title: Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.
abstract: BACKGROUND
  Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers.
  
  
  METHODS
  Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used.
  
  
  CONCLUSIONS
  To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN15427433.
authors.affiliation: Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland. masamitsu.amemori@helsinki.fi
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Amemori
authors.forename: Tellervo
authors.initials: T
authors.lastname: Korhonen
authors.forename: Taru
authors.initials: T
authors.lastname: Kinnunen
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.forename: Heikki
authors.initials: H
authors.lastname: Murtomaa
mesh_terms: D000328:Adult; D003729:Dental Care / Q000379:methods*; D003756:Dental Hygienists; D003815:Dentists; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D005387:Finland; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016730:Program Development; D016540:Smoking Cessation / Q000379:methods*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000517:prevention & control*; D000078329:Workforce