Background:
Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, the implementation remains low in most regions. This lack of implementation and scale up of tobacco cessation interventions, which have been found effective in dental settings, requires an understanding of the influences that drive effective implementation. The purpose of this study, was to explore the influences governing ST cessation support in dental hospitals.

Methods:
A multi-centre exploratory qualitative study was conducted at two tertiary-care dental hospitals, in Pakistan. Semi-structured interview guides; containing open ended questions guided by the Capability-Opportunity-Motivation-Behaviour (COM-B) model were used, to capture the views of dental patients (n=12) and dentists (n=12) regarding behavioural interventions for ST cessation in dental hospitals. Framework approach was used to thematically analyse the data.

Results:
Screening of ST users in routine dental practice was seldom practiced and the cessation support offered was brief advice. Common barriers identified by dentists included: fear of offending patients; stereotyping patients; lack of knowledge and skills; lack of privacy; lack of belief in the effectiveness of behavioural support; lack of time and workload pressure; ST use amongst dentists; lack of referral systems and the absence of a mandatory requirement of offering ST cessation support. Facilitators included: delivering support through junior dentists and the length of interaction between the dentist and the patient. Naswar was the most common ST product used by dental patients. Previous cessation attempts were unassisted, with patients reporting receiving negligible cessation support from any healthcare providers. Patients overwhelmingly expressed the need for cessation support.

Conclusions:
A range of influences that hinder and facilitate the implementation of behavioural support for ST cessation in dental hospitals were identified. These findings can inform the implementation of behavioural interventions for ST cessation in dental and other clinical settings in low and middle income countries.