefore, utilizing a rat model of cocaine self-administration, we investigated the circuitry mechanisms underlying drug-seeking behavior post-drug withdrawal involving the NAc-VP pathway. Initially, we observed a significant enhancement in drug-seeking behavior 14 days after cocaine withdrawal. Subsequently, we identified the feedback mechanism through which the NAc-VP regulates this behavior. Immunofluorescence results indicated an increase in c-Fos expression levels in the ventral pallidum ventromedial (VPvm) and ventrolateral ventral pallidum (VPvl) following drug withdrawal. Calcium fiber photometry further elucidated that during the expression of high motivational drug-seeking behavior, there was a specific enhancement in VPvm neuronal activity, and retrograde tracing techniques suggested a weakened transmission function in the NAc-VPm pathway. Additionally, chemical genetic techniques demonstrated that inhibiting the activity of the NAc-VP pathway could increase the motivational level of drug-seeking behavior. These findings indicate that the reduced inhibitory function of the NAc-VP pathway following prolonged cocaine withdrawal forms the basis for heightened reactivity in VPvm neurons, thus regulating the expression of high motivational behavior triggered by drug-related cues. Our study results suggest that maintaining normal NAc-VP pathway functionality may decrease drug-seeking motivation post long-term drug withdrawal, offering new insights for interventions targeting relapse.

Exercise recovers weight gain, but not increased impulsive choice, caused by a high-fat diet

A high-fat diet has negative effects on physical, neurological, and behavioral outcomes. One consistent finding is that a diet high in fat increases impulsive choice behavior—behavior that is linked to a wide range of other negative health behaviors. While the mechanism for this increase in impulsive choice is not well understood, exercise, with its well-known and many benefits, may serve as an effective and accessible way to combat increased impulsive choice associated with a high-fat diet. The goal of this work was to test this possibility. Rats were divided into four groups in a two-by-two factorial design: exercise and control diet, sedentary and control diet, exercise and high-fat diet, sedentary and high-fat diet. Rats in the exercise groups engaged in 30-min of forced, moderate intensity wheel-running exercise five days per week. Rats in the high-fat diet groups ate a diet high in fat. Impulsive choice was measured using a delay discounting task. Exercise prevented weight gain associated with the high-fat diet. Exercise also preserved relative motivation for food reinforcement. However, exercise did not prevent increases in impulsive choice observed for rats that consumed a high-fat diet relative to the rats that consumed the control diet. This work rules out several possible mechanisms by which a high-fat diet may increase impulsive choice behavior. It makes clear that exercise alone may not stave off increases in impulsive choice caused by a high-fat diet. Future work is necessary to uncover the underlying mechanism for this effect and discover interventions, perhaps ones that combine both physically and cognitively demanding activities, to improve health and behavior as it relates to decision making processes.

북유럽 출소자의 갱생보호 프로그램 동향

The aim of the study is to make policy suggestions that are suitable for the situation of the Korea Rehabilitation Agency. Therefore, we compared and analyzed the domestic Rehabilitation Policy with advanced North European countries, and derived shortcomings and improvements of the Korea Rehabilitation Agency. As a result, regarding the improvements for the domestic Rehabilitation Policy, first, it is necessary to actively utilize Nordic Rehabilitation policies to solve problems related to addiction and mental illness. Second, actively implementing empathy-building programs such as prison experience programs or camps with peers is needed. Third, we suggest strengthening the willingness for social adaptation by incorporating a motivation reinforcement program (MI) into prior counseling. Fourth, through the procedure of the program certification system, we propose to benchmark advanced programs that have been proven effective in reducing recidivism. Fifth, it is crucial to strengthen the expertise of employees and volunteers who are performing rehabilitation protection tasks by providing systematic and specialized education. Sixth, in order to effectively help released prisoners return to society and manage them professionally and systematically, the scope of social welfare services should be expanded to released prisoners and their families.

