Training dentists in tobacco cessation counselling in Manila, Philippines: a mixed-methods study with implications for practice and education.

Introduction: Tobacco use remains a leading public health challenge in the Philippines, contributing substantially to oral and systemic diseases. Dental professionals are well placed to deliver tobacco cessation counselling (TCC), yet its integration into routine practice remains limited. Evidence on theory-informed training interventions for dental professionals in low- and middle-income countries is scarce. This study evaluated the effectiveness of a structured training intervention on dentists' capability, opportunity and motivation to deliver TCC within dental settings. Methods: A convergent mixed-methods design was used. 30 practising dentists involved in clinical teaching and patient care were purposively recruited from 14 dental schools in Manila, Philippines. Participants completed an 8-hour face-to-face training based on WHO-endorsed brief tobacco intervention models (5A's/5R's) and motivational interviewing. Quantitative data were collected using pretraining and immediate post-training surveys assessing knowledge, preparedness, attitudes and perceived barriers. Data were analysed using the Wilcoxon signed-rank test. Qualitative data were collected through semistructured interviews with 11 participants within 4 weeks of training. Eight transcripts were included in the final analysis and analysed thematically using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework. Findings were integrated during interpretation using a side-by-side comparison mapped to COM-B domains. Results: Post-training scores showed statistically significant improvements across all domains (all p<0.05). Awareness/knowledge increased by 60% and preparedness/skills by 64%. Qualitative findings indicated enhanced counselling capability, improved awareness of referral pathways (opportunity) and stronger professional motivation. However, system-level barriers, such as limited referral infrastructure and time constraints, persisted. Conclusions: A brief, structured training intervention significantly improved Filipino dentists' capability, opportunity and motivation to deliver TCC. However, sustained implementation will require integration into dental curricula, establishment of clear referral pathways and broader health system support. These findings provide context-specific evidence to inform the next phase of the research programme, which focuses on policy integration and curriculum reform.