Using a theoretically informed process evaluation alongside a trial to improve oral health for care home residents.

BACKGROUND: Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES: This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS: SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS: An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION: Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.

uSing rolE-substitutioN In care homes to improve ORal health (SENIOR): a study protocol.

BACKGROUND: Dental service provision in the care home sector is poor, with little emphasis on prevention. Emerging evidence suggests that the use of Dental Care Professionals (dental therapists and dental nurses) as an alternative to dentists has the potential to improve preventive advice, the provision of care and access to services within care homes. However, robust empirical evidence from definitive trials on how to successfully implement and sustain these interventions within care homes is currently lacking. The aim of the study is to determine whether Dental Care Professionals could reduce plaque levels of dentate older adults (65 + years) residing in care homes. METHODS: This protocol describes a two-arm cluster-randomised controlled trial that will be undertaken in care homes across Wales, Northern Ireland and England. In the intervention arm, the dental therapists will visit the care homes every 6 months to assess and then treat eligible residents, where necessary. All treatment will be conducted within their Scope of Practice. Dental nurses will visit the care homes every month for the first 3 months and then three-monthly afterwards to promulgate advice to improve the day-to-day prevention offered to residents by carers. The control arm will be 'treatment as usual'. Eligible care homes (n = 40) will be randomised based on a 1:1 ratio (20 intervention and 20 control), with an average of seven residents recruited in each home resulting in an estimated sample of 280. Assessments will be undertaken at baseline, 6 months and 12 months and will include a dental examination and quality of life questionnaires. Care home staff will collect weekly information on the residents' oral health (e.g. episodes of pain and unscheduled care). The primary outcome will be a binary classification of the mean reduction in Silness-Löe Plaque Index at 6 months. A parallel process evaluation will be undertaken to explore the intervention's acceptability and how it could be embedded in standard practice (described in a separate paper), whilst a cost-effectiveness analysis will examine the potential long-term costs and benefits of the intervention. DISCUSSION: This trial will provide evidence on how to successfully implement and sustain a Dental Care Professional-led intervention within care homes to promote access and prevention. TRIAL REGISTRATION: ISRCTN16332897 . Registered on 3 December 2021.

A word from wales.

The secretary of state for Wales, Peter Hain, has confirmed that a draft bill to establish a commissioner for older people will be introduced into parliament for pre-legislative scrutiny early this year, which means an independent commissioner could be appointed in 2007. The post-holder will have a major role in ensuring that older people in Wales enjoy basic human rights such as freedom from discrimination, access to health and social services, and protection from abuse.

We are the champions.

The Welsh Government Assembly has agreed to support the principle of free personal care in Wales. But the decision will make no difference to the lives of the thousands of people who could benefit because the assembly cannot produce the money to support its principles.

Exchange network wales.

Promoting the value of nursing with older people is a priority of both the RCN Advisory Panel and the Nursing and Care Homes Forum in Wales. There is good care practice which needs to be highlighted, praised and shared for the benefit of the public and the profession. However, there is also poor, underdeveloped and entrenched practice about which we sadly hear in the media. This has concerned me for some time ( Morgan 1992 ). There needs to be a mechanism whereby nurses can share practice which is person-centred, high quality and offers the best to the public. I see the RCN, and particularly the forums, as the professional organisation to take this forward.

Voices in the valleys.

In Wales, as throughout Britain, older people were looking forward to October 1 - the day the government promised free long-term care. But everywhere they have been let down. Older people clearly feel they are entitled to free care through the National Insurance contributions they have paid, and here in Wales, Age Concern Cymru (ACC) is asking for all personal and nursing care to be provided free to older people, funded from taxation.