Development and Validation of the Maternal Drinking Motives Scale (M-DMS)

Background Alcohol use is a gendered behavior and motherhood is a life stage which may influence drinking motives. However, there are no drinking motive scales uniquely tailored to maternal populations. This work developed a new maternal drinking motives scale (M-DMS) and determined associations between the M-DMS and alcohol-related behavior. Methods An online observational survey (n = 534) and online test–retest survey (n = 164) were conducted with adult, UK mothers. From the observational study, data on drinking motives was extracted to determine M-DMS items and factor loading. This was split into two data sets for exploratory and confirmatory factor analyses. Alcohol Use Disorders Identification Test (AUDIT) and Timeline Follow back data, taken from both surveys, were combined to determine the M-DMS’s predictive validity. Results Following a parallel analysis and exploratory factor analysis, a two-factor model (positive reinforcement motives, negative reinforcement motives) was deemed the best fit. Probability functional analysis identified items with problematic responses. These were removed before confirmatory factor analysis (on the second dataset) demonstrated a good fit for the two-factor model. All factor loadings were significant and positive (βs > 0.56). Reliability of the two subscales was excellent: negative reinforcement (ωT = 0.95), positive reinforcement (ωT = 0.89). Test–retest reliability was good for both negative (ICC = 0.84, 95%CI = 0.80–0.88) and positive (ICC = 0.77, 95% CI = 0.71–0.82) subscales. Both subscales predicted AUDIT and quantity of alcohol consumption (ps < 0.001). Conclusion The first tailored Maternal Drinking Motives Scale (M-DMS) provides a more valid research tool for assessing psychological mechanisms of alcohol use in mothers.

Hypnosis: a complementary tool for managing adolescents affected by anorexia nervosa

Anorexia Nervosa (AN) mainly affects adolescent girls and requires specialized, multidisciplinary care. In Geneva, the HUG's AliNEA unit and the pediatric hypnosis consultation have been collaborating since 2021 to integrate hypnosis into the management of AN. Hypnosis is seen as a complementary tool to the Maudsley therapeutic model, but not a miracle solution. It needs to be adapted to each patient's individual needs and to the different phases of treatment : re-association with the body, reinforcement of motivation, exploration of interpersonal relationships and consolidation of progress. Although scientific evidence is limited, patient testimonials underline its beneficial potential as a non-medicinal, individualized form of support.

행동활성화체계 및 행동억제체계가 SNS 중독경향성에 미치는 영향

Objectives The purpose of the study examines the effects of the behavioral activation system(BAS) and the be-havioral inhibition system(BIS) on social network service(SNS) addiction proneness, the mediation effect of SNS use motives, and the moderated mediation effect of self-control and distress tolerance in the link between BAS, BIS, SNS use motives, and SNS addiction proneness. Methods BAS, BIS, SNS use motives, self-control, distress tolerance, and SNS addiction proneness of 342 adults were measured online. Results First, BAS and BIS predicted SNS addiction proneness. Second, positive reinforcement motives mediated the relationship between BAS and SNS addiction proneness, and negative reinforcement motives mediated the relationship between BIS and SNS addiction proneness. Third, self-control moderated the mediation effect of positive reinforcement motives between BAS and SNS proneness among passive users. Fourth, distress tolerance moderated the path from negative reinforcement motives to SNS addiction proneness in the mediation model. Conclusions These results expanded the understanding of the effect of the organic and motivational factors on SNS addiction proneness, and suggested that distress tolerance could have a significant role in reducing the effect of BIS on SNS addiction proneness.

Effects of a virtual reality-based motivational reinforcement + desensitization intervention program on psychological craving and addiction memory in female MA-dependent young adults.

The aim of this study was to explore the effects of a virtual reality (VR)-based motivational reinforcement + desensitization intervention program on psychological craving and addiction memory in female methamphetamine (MA)-dependent young adults. We recruited 60 female MA-dependent young adults in a compulsory isolation drug rehabilitation facility in Sichuan Province, and randomly assigned them to intervention (mean age = 23.24 ± 2.06) and control groups (mean age = 23.33 ± 2.09). The intervention group received a VR-based motivational enhancement + desensitization intervention (total of eight sessions over a 4-week period), while the control group received regular detoxification management during the same period. Assessments were conducted before, immediately after, and 1 month after the intervention, with a visual analogue scale (VAS) being used to assess subjective craving, electronic sphygmomanometer employed to measure physiological parameters, and the Addiction Memory Intensity Scale (AMIS) applied to assess addiction memory intensity. Generalized estimating equation analysis showed significant main effects of group on changes in heart rate difference, systolic blood pressure difference, VAS and AMIS scores (all p < 0.01), and a significant time main effect on changes in diastolic blood pressure difference, VAS and AMIS scores (all p < 0.01), and a significant group × time interaction effect on changes in the difference values of three physiological parameters, VAS and AMIS scores (p < 0.01 or p < 0.05). After the intervention, the differences in three physiological parameters, and the VAS and AMIS scores, were significantly lower in the intervention than in the control group (all p < 0.05), and the difference between the two groups remained significant 1 month after the end of the intervention (both p < 0.01). VAS scores, heart rate difference, and diastolic blood pressure difference in the intervention group were significantly lower than baseline scores, both at the end of the intervention and 1 month thereafter (all p < 0.01); the systolic blood pressure difference in the intervention group was significantly lower at the end of the intervention than at baseline (p < 0.05); AMIS scores in the intervention group were significantly lower than the baseline scores 1 month after the end of the intervention (p < 0.01). Our VR-based motivational reinforcement + desensitization intervention program can effectively reduce psychological craving and physiological reactivity for drugs, and the intensity of addictive memories in female MA-dependent young adults, even after 1 month.

