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Updated: Aug 12, 2026

Oral Health Assessment by Lay Personnel for Older Adults
Published on: February 2, 2020
Barriers and Facilitators to Evidence-Based Oral Care in Head and Neck Cancer: A Mixed-Methods Study
Yiqing Wang1, Jia Ma, Xin Zhang
1Author affiliations: Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou City, Zhejiang Province, China (Drs Wang and Zhang); and Department of Oncology, Hangzhou Cancer Hospital, Hangzhou City, Zhejiang Province, China (Dr Ma).
Background:
Oral complications significantly burden patients with head and neck cancer undergoing treatment. Despite the proven efficacy of evidence-based oral care protocols, clinical implementation remains inconsistent. This study employed the behavior change wheel framework to systematically analyze implementation barriers and facilitators from health care providers' perspectives.
Methods:
A convergent mixed-methods design was used. Health care providers (n = 118) completed validated capability, opportunity, motivation-behavior surveys, and a subset (n = 28) participated in semi-structured interviews analyzed using theoretical domains framework (TDF)-informed thematic analysis. Self-reported adherence to the oral care bundle was measured using a visual analog scale.
Results:
Physical opportunity barriers scored highest (M = 3.36, SD = 0.72), whereas reflective motivation showed the lowest barrier scores (M = 2.11, SD = 0.59). Environmental Context and Resources was the predominant TDF barrier domain (86%). Multiple regression showed that barrier scores significantly predicted self-reported adherence (β = -0.124, P < .001, R2 = 0.821).
Conclusions:
Physical opportunity barriers represent the primary implementation challenge. Multicomponent interventions targeting environmental restructuring, training, and enablement are recommended.
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