Application of the COM-B model to identify barriers and facilitators of oral health self-management behaviors among orthodontic adolescents: a scoping review

Project Description This research project aims to systematically map and synthesise the existing literature on the barriers and facilitators of oral health self-management behaviours among orthodontic adolescents, using the COM-B model (Capability, Opportunity, Motivation – Behaviour) as the theoretical framework. Adolescents undergoing orthodontic treatment represent a unique population in which effective oral health self-management is particularly critical, due to the increased risk of plaque accumulation, enamel demineralisation, gingivitis, and other treatment-related complications associated with orthodontic appliances. Oral health self-management behaviours in orthodontic adolescents include, but are not limited to, daily oral hygiene practices (e.g., tooth brushing, interdental cleaning), dietary control, adherence to orthodontic instructions, regular dental visits, and management of oral habits. These behaviours are known to be influenced by a complex interaction of individual, social, and environmental factors. However, existing studies report these influences using heterogeneous theoretical perspectives and inconsistent conceptual frameworks, which limits the integration of evidence and the development of theory-informed interventions. To address this gap, this study will adopt the COM-B model as an organising framework to categorise and interpret behavioural determinants. The COM-B model conceptualises behaviour as the result of interactions between individuals’ capability (physical and psychological), opportunity (social and physical), and motivation (reflective and automatic). This framework allows for a comprehensive and systematic classification of behavioural barriers and facilitators, and provides a direct link between empirical findings and potential intervention strategies. A scoping review methodology will be employed, following established guidelines such as the Joanna Briggs Institute (JBI) framework and the PRISMA-ScR reporting checklist. Relevant studies will be identified through systematic searches of major electronic databases, including both qualitative and quantitative research focusing on orthodontic adolescents. Studies will be included if they report factors influencing oral health self-management behaviours, regardless of orthodontic appliance type and geographical context. Data will be charted to extract key information such as study characteristics, behavioural domains, and reported barriers and facilitators. These factors will then be mapped onto the COM-B components and, where appropriate, further linked to domains of the Theoretical Domains Framework (TDF) to enhance conceptual depth. Expected Outcomes The expected outcomes of this study include: A comprehensive evidence map of behavioural barriers and facilitators affecting oral health self-management in orthodontic adolescents. A theoretically structured synthesis of these factors based on the COM-B model and TDF, improving conceptual clarity in this research field. Identification of key behavioural mechanisms, highlighting which aspects of capability, opportunity, and motivation are most influential. Practical implications for intervention design, providing a theoretical basis for developing targeted, behaviourally informed oral health promotion strategies for orthodontic adolescents. Overall, this study is expected to contribute to both theory and practice by strengthening the behavioural understanding of oral health management in orthodontic care, and by offering an evidence-informed framework to support future intervention development and clinical decision-making.