Distance learning and student motivation reinforcement during the COVID-19 pandemic through KKN Tematik UPI program

During the COVID-19 pandemic, the government decided to stop activities at schools. Students are forced to carry out learning activities boldly. In distance learning, several obstacles must be identified, and solutions sought. This service aims to help teachers, students, and parents deal with problems arising from implementing distance learning. One way to organize community service activities is KKN in the field of education at SDN Pancasila Lembang. The service method strengthens distance learning by selecting suitable learning media for students. Also, the implementation of talk show activities with the theme of growing student learning motivation to achieve goals. This activity is carried out to make it easy for students to carry out distance learning activities while remaining enthusiastic to reach their goals. The findings from the KKN program activities are that teachers and parents perceive positively related to the implementation of the entire program. Teachers and parents were satisfied with the series of actions that had been prepared and found it helpful to find new ways and perspectives. Also, activity programs make student learning experiences more effective and increase student motivation.

Considerations and recommendations for mHealth interventions for substance use among Sexual and Gender Minority (SGM) individuals: A narrative review of the past 5years.

The prevalence of problematic substance use is disproportionately higher among sexual and gender minority (SGM) adults compared to adults in the general population. mHealth as a treatment modality could reduce barriers to accessing substance use treatments among SGM populations. Through a qualitative literature search, the current narrative review aimed to understand the lived experiences of SGM individuals who use substances and to synthesize recommendations made in the literature to inform future mHealth interventions. Positive and negative reinforcement motives were prominent reasons for substance use, which included SGM identity expression and conformity motives. Individual- and system-level treatment barriers included a lack of safe and nonjudgmental environment, shame and stigma, and limited knowledge about treatment options. Barriers were directly linked to the reported substance use treatment needs in this population. On-demand app features, real-time intervention and assessment, and anonymity should be considered in future mHealth trials. The online version contains supplementary material available at 10.1007/s40429-023-00497-0.

The Influence of Work Motivation, Compensation, and Work Procedures on Job Satisfaction and Field Extension Performance Family Planning in South Sulawesi

Purpose: This study was conducted with the aim of (1). Analyzing and interpreting the impact of work motivation on job satisfaction of family planning instructors (PLKBs) in South Sulawesi. (2) Analyzing and interpreting the impact of compensation on PLKB job satisfaction in South Sulawesi. Theoretical framework: The theoretical implication is that this study integrates the theory of reinforcement of motivation and self-determination to investigate the determinants of extension worker performance. The theory of motivational reinforcement was put forward by Skinner (2014), who states that behavior is influenced by its consequences. Design/methodology/approach: The research methods used in this study are descriptive analysis and SEM (structural equation modeling) analysis using the AMOS program. The research method used is a survey research method, i.e., primary data collection using a questionnaire (Suzerweni, 2020: 13). A representative of the Regional Family Planning Agency (OPDKB) of the National Family Planning Population Organization of South Sulawesi developed the questionnaire to measure job motivation, compensation, work methods, job satisfaction, and employee performance. Findings: The results of the study show that (1). Job motivation (X1) has a direct positive and significant effect on job satisfaction. Compensation has a positive and significant effect on job satisfaction (3). Work methods have a positive and significant effect on job satisfaction (4). Expanding work motivation has a positive and negligible impact on employee performance. Research, practical and social implications: The summary of the discussion of the results of this study is that according to the results of the research analysis, each observation is described in a coherent manner based on the interpretation of the effect between variable variables and variable indicators, then supported by several relevant theories and links to several previous studies. Originality/Value: Compensation indirectly has a positive and significant impact on the performance of extension workers. Indirect expansion of work approaches has a positive and not significant impact on employee performance.

