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

Abstract

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.

'It's their mouth at the end of the day': dental professionals' reactions to oral health education outcomes

“…39 Some researchers are not rigorous in their application of the frameworks and instead are selective, only exploring the domains they perceive as relevant for their phenomenon. 30 Despite drawing on behaviour change theories, both COM-B and TDF, like other behaviour change taxonomies, are descriptive frameworks rather than theories and do not explain the mechanisms operating between domains. It is thus not possible to conclude testable hypotheses of behaviour.…”

“…The study applied the Capability-Opportunity-Motivation-Behaviour (COM-B) model framework 26 and the Theoretical Domains Framework (TDF) 27 to better understand the influences on participants' professional behaviour. These frameworks have been used in studies of oral health interventions 28,29,30 and are suggested to be useful in exploring healthcare professionals' engagement in opportunistic behaviour change interventions. 31 COM-B has also been used in the recently published edition of the Delivering better oral health toolkit 32 to explain the different factors that impede or facilitate patient behaviour change.…”

“…In the COM-B model, each component is broken down into two elements, with capability including psychological aspects, such as possession of the necessary knowledge and the ability to understand its application, and physical aspects, such as the skills to carry out the intended change. 26,29,30 Motivation comprises reflective processes, such as planning and goal setting and automatic processes, such as the influence of habits and emotions. 26,29,31 Opportunity factors are external to the individual and include physical factors, which are environmental, such as access to resources and materials, or social factors, which are social norms or behaviours that support or inhibit behaviour.…”

“…26,29,31 Opportunity factors are external to the individual and include physical factors, which are environmental, such as access to resources and materials, or social factors, which are social norms or behaviours that support or inhibit behaviour. 26,29,30 Related to the COM-B model is the TDF. 27,34 Designed by a team of psychologists and health service researchers, the framework synthesises common elements from behaviour change theories into a series of 14 domains.…”

“…27,34 Designed by a team of psychologists and health service researchers, the framework synthesises common elements from behaviour change theories into a series of 14 domains. 27,30,34 These domains broadly map onto the three COM-B domains. For example, the domains 'knowledge' , 'skills' , and 'memory, attention and decision processes' all fall within the COM-B 'capability' domain.…”