Using the COM-B Model and Theoretical Domains Framework to Understand Patients’ Referral Compliance Following a Diabetes Screening in the Dental Setting

Background/Objectives: The dental setting has been suggested as a location for opportunistic diabetes screenings. Diabetes screening is a pathway consisting of several steps that must be completed to reach a diagnosis. Previous research has found that most patients in the dental setting, when offered the opportunity to screen for diabetes, are willing to do so; however, amongst those who are referred for medical follow-up, there is low compliance. If diabetes screening in the dental setting is to be effective, strategies are required to maximise uptake and ensure completion of the screening pathway. Methods: This qualitative study examined participants in a diabetes screening trial held at dental clinics in Victoria, Australia. Semi-structured interviews were conducted by telephone, transcribed and analysed thematically. The themes identified were then deductively mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Results: Ten individuals who were screened for diabetes and referred to their general medical practitioner (GP) for a diabetes diagnosis were interviewed. The themes identified from the interviews were mapped to five COM-B domains: reflective motivation and automatic motivation, social and physical opportunity and psychological capability. These were linked to eight TDF domains associated with issues related to knowledge, environmental context and resources, memory, attention and decision processes, social influences, beliefs about consequences, emotions, and beliefs about capability. Conclusions: This study investigated the determinants influencing individuals’ decision to participate in diabetes screening and comply with referral advice. The results demonstrate the need to increase community knowledge around diabetes and screening for the condition, facilitate risk interpretation, and streamline the referral pathway between oral health professionals (OHP) and GPs. The study provides evidence that can be utilised for the development of future interventions that promote diabetes screening participation and maximise medical follow-up of referred individuals.