Hendry Annie, Baker Sarah R, McKenna Gerry, Tsakos Georgios, Chestnutt Ivor, 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, Brocklehurst Paul R
Bangor Institute of Health and Medical Research, Bangor University, Bangor, UK.
Department for Oral Health, Dentistry and Society, University of Sheffield, Sheffield, UK.
Gerodontology. 2024 Dec;41(4):535-546. doi: 10.1111/ger.12749. Epub 2024 Mar 27.
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.
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.
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.
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.
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.
SENIOR（利用养老院中的角色替代改善口腔健康）是一项随机对照试验，旨在确定角色替代是否能改善该人群的口腔健康。同时进行了一项平行的过程评估以了解背景情况。本文报告了过程评估的第一阶段。
居住在养老院的老年人的口腔健康和生活质量比社区中的老年人差。通常无法提供口腔保健服务，这对管理人员来说是一个担忧和挑战。使用牙科治疗师和牙科护士而非牙医可能潜在地满足这些需求。
对21名在依赖护理机构工作或有相关经验的关键利益相关者进行了半结构化访谈。问题在理论上以卫生服务研究实施促进行动（PAHRIS）框架为依据。重点是可能影响实践中采用情况和影响途径的背景因素。访谈内容全部转录并进行了主题分析。
产生了三个主题（接受性背景、文化和领导力）和11个编码。数据显示了该环境的复杂性以及可能成为干预实施的障碍和促进因素的背景因素。管理人员意识到口腔健康问题并寻求提供最佳护理，但面临许多挑战，包括人员流动、时间压力、需求竞争、服务获取和资金限制。牙科专业人员认识到需要改进，并将角色替代视为当前实践的可行替代方案。
尽管角色替代可能潜在地满足该人群的需求，但深入了解背景因素对于理解干预实施和执行似乎很重要。
