Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers
Open accessAbstract
BACKGROUND: Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. METHODS: A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. RESULTS: Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71). CONCLUSIONS: This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.
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The TDF-based questionnaires were developed to assess determinants of specific implementation behaviors in specific settings.
“Furthermore, the questionnaires were developed to assess determinants of specific implementation behaviors in specific settings (i.e., tobacco use prevention and smoking cessation in dental healthcare [34], smoking cessation in maternal care [35], and different types of patient safety behaviors in hospitals [36])”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [34]
The TDF has been used in a number of studies.
“The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [34]
Internal consistency reliability of the TDF-based questionnaires was low or could be improved.
“and internal consistency reliability was low [34] or could be improved [35,36].”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [34]
The TDF was demonstrated to be useful for the development of qualitative and quantitative measurement tools to assess potential implementation behavior determinants.
“The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [34]
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- Authors
- Amemori, M., Michie, S., Korhonen, T., Murtomaa, H., & Kinnunen, T. H.
- Affiliations
- University of Helsinki (FI)
- University College London (GB)
- Harvard University (US)
- Corresponding author
- Amemori, Masamitsu
- Venue
- Implementation Science
- Published
- 2011-05-26
- Volume
- 6
- Issue
- 1
- Pages
- 50-50
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3130685
- OpenAlex
- W2145824848
- Cited by
- 82
- References
- 35
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 6 · 2022: 10 · 2021: 7 · 2020: 6 · 2019: 1 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 8 · 2014: 7 · 2013: 2 · 2012: 4
- FWCI
- 7.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Yrjö Jahnssonin Säätiö
- Academy of Finland (1130966)
- Juho Vainion Säätiö
- Suomen Hammaslääkäriseura Apollonia
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- tobacco use prevention, tobacco cessation counselling, dental professionals, dentists, dental hygienists, implementation barriers, Theoretical Domains Framework, provider behavior, guideline adherence, motivation, capabilities, opportunity, environmental context and resources, emotions, questionnaire development
- MeSH terms
- Counseling, Dental Hygienists, Factor Analysis, Statistical, Female, Finland, Health Plan Implementation, Humans, Male, Models, Theoretical, Patient Education as Topic, Surveys and Questionnaires, Practice Guidelines as Topic, Practice Patterns, Dentists', Guideline Adherence, Tobacco Use Cessation
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