Coping and Conformity Motives Mediate the Joint Effects of the Behavioral Inhibition and Approach Systems on Alcohol Problems in Young Adults

Background: Gray’s original Reinforcement Sensitivity Theory (RST) posits that an oversensitive behavioral inhibition system (BIS) may increase risk for negative-reinforcement-motivated drinking, given its role in anxiety. However, existing data provides mixed support for the BIS-alcohol use association. The inconsistent evidence is not surprising, as the revised RST predicts that the behavioral approach system (BAS) should moderate the effect of the BIS on alcohol use. A strong BAS is thought to bring attention to the negatively reinforcing effects of alcohol, leading to problem drinking among those with a strong BIS. While emerging results support this interaction, we still have much to learn about the mechanisms underlying this effect on alcohol use. Accordingly, we examined motives for alcohol use as mediators of the joint associations of the BIS and the BAS on drinking behaviors. Specifically, our central hypothesis was that individuals with a strong BIS and a strong BAS would endorse increased negative reinforcement motives for drinking (coping and conformity motives), which in turn would predict heavy drinking and alcohol problems. Method: Participants (N=346; 195 women) completed study measures as part of the baseline assessment for a larger study. Results: Overall, results partially supported the hypotheses. Mediated moderation analyses showed that the indirect effect of the BIS on alcohol problems, through coping and conformity motives, was strongest at high levels of the BAS. This effect was not supported for alcohol use. Conclusions: Our findings suggest that clinical interventions should target coping and conformity reasons for drinking among anxious, reward responsive, young adults.

Alcohol and Athletics: A Study of Canadian Student-Athlete Risk

American student-athletes (SAs) are at heightened risk for hazardous alcohol consumption compared with their nonathlete peers. However, little is known about this risk or the influence of psychosocial predictors on drinking behavior among Canadian SAs. This study compared rates of alcohol use across Canadian SAs and nonathletes and investigated whether the use of athlete-specific psychosocial predictors can improve the prediction of alcohol use outcomes in SAs. Participants (179 varsity athletes and 366 nonathletes) completed anonymous self-report questionnaires. Results suggest that Canadian athletes are at a heightened risk for experiencing alcohol-related problems compared with nonathletes, with general psychosocial predictors explaining the majority of variance in SA alcohol use. However, and quite notably, athlete-specific positive reinforcement motives predicted SA binge drinking. This research provides some of the first evidence of drinking-related problems among Canadian SAs and supports the potential use of preventative efforts to help SAs develop safe strategies for alcohol use.

Impact of acute stress on neural indices of positive and negative reinforcement processing in cannabis users.

Chronic cannabis use is maintained in part through dysregulated stress and reward response systems. Specifically, stress-related negative affect is thought to act as a salient motivator for chronic substance use. Models of addiction posit that the transition from positive to negative reinforcement motives for substance use is a key mechanism of disordered use. However, research in substance-using samples has not assessed stress-related neural processing of both positive and negative reinforcement. Therefore, the present study utilized laboratory stress induction to examine how stress affects the reward positivity, an event-related potential sensitive to both positive (RewP) and negative (relief-RewP) reinforcement, in 87 cannabis users (58.10% female, Mage = 19.40) varying in cannabis use disorder (CUD) severity and, as part of larger study aims, history of traumatic brain injury (TBI). We predicted greater CUD severity would be associated with a blunted RewP and enhanced relief-RewP, particularly after stress induction, independent of TBI status. Findings indicated that CUD severity was not associated with RewP/relief-RewP amplitude regardless of acute stress. Exploratory analyses revealed, however, that among those with history of TBI +, CUD severity was associated with greater stress-elicited blunting of the RewP and enhancement of the relief-RewP. Although initial findings contradict current allostatic models of addiction, exploratory findings suggest that history of TBI, and potentially other confounding variables related to increased risk of TBI experience, may influence the extent to which stressful experiences modulate the neurophysiology of both positive and negative reinforcement reward processing in CUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Identifying the psychological processes delineating non-harmful from problematic binge-watching: A machine learning analytical approach

