Establishing oral care routines in people with mental health challenges: an analysis of a self-regulation intervention using the Capability, Opportunity, Motivation–Behaviour model

Background - People living with mental illness experience significantly poorer oral health compared with the general population, yet oral hygiene behaviours are often overlooked in mental health care. This mixed-methods study explored behavioural drivers of daily toothbrushing among mental health consumers and their care coordinators, using the Capability, Opportunity, Motivation – Behaviour framework. Methods - Participants from two community mental health centres engaged in an oral health program that included education, oral health assessments, plaque disclosure and brushing diaries to support routine-building. Follow ups at 4 and 8 weeks reinforced habit formation. Semi-structured interviews were conducted with consumers and care coordinators. Quantitative data, including the Treatment Self-Regulation Questionnaire, Perceived Competence Scale, plaque score and oral health knowledge, were drawn from a preceding feasibility study to support triangulation of findings. Data were analysed using a hybrid inductive–deductive approach guided by the Capability, Opportunity, Motivation – Behaviour framework. Results - Consumers described psychological barriers, such as forgetfulness, low mood and cognitive overload, that disrupted oral hygiene routines. Visual and hands-on tools, such as animated videos and plaque disclosure, enhanced motivation. Linking toothbrushing with existing routines, such as taking medication, emerged as a practical enabler through habit stacking. Care coordinators highlighted the importance of social support, structured prompts and environmental cues. Quantitative findings aligned with qualitative insights, underscoring the importance of autonomous motivation and perceived competence in supporting behavioural change. Conclusion - Integrating oral health promotion into routine mental health care through person-centred, behavioural strategies appears to support oral health practices and may reduce health disparities in this vulnerable population.