‘We Didn't Really Learn How to Manage It’: An In‐Depth Mixed‐Methods Exploration Into Temporomandibular Disorder Management Behaviours of First‐Contact Healthcare Practitioners in Australia

BACKGROUND: Temporomandibular disorders (TMDs) affect approximately 10% of the population. Management is often challenging, which can negatively affect patient outcomes and experiences with care. OBJECTIVES: To explore the TMD management behaviours of first-contact healthcare practitioners in Australia and gain insight into factors influencing care. METHODS: Sequential explanatory mixed methods design. Dentists, physiotherapists and general medical practitioners were recruited for a COM-B informed online survey (n = 150) and semi-structured interviews (n = 11). Data were analysed using descriptive statistics (survey) and a codebook analysis approach (interviews). RESULTS: Most participants reported referring to dentists and physiotherapists for initial care. Interventions perceived most important in first-line management included self-management strategies, advice and education and stress management (≥ 73%). Small but statistically significant associations were observed between practitioners' referral behaviours and their occupation, and patients' main presenting complaint (p < 0.05). Leading care challenges included 'lacking knowledge about TMD and possible management options', concerns about the financial cost of treatment to patients and difficulty accessing relevant healthcare practitioners (≥ 41%). Qualitative themes were: (1) Alignment between management beliefs, behaviours and best-practice recommendations, (2) Uncertainty sits between beliefs and behaviours, (3) Patient factors mediate the space between beliefs and management behaviours, (4) Decisions are contextualised within the realities of the broader healthcare system. CONCLUSION: Strong alignment appears to exist between practitioners' TMD management beliefs, behaviours and best-practice recommendations; however, factors like uncertainty, concerns about patients' acceptance of management plans, and practitioners' occupation also impact care decisions. Findings may be helpful to inform strategies to improve TMD management.