Education to Implementation: A Mixed-Methods Study of Tobacco Cessation Counselling Practices Among Recently Graduated Dentists in India

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BACKGROUND: India bears a high burden of tobacco-related oral disease. The Dental Council of India (DCI) has recently mandated the establishment of Tobacco Cessation Centres (TCCs) in dental colleges and released operating guidelines to standardise their functioning. Evidence on how recently graduated dental practitioners engage with TCC-related competencies in actual practice remains limited. METHODS: A sequential explanatory mixed-methods study was conducted among BDS graduates (2018 onwards) currently in clinical practice in Uttar Pradesh, India. A cross-sectional online survey (n = 264) assessed TCC practices, attitudes, perceived barriers, and support needs. A composite Attitude-and-Practice Score was generated, and univariate linear regression examined associations with participant characteristics. In the qualitative phase, eight semi-structured in-depth interviews were analyzed using reflexive thematic analysis and interpreted through the COM-B (Capability-Opportunity-Motivation-Behaviour) model. RESULTS: Although 83.7% of respondents reported undergraduate posting in a TCC centre, only 37.1% had received additional cessation-related training and 14.8% reported personal tobacco use. Routine enquiry and brief advice were common, but pharmacotherapy use, structured follow-up and formal referral were inconsistent. The mean Attitude-and-Practice Score was approximately 74%, with personal tobacco use emerging as the only significant negative predictor. Qualitative analysis identified four interacting themes: procedure-driven clinical identity, system-level constraints, patient-related, challenges and training-related capability gaps. These collectively reflected limited capability, constrained opportunity, and fragile motivation within COM-B. CONCLUSION: Undergraduate training alone has not ensured routine tobacco cessation counselling among recently graduated dentists. Bridging the gap between training and practice requires competency-based education, supportive systems, and a shift in dentist's perceptions to value preventive counselling as an integral part of clinical care. Strengthening these elements is essential for enhancing the role of dental professionals in oral cancer prevention.

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