Understanding how to Promote Oral-Care in Care Homes

Objectives: To use COM-B to explore what facilitates care staff to support mouth care of residents in UK care homes (CH).
Methods: A topic guide developed from a scoping review and stakeholder consultation was utilized in six UK focus groups (45-60mins). These involved 50 participants: 11 CH residents, 6 relatives, 20 CH carers, 5 CH managers and 8 dental professionals
Focus group transcriptions were analyzed collectively using deductive framework analysis according to recommendations by (Ritchie & Spencer, 1994). Codes were mapped independently by 3 researchers to the Theoretical Domains Framework (TDF) and then fitted to the COM-B model of behaviour change (Capability, Opportunity and Motivation).
Results: Overarching findings were that: it is recognised that residents’ oral health is a shared responsibility; establishing relationships at all levels is vital; and that knowledge of the correlation between poor oral health with general health is impactful. Under the lens of COM-B, across all groups, matters concerning Opportunity (O) were most frequently discussed, thereafter the importance of motivation (M) and capability (C) differed between groups.
Examples of facilitators included: (i) Supportive systems to help prioritise oral health e.g. care plans, protocols, aide memoires (O). (ii) External support in terms of resources and professional advice/care (O) (iii) Empowerment through positive feedback (M). (iv) Beliefs about consequences (M). (v) Resident-centred, bespoke, interactive training delivered face to face (C).
Conclusions: Even though there has been extensive research in this area, oral care in care homes remains a concern. Utilising a theoretical behaviour change approach offered a way to identify modifiable determinants for interventions aiming to improve oral health in this setting.