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Strategies to promote oral health improve knowledge but not necessarily the oral health of people living in long-term care facilities
Weening-Verbree L, Huisman-de Waal G, van Dusseldorp L, van Achterberg T, Schoonhoven L. Oral health care in older people in long term care facilities: A systematic review of implementation strategies. Int J Nurs Stud. 2013; 50:569-582
How effective are implementation strategies in promoting or improving oral health care for older people in long-term care facilities?
Oral hygiene is needed to maintain oral health and quality of life. Delivering oral health care is standard practice in long-term care facilities. Compliance with available guidelines and protocols, however, is inconsistent. Strategies have been designed to address this problem, but the effects have been small to moderate and are often short-term. Analyzing the behaviour change recommended in the guidelines may provide insight on how to improve oral health among seniors in long-term care facilities.
How the review was done
This is a summary based on a systematic review of 20 implementation studies, conducted mainly in nursing homes, and ranging from 41 to almost 2,000 participants. Dentists or dental hygienists delivered the implementation strategy to nurses and nurse assistants, who provided the oral health care to seniors. Half of the included studies were uncontrolled before-after studies; the rest were controlled before-after studies, randomized controlled trials or controlled clinical trials. Outcomes were measured from several weeks to several years following the implementation strategy.
What the researchers found
Implementation strategies were developed to impact knowledge, awareness, social influence, self-efficacy, intention and maintenance. While significant positive effects were reported for knowledge and health beliefs, inconsistent findings were observed for oral health. The most successful strategies for improving oral health focused on improving knowledge and self-efficacy, and facilitation of behaviour.
Implementation strategies for promoting or improving oral health care have a positive impact on knowledge and health beliefs, but do not necessarily improve oral health.
Studies where people are assigned to one of the treatments but not purely by chance.
Controlled clinical trials
A research design that differs from experimental studies in that participants are not randomly assigned to groups, but the investigator still controls the intervention(s) (e.g. test, or treatment) received by at least one of the groups. This means a researcher can't draw conclusions about 'cause and effect'. This design is frequently used when it is not feasible, or not ethical, to conduct a randomized controlled trial.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
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