Table 3 Mapping of identified themes to COM-B (capability, opportunity, motivation) of the Wheel of Change [36] and TDF domains and constructs [19]
COM-B domain | TDF domain | TDF construct | Identified enabler (+) or barrier (−) or conflicting theme (?) | Explanation | Reference |
|---|---|---|---|---|---|
Capability | Knowledge | Knowledge of condition, scientific rationale | (−) age (younger dentists more likely to perform SE or SW) (+) understanding of caries (acceptance of remaining bacteria being sealed) | Younger dentists have different knowledge on caries and the rationale of carious tissue removal. | |
Skills | Procedural knowledge, skills, competence, ability | (+) dentists oftentimes adopt to new techniques (liners, burs etc.) | Many dentists are adopters of technical change; skills are not a barrier for different carious tissue removal. | ||
Opportunity | Social influence | Social pressure, norms, support, modelling | (−) peers (+) being part of a practice network | Fears of peers not accepting SE or SW are barriers. A practice network drives a different group dynamics and facilitates change. | |
Social role | Professional identity, confidence | (?) gender (most studies found female dentists choosing SE or SW more often) | Male dentists might have different professional identity which could act as barrier. | ||
Environmental context and resources | Stressors, resources, organizational culture | (−) financial aspects, private practice model associated with more invasive treatments (+) presence of guidelines (e.g. for stepwise in Norway) (?) healthcare organization (significant between-country differences) | Being paid for quantities of treatment sets the incentive to treat, not to maintain pulp vitality. Such incentive was especially found in private practices (fee for item reimbursement). Reimbursement and regulation in different countries could lead to observed between-country differences. Having guidelines towards less invasive excavation facilitates change. | ||
Motivation | Beliefs about capabilities | Self-confidence, competence, control | (−) education, role of the dentists as perceived as expert | Dentists see themselves as experts. The acquired education is a firm foundation for their beliefs, which could act as barrier. | |
Beliefs about consequences | Outcome expectancies | (?) knowledge on expected outcomes (?) patient or tooth specific expectations (−) compliance needed in SW | The expected outcome might drive some decisions (decisions are tailored to teeth or patients based on different expectations). However, expectations are not always predicting decisions. | ||
Reinforcement | Rewards, incentives | (−) financial aspects, practice settings | See above. | ||
Sanctions, punishment | (−) healthcare organization (country-specific, guarantee times for restorative) | See above. | |||
Memory attention and decision process, optimism | Decision process, pessimism | (−) compliance needed in SW | See above. |