Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis
Section snippets
What is already known about the topic?
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Oral health is generally poor in nursing homes, and care aides − a largely untrained and unregulated workforce that provides up to 80% of the direct care (including oral care) to nursing home residents − encounter multiple barriers in providing oral care to nursing home residents.
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Interventions to improve oral care must tailor to barriers and facilitators as perceived by care aides in order to be effective.
What this paper adds
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The multiple barriers and facilitators in providing oral care to nursing home residents, as perceived by care aides, are related to 1 residents, 2 residents members, 3 care providers, 4 organization of care services, and 5 social interactions.
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Residents resisting oral care is the barrier most frequently reported, followed by care aides lack of time, and care aides lack of oral care knowledge, education or training.
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Effective strategies to help care aides prevent or manage residents responsive
Background
Oral care in nursing homes needs urgent improvement. Internationally, studies have reported persistently high rates of preventable or treatable oral/dental problems for decades:
- a)
Caries in residents with natural teeth: 41%–79% (Arpin et al., 2008, Chalmers et al., 2002, Matthews et al., 2012, Maupome et al., 2002, Patrick et al., 2010, Porter et al., 2015, Shimazaki et al., 2004, Wyatt, 2002)
- b)
Gingivitis: 66%–74% of all residents (Matthews et al., 2012, Patrick et al., 2010)
- c)
Need of periodontal
Methods
We registered this review with PROSPERO (CRD42015032454) and published a systematic review protocol (Hoben et al., 2016a, Hoben et al., 2016b, Hoben et al., 2016c).
Study selection
Fig. 1 summarizes the steps of our search and the number of records included and excluded at each step. We did not identify any additional records in the key author and key journal searches, but we included six additional records from screening reference lists of records included from the database search. In total, we included 45 records that represent 41 unique studies. Four technical reports (Fallon, 2009, Fricker and Lewis, 2009, Jones and Sleeman, 2009, Tan et al., 2009) describe the
Barriers and facilitators identified
In this systematic review and meta-analysis, we identified barriers and facilitators that care aides perceived in providing oral care to nursing home residents. These barriers and facilitators relate to broad categories of: 1) residents, 2) residents’ family members, 3) care providers, 4) organization of care services, and 5) social interactions. This aligns with categories of barriers and facilitators for knowledge translation processes (Chaudoir et al., 2013, Damschroder et al., 2009).
Conclusion
This systematic review clearly highlights the need for more rigorous research on barriers and facilitators, as perceived by care aides, in providing oral care to nursing home residents. Dominant barriers and facilitators are relatively well understood: a) residents resisting oral care; b) care providers’ lack of knowledge, education or training in providing oral care; c) care providers’ attitudes toward oral care; d) staffing and time issues; and e) quality of communication/collaboration among
Conflict of interest
The authors declare that they have no conflicts of interest.
Funding
MH conducted this research as part of his post-doctoral work, funded by an Alberta Innovates—Health Solutions Post-Doctoral Fellowship (201300543). This research has been supported by intramural funds from the School of Dentistry, University of Alberta, and the Faculty of Nursing, University of Alberta. Furthermore, HH, RACP, TX, KY, and HX each conducted this research as part of a summer studentship, funded by the University of Alberta Research Experience (UARE) program and Dr. Carole
Author contributions
MH and MNY conceptualized the protocol of this review and meta-analysis, supervised and participated in the screening of abstracts and full texts, data extraction, thematic analysis of barriers and facilitators, and supervised the reconciliation of discrepancies at any stage of the review. MH carried out the search and meta-analyses, and drafted the manuscript, including tables, figures and Supplementary files. AC, KTH, NK, AK, HH, RACP, TX, KY, and HX carried out the screening of abstracts and
Acknowledgments
We would like to thank Dr. Carole Estabrooks for her mentorship and support of this study. We would also like Thane Chambers for her valuable assistance with developing the search strategy for this review and meta-analysis. Furthermore, we would like to thank Cathy McPhalen for editing this manuscript.
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