Setting the context for a complex dental intervention of role substitution in care homes: Initial process evaluation findings

Hendry, Annie, Baker, Sarah R., McKenna, Gerry, Tsakos, Georgios, Chestnutt, Ivor ORCID: https://orcid.org/0000-0002-9228-800X, Smith, Craig, Jones, Vicki, O'Neill, Ciaran, Jenkins, Alison, Evans, Rachel, Syed, Saif Sayeed, Mirza, Afshan, Harvey, Michelle, Karki, Anup, Moons, Kirstie, Sandom, Fiona, Donaldson, Michael, Lappin, Caroline, Shepherd, Karen and Brocklehurst, Paul R. 2024. Setting the context for a complex dental intervention of role substitution in care homes: Initial process evaluation findings. Gerodontology 10.1111/ger.12749

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Abstract

Objectives: SENIOR (uSing rolE‐substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation. Background: The oral health and quality‐of‐life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs. Materials and Methods: Semi‐structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway‐to‐impact. Interviews were fully transcribed and analysed thematically. Results: Three themes (receptive context, culture, and leadership) and 11 codes were generated. Data show the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services, and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice. Conclusion: Although role substitution could potentially meet the needs of this population, an in‐depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Dentistry
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/
Publisher:	Wiley
ISSN:	0734-0664
Date of First Compliant Deposit:	8 April 2024
Date of Acceptance:	3 March 2024
Last Modified:	08 Apr 2024 09:30
URI:	https://orca.cardiff.ac.uk/id/eprint/167787

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