As on-demand streaming technology rapidly expanded, binge-watching (i.e., watching multiple episodes of TV series back-to-back) has become a widespread activity, and substantial research has been conducted to explore its potential harmfulness. There is, however, a need for differentiating non-harmful and problematic binge-watching. This is the first study using a machine learning analytical strategy to further investigate the distinct psychological predictors of these two binge-watching patterns. A total of 4275 TV series viewers completed an online survey assessing sociodemographic variables, binge-watching engagement, and relevant predictor variables (i.e., viewing motivations, impulsivity facets, and affect). In one set of analyses, we modeled intensity of non-harmful involvement in binge-watching as the dependent variable, while in a following set of analyses, we modeled intensity of problematic involvement in binge-watching as the dependent variable. Emotional enhancement motivation, followed by enrichment and social motivations, were the most important variables in modeling non-harmful involvement. Coping/escapism motivation, followed by urgency and lack of perseverance (two impulsivity traits), were found as the most important predictors of problematic involvement. These findings indicate that non-harmful involvement is characterized by positive reinforcement triggered by TV series watching, while problematic involvement is linked to negative reinforcement motives and impulsivity traits.

Internalizing and externalizing subtypes of alcohol misuse and their relation to drinking motives

BackgroundSeveral typologies have proposed two etiological pathways involved in the development of alcohol misuse which are associated with the internalizing and externalizing domains of psychopathology, respectively. This study’s aim was to investigate this typology in a young adult sample, and test whether drinking motives, specifically drinking for negative or positive reinforcement, may provide a plausible mechanism characterizing these pathways. MethodMixture modeling was conducted on a set of internalizing (anxiety, depression, neuroticism), externalizing (antisocial behavior, conscientiousness, sensation seeking, drug use), and alcohol misuse items (binge drinking, alcohol use disorder symptoms [AUDsx]) measured by self-report in a sample of 9,807 college students. Linear regression and chi-square tests were used to determine how latent class membership was associated with drinking motives, demographics, and personality characteristics. ResultsThe model identified 3 latent classes: a Low Risk class (70%), an Internalizing class (19%) with elevated levels of internalizing traits/symptoms and AUDsx, and an Externalizing class (10%) with elevated levels of externalizing traits/symptoms and both binge drinking and AUDsx. All drinking motives were substantially elevated in the Internalizing and Externalizing (vs Low Risk) classes (p < 3.0E-10), while positive reinforcement motives were specifically elevated in the Externalizing (vs Internalizing) class (p < 2.0E-55). Personality comparisons further emphasized the relevance of class distinctions. ConclusionsThese findings provide additional support for both a specific internalizing and a broadband externalizing association with subtypes of alcohol misuse. Drinking motives may be useful intermediate indicators of these different risk processes.

The Development Of Professional Judgment Research

The auditor's professional judgment quality is essential to maintain and improve. Therefore, careful judgment by an independent third-party can assist the company in its operations. The purpose of this research is to see the development of judgment and decision-making (JDM) in Indonesia and its benefits in improving the quality of auditor judgment, especially auditors in the Indonesian supreme audit institution environment. This thinking is based on that (1) there has been a shift in JDM audit research from a normative model to a cognitive process (2) human cognition is limited, so a cognitive strategy is needed to assist humans in making quality judgments. This study guides designing effective empirical research using this conceptual framework. The framework adopted from this research helps improve the auditor's understanding of the appraisal process that can assist the auditor's appraisal performance by providing a practical suggestion through a cognitive strategy. The result of this research is that the personality factor is one of the factors that influence the auditor's assessment. Certain behaviors are more likely to occur if associated with high expectations and motivational reinforcement. Motivation is linearly related to individual expectations. Future researchers are expected to determine which type of character should be displayed higher. When researchers know which characters can stand out in improving performance, providing motivational reinforcement for the whole individual will be effective. Individual motivation will cause human cognition to be better because there is an urge to direct maximum thinking skills to get the best work results.

