Adopting the COM-B model and TDF framework in oral and dental research: A narrative review

Background Recent advances in the psychological understanding of health-related behaviour have focused on producing a comprehensive framework to model such behaviour. The Capability-Opportunity-Motivation-Behaviour (COM-B) and its associated Theoretical Domains Framework (TDF) allow researchers to classify psychological and behavioural constructs in a consistent and transferable manner across studies. Aim To identify oral and dental health-related studies that have used the TDF and/or COM-B as frameworks to guide research and examine the ways in which these concepts have been practically used in such research. Method Narrative review of published literature. To be included, the paper had to (1) state that the TDF or COM-B had been used and to have targeted at least one construct identified in either framework, (2) include primary empirical data, (3) focus on a behaviour directly related to oral or dental-related health (eg brushing, applying fluoride varnish, flossing) and/or attitudes, intentions and beliefs related to the behaviour. Studies could include any research design, and participants of any age or gender and include patients, parents or dental health professionals. Findings Nine studies were identified that had drawn on the COM-B and/or TDF as the framework for their research. Seven of the studies were based on the TDF only, with one employing both the COM-B and Health Belief Model, and one using the TDF with COM-B. The nine studies covered a broad range of oral health-related behaviours including child tooth brushing, fluoride varnish application and non- or micro-invasive management of proximal caries lesions. The populations in the studies included dentists, dental teams and parents of children. All studies adopted only a subset of the constructs within the TDF, often without justification. Conclusions It is encouraging that oral health researchers are adopting standardized psychological frameworks to develop their research and oral health interventions. Future work should build on the small number of studies identified in this review and consider using standardized tools to do so.