Barriers and Facilitators to Evidence-Based Oral Care in Head and Neck Cancer: A Mixed-Methods Study

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.