Motivation Reinforcement Strategies to Improve Teachers’ Performance in High Schools: A Perspective of Amathole East District of South African

Teacher job-related stress, high turnover, poor educational quality, and a lack of interest in work have all resulted from the rising prevalence of low teacher motivation for work. The goal of this research is to look at incentive reinforcement tactics for teachers to increase their performance. This study took a qualitative approach and used a case study research methodology. Focus group and one-on-one interviews were used to collect data from participants, while purposive and convenient sampling techniques were employed to select ten participants. These entailed eight teachers from two schools and two district education officials. Data were analysed through thematic and comparative analyses. Many strategies to improve motivation and teacher performance emerged from data, were analysed, and presented. The study recommended school leaders to address factors leading to demotivation of teachers. A further recommendation was making use of content knowledge and professional development to deal with teacher content gap.

EDUKASI KEBERLANJUTAN STUDI GUNA KETUNTASAN PENDIDIKAN TINGGI BAGI SISWA SEKOLAH MENENGAH ATAS DI PAPUA BARAT

The purpose of this service activity is to provide motivational reinforcement, dissemination of information, and efforts to build awareness of high school students (SMA) equivalent to the urgency of continuing study to university which has implications for education, career, and family economic income. The method of service implementation is carried out in the form of socialization and motivational training in each selected sample school. There are five sample schools with a total target of 12th-grade high school students. The description of this activity is reviewed from the stages of activity planning, implementation, and evaluation of activities. Data collection techniques in evaluating this activity use pre-test and post-test in the form of direct questions about students' interest in continuing their studies in college. The technique of analyzing the results of the evaluation uses a comparison of the number of students who are interested in further studies during pre-training and post-training. The results of this service activity showed that educational activities for the continuation of studies up to university were quite effective. This is evidenced by the increase in the number of students who are interested in further studies after the education or socialization process is carried out. With these results, it is hoped that similar activities will be held in the coming year for different students so that the continuity of study is evenly distributed among all high schools

A Cross-Cultural Examination of the Sexting Motives and Attitudes: Bosnia and Herzegovina vs. Croatia

Many sexting studies conducted in the Western cultures have shown that the percentage is higher in less traditional cultures. However, the generalizability of this phenomenon to non-Western cultures has not been extensively researched. The purpose of this study is to examine and explain cross-cultural differences in sexting behavior among subjects from Bosnia and Herzegovina and Croatia. A mixed methods approach was used. The first, qualitative phase included focus groups with two groups of high school students from Bosnia and Herzegovina and Croatia ( N = 57 ), aged 15 to 19. In the second, quantitative phase, questionnaires were sent to 440 young adults with an average age of 21 years ( SD = 3.8 ). From the interviews with the young people, nonconsensual sexting was perceived as less beneficial. Sexting was viewed as a double standard. The quantitative study revealed gender and country differences in attitudes toward sexting and motives for sexting. Positive attitudes toward sexting were found to predict different forms of sexting motives in both samples. In the sample from Bosnia and Herzegovina, age was found to predict sexting with instrumental motives and body image reinforcement motives. Gender, on the other hand, was found to be predictive of instrumental sexting motives in the Croatian sample and body image reinforcement sexting motives in the Bosnia and Herzegovina sample. This study illustrates the value of cross-cultural approaches combined with mixed methods as a design to study sexting behavior.

Adoption of change in endodontic practice after an educational program: A qualitative study.

ObjectivesThe aim was to define the characteristics of successful implementation of new clinical endodontic routines within a public dental health organization, following an educational program.Materials and MethodsFifteen staff members were strategically selected for the interview. All had completed a theoretical educational intervention including a complementary endodontic treatment strategy and, for the dentists, comprising training in the nickel‐titanium‐rotary‐technique. All experienced the successful acceptance of new clinical routines. Two thematic in‐depth audiotaped interviews were conducted, wherein the informants described the implementation process in their own words. The interviews were transcribed verbatim and analyzed according to Qualitative Content Analysis.ResultsA theme was identified: A multiple flexible process with governance support and gradual reinforcement of motivation, with the following main categories: Firstly, contextual facilitation, with two subcategories (i) a multifaceted organizational foundation and (ii) a tolerance of flexibility. Secondly, emotional facilitation, with two subcategories (i) an experience of simplification and (ii) an experience of improvement.ConclusionThe results improve the understanding of a multifaceted process underlying the acceptance of changes to clinical endodontic procedures by dentists in a public dental health organization. Important contributing factors identified were governance support, a committed resource person with contextual knowledge, tolerance of flexibility in implementation, and permissive informal communication channels within the local workplace. These findings might be a valuable contribution to an evidence base, facilitating the selection of the most appropriate educational strategy and structure for a specified purpose.