Introduction: Oral health care of older people in long-term care facilities is insufficient, stressing the need for clear evidence-based implementation strategies to improve oral care. In 2013, a systematic review was performed and new evidence was published. This study aimed to gain insights into implementation strategies used to promote or improve oral health care for older people in long-term care facilities, explore their effectiveness and uncover strategy content in behavioral change techniques, and report the differences between the current results and those of the 2013 study. Methods: A systematic review of the literature according to PRISMA guidelines and meta-analyses of implementation strategies were performed. Cochrane Library, PubMed, and CINAHL databases were searched for papers published between 2011 and 2023. Strategies were identified using the Coding Manual for Behavioral Change Techniques. Meta-analyses of oral health outcomes (“plaque” and “denture plaque”) were performed with random-effects models using R language for statistical computing. Results: 16 studies were included in the current results; 20 studies were included in the 2013 findings. More high-quality studies (67 %) were included in this review than in 2013 (47 %). Dental care professionals were involved in 14 of the 16 studies. Fourteen of the 16 studies used and/ or combined five or more different implementation strategies: knowledge, intention, awareness, self-efficacy, attitude, and facilitation of behavior. Implementation positively affected the knowledge and attitudes of the nursing staff; however, the oral health of older people did not necessarily improve. In the 2013 review, more studies indicated combined oral health measurements were effective (71 %) than in the current review (20 %–33 %). Meta-analysis of four studies on dental plaque (0—3 scale) showed a significant, statistically small mean difference of -.21 (CI -.36; -.07, Cohen's d -.29) between the control and treatment group. Meta-analysis of three studies on denture plaque (0—4 scale), showed a significant, statistically large mean difference of -.76 (CI -1.48; -.05, Cohen's d -.88). Conclusions: In this review, more implementation strategies and combinations were used to implement oral care in long-term care. Implementation strategies positively affected the knowledge and attitudes of nursing staff; however, the oral health of older people did not necessarily improve. Meta-analyses on plaque showed that oral care implementations are effective; for denture plaque, the effect size was large and thus may have more clinical value than for dental plaque.
Introduction: In 2011 5,3 million people had a chronic disease. Secondly patients want to have more influence in regulating their own disease. Self-management is increasingly being mentioned as a possible solution. However the practice learns that this involves ethical dilemmas, which nurses are often confronted with. Aim: ‘What factors are important for nurses who promote self-management in patient with a chronical disease to maintain a healthy lifestyle, while taking into account de patients’ autonomy?Method: a literature search was done in databases Pubmed and Cochrane. Inclusion criteria were: Qualitative research studies published after 2003 in English or Dutch language, concerning adult patients with a chronical disease and related to the nursing profession.Secondly a semi-structural interview was done with two dialysis care professionals and transcripted verbatim. Results: Six studies met the selection criteria and were used to answer the question. The literature data indicate five factors that influence self-management: (1) Professional attitude of nurses: nurses use their own values and convictions in ethical decisions which leads to moral conflicts (2) Shared-decision making: sharing knowledge as a professional with the patient is a significant component in giving the patient autonomy (3) Patient directed support contributes to the success of self-management (4) Change of the traditional relation as professional-patient into a professional cooperation (5) Reflection on ethical dilemmas.During the semi-structural interviews as most important aspects of self-management were mentioned that patients must be informed adequately and supported by making decisions. Patients autonomy must be central in the organization of care. Conclusion: Within self-management the patient should be in a central position. While performing self management care, nurses can be confronted with personal opinions that conflict with patients’ values. Shared decision making, patient directed support, professional attitude of the caregivers and reflection on ethical dilemmas, are key elements for effective self-management.
OBJECTIVES: To make practical recommendations for improving oral hygiene behavior (OHB) potential predictors based on the Theory of Planned Behavior (TPB) were assessed. Measurements of oral health knowledge (OHK) and the expected social effect for having healthy teeth were included.METHODS: 216 recruits in the Dutch Army ground forces completed a questionnaire about oral hygiene behavior, attitudes, social norms, perceived behavioral control (PBC), intention to perform optimal OHB, OHK, and expected social outcomes.RESULTS: The multivariate regression analysis revealed that attitude and PBC explained 37.2% of the variance in intention to perform optimal oral hygiene behavior, which is a substantial proportion. Furthermore, actual oral hygiene behavior was only predicted by attitude, explaining 7.1% of the variance.CONCLUSION: The present findings suggest that recruits' oral hygiene behavior may be improved by promoting a more positive attitude and especially by enhancing perceived behavior control.
