Weening-Verbree Lina F, Douma Anouk, van der Schans Cees P, Huisman-de Waal Getty J, Schuller Annemarie A, Zuidema Sytse U, Krijnen Wim P, Hobbelen Johannes S M
Research Group Healthy Ageing, Allied Health Care and Nursing and FAITH Research, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714, CA, Groningen, The Netherlands.
Center for Dentistry and Oral Hygiene, University Medical Center Groningen A, Deusinglaan 1 FB 21, 9713, AV, Groningen, The Netherlands.
Int J Nurs Stud Adv. 2024 Dec 31;8:100289. doi: 10.1016/j.ijnsa.2024.100289. eCollection 2025 Jun.
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.
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.
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 .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 -.88).
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.
长期护理机构中老年人的口腔保健服务不足，这凸显了制定明确的循证实施策略以改善口腔护理的必要性。2013年进行了一项系统评价并发表了新的证据。本研究旨在深入了解用于促进或改善长期护理机构中老年人口腔保健的实施策略，探讨其有效性，揭示行为改变技术中的策略内容，并报告当前结果与2013年研究结果之间的差异。
根据PRISMA指南对文献进行系统评价，并对实施策略进行荟萃分析。在Cochrane图书馆、PubMed和CINAHL数据库中检索2011年至2023年发表的论文。使用行为改变技术编码手册识别策略。使用R语言进行统计计算，采用随机效应模型对口腔健康结果（“牙菌斑”和“义齿菌斑”）进行荟萃分析。
当前结果纳入了16项研究；2013年的研究结果纳入了20项研究。与2013年（47%）相比，本次综述纳入了更多高质量研究（67%）。16项研究中有14项涉及牙科护理专业人员。16项研究中有14项使用和/或结合了五种或更多不同的实施策略：知识、意图、意识、自我效能、态度和行为促进。实施对护理人员的知识和态度产生了积极影响；然而，老年人的口腔健康不一定得到改善。在2013年的综述中，更多研究表明联合口腔健康测量是有效的（71%），而在本次综述中这一比例为20%-33%。对四项关于牙菌斑（0-3级）的研究进行荟萃分析显示，对照组和治疗组之间的平均差异具有统计学意义且数值较小，为-.21（置信区间为-.36；-.07，科恩d值为.29）。对三项关于义齿菌斑（0-4级）的研究进行荟萃分析显示，平均差异具有统计学意义且数值较大，为-.76（置信区间为-1.48；-.05，科恩d值为-.88）。
在本次综述中，更多的实施策略及其组合被用于长期护理中的口腔护理实施。实施策略对护理人员的知识和态度产生了积极影响；然而，老年人的口腔健康不一定得到改善。对牙菌斑的荟萃分析表明口腔护理实施是有效的；对于义齿菌斑，效应量较大，因此可能比牙菌斑具有更多的临床价值。
