Table 1 Themes (domains from the Theoretical Domains Framework [43]), in the content analysis of the barriers and facilitators
TDF domain (Theme) | Definition | Barrier from interview | Facilitator from interview |
|---|---|---|---|
Knowledge | An awareness of the existence of something | “Someone came to teach us about brushing. But I don't remember exactly the name of the method of brushing… Something that starts with a B…. We watched a video about it” – Student | “The story book told us that brushing daily can prevent teeth from decaying.” - Student |
Skills | An ability or proficiency acquired through practice | – | “I want someone to confirm whether I brush properly or not.” - Student |
Social/professional role and identity | A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting | “School is a place for education. There is something needing to be covered in each session. In addition to oral hygiene issue, there are also drug issue, physical education. … Students need to apply what they have learned. They should brush themselves at home, instead of doing everything at school” - Teacher | “What said by teachers to children is very influential.” - Deputy head teacher |
Beliefs about capabilities | Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use | “It may be too difficult for children under 7 to do it (flossing) by themselves, but children above 8 could give it a try.” - Teacher | “The problem with brushing skill can be solved by teaching in lectures. The difficulties in children’s brushing skill can be managed by teaching sessions. Children are all trainable.” - Teacher |
Optimism | The confidence that things will happen for the best or that desired goals will be attained | “I will continue to brush when I become a junior high school student, but I may not be able to brush in the morning.” - Student “Brushing twice daily does not place much burden on schools.” - Deputy head teacher | “Children do not think about whether they brushing properly or not. Children usually think they know how to brush, and they are brushing pretty well.” - Teacher |
Beliefs about consequences | Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation | “If I do not brush, I am afraid that I will have cavities. However, I have no idea what would happen if I have cavities.” -Student | “I am afraid that my teeth may get yellowish or decayed. This makes me want to brush after eating.” - Student |
Reinforcement | Increasing the probability of a response by arranging a dependent relationship, or contingency between the response and a given stimulus | “Children can get gifts as they brush. However, I am afraid that children will only brush when they can get gifts later in life.” - Teacher | “The red thing (disclosing agent) looks funny, we can have a competition with gift about it.” - Student |
Intentions | A conscious decision to perform a behaviour or a resolve to act in a certain way | “Sometimes, I am so tired during the lunch break so I do not brush.” – Student “The reason of skipping brushing is slacking off.” – Teacher | – |
Goals | Mental representations of outcomes or end states that an individual wants to achieve | “Brushing twice a day to gain points for gifts can be implemented well by children. However, the reason of brushing became the gifts.” – Teacher | “I want to brush even more, if I can collect the points for gifts.” - Student |
Memory, attention and decision processes | The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives | “I do not remember that there were people (dental students) who came to teach us brushing.” - Student | “When I buy toothpaste, I occasionally want to buy the one I got from school.” - Student |
Environment context and resources | Any circumstance of a person's situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour | “There are only 5 min in the other two breaks in the morning. Students do not have enough time to brush.” - Teacher | “Students would not spend money buying oral hygiene kit, but they would use it if the kits were provided free.” - Teacher |
Social influences | Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours | “My parents remind me to brush all the time, but they do not brush with me.”—Student | “One student would get another student to brush. They would remind each other to brush.”—Teacher |
Emotion | A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event | “It should be not too embarrassing to brush in front of classmates.” – Teacher | “It is fun to see other people brushing.” – Student |
Behavioural regulation | Anything aimed at managing or changing objectively observed or measured actions | “We won’t remind each other to brush during winter and summer vacation.” - Student | “The brushing song (which reminds children to brush) would be played at the brushing time - Teacher |