Department of Oral Diagnostics, Digital Health and Health Services Research, Charite University Medical Center 3 Dental Oral and Maxillary Medicine, Berlin, Germany
Social Sciences, Humboldt-Universitat zu Berlin, Berlin, Germany.
BMJ Open. 2022 Mar 29;12(3):e049306. doi: 10.1136/bmjopen-2021-049306.
To assess possible health policy interventions derived from the theoretical domains framework (TDF) by studying barriers and facilitators on the delivery of oral healthcare and oral hygiene in German care homes using a behavioural change framework.
Qualitative correlational study to evaluate a national intervention programme.
Primary healthcare in two care homes in rural Germany.
Eleven stakeholders participating in the delivery of oral healthcare (hygiene, treatment) to older people, including two care home managers, four section managers, two nurses/carers and three dentists.
Semistructured interviews conducted in person in the care homes or by phone. A questionnaire developed along the domains of the TDF and the Capabilities, Opportunities and Motivations influencing Behaviours model was used to guide the interviews. Interviews were transcribed and systematised using Mayring's content analysis along the TDF.
860 statements were collected. We identified 19 barriers, facilitators and conflicting themes related to capabilities, 34 to opportunities and 24 to motivation. The lack of access to professional dental care was confirmed by all stakeholders as a major limitation hampering better oral health.
A range of interventions can be discussed with the methodology we utilised. In our interviews, lack of dentists willing to treat patients at these facilities was the most discussed barrier for improving oral health of nursing home residents.
Dentists highlighted the need for better incentives and facilities to deliver oral healthcare in these institutions. Differences with urban settings regarding access to healthcare were frequently discussed by our study participants.
Within our sample, greater capacitation of care home staff, better financial incentives for dentists and increased cooperation between the two stakeholders should be considered when designing interventions to tackle oral health of care home residents in Germany.
通过使用行为改变框架，研究德国养老院提供口腔保健和口腔卫生服务的障碍和促进因素，评估源自理论领域框架（TDF）的可能的卫生政策干预措施。
评估国家干预计划的定性相关研究。
德国农村的两家养老院的初级保健。
11 名利益相关者参与为老年人提供口腔保健（保健、治疗），包括两名养老院经理、四名部门经理、两名护士/护理人员和三名牙医。
在养老院或通过电话进行半结构化访谈。调查问卷是根据 TDF 的领域以及影响行为的能力、机会和动机模型制定的，用于指导访谈。访谈记录并使用 Mayring 的内容分析系统地按照 TDF 进行分析。
共收集了 860 条陈述。我们确定了与能力相关的 19 个障碍、促进因素和冲突主题，与机会相关的 34 个，与动机相关的 24 个。所有利益相关者都确认，缺乏获得专业牙科护理的机会是阻碍更好的口腔健康的主要限制。
我们可以用我们使用的方法来讨论一系列的干预措施。在我们的访谈中，缺乏愿意在这些设施中治疗患者的牙医被所有利益相关者认为是改善养老院居民口腔健康的最大障碍。
牙医强调需要更好的激励措施和设施，以便在这些机构提供口腔保健。我们的研究参与者经常讨论与城市环境相比，在获得医疗保健方面的差异。
在我们的样本中，应考虑增强养老院工作人员的能力、为牙医提供更好的经济激励以及增加两个利益相关者之间的合作，以设计干预措施来解决德国养老院居民的口腔健康问题。
