Implementation issues and barriers for assessing oral health in dependent patients after stroke: A qualitative study.

OBJECTIVES: To explore implementation issues and potential barriers for assessing oral health in dependent post-stroke patients. METHODS: Semi-structured interviews were conducted with a purposively identified sample of healthcare service providers who work in two National Health Service (NHS) Trusts in the north of England. Interviews were conducted until data saturation was achieved (n = 30). Data were analysed using the constant comparative method. RESULTS: Six themes were drawn out in this study, which described potential barriers to assessing oral health in post-stroke patients, aspects of oral health that need assessment, streamlining the oral health assessment, input methods for oral health assessment, characteristics of assessors, and how oral care should be planned. CONCLUSIONS: Assessment of oral health for post-stroke patients has been viewed as a complex task because of several identified barriers. Several suggestions have been proposed to overcome these barriers, aiming to enable more feasible and effective oral health assessments for post-stroke patients. CLINICAL SIGNIFICANCE: The findings from this study have the potential to contribute to developing oral health measurement instruments that might be more successfully implemented and guide oral care planning for dependent patients after stroke.

Establishing an empirical conceptual model of oral health in dependent adults: Systematic review.

AIM: This qualitative evidence synthesis was performed to establish a conceptual model of oral health in dependent adults that defines the construct of oral health and describes its interrelationships based on dependent adults' and their caregivers' experiences and views. METHODS: Six bibliographic databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, OATD, and OpenGrey. Citations and reference lists were manually searched. A quality assessment of included studies was conducted independently by two reviewers using the Critical Appraisal Skills Programme (CASP) checklist. The 'best fit' framework synthesis method was applied. Data were coded against an a priori framework and data not captured by this framework were thematically analyzed. To assess the confidence of the findings from this review, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used. RESULTS: Twenty-seven eligible studies were included from 6126 retrieved studies. Four themes were generated to further understand oral health in dependent adults: oral health status, oral health impact, oral care, and oral health value. CONCLUSION: This synthesis and conceptual model offer a better understanding of oral health in dependent adults and subsequently provide a starting point to guide establishment of person-centred oral care interventions.

Oral health decline in patients after stroke: a qualitative study.

Introduction To develop and implement effective oral care interventions for patients after stroke, there is a need to understand the causes behind the decline in their oral health. This qualitative study was, therefore, undertaken to explore experiences and views of health service providers about the causes of oral health decline in this group of patients.Methods A purposively selected sample of healthcare service providers who work in two NHS Trusts in the North of England were interviewed utilising a semi-structured interview technique. Interviews were conducted with the assistance of a topic guide and continued until data saturation (n = 30) was reached. The constant comparative approach was used to analyse the data.Results Two major factors, perceived by the participants, were thought to cause oral health decline in patients after stroke. Post-stroke neurological deficits resulting in oral-related functional disturbances was the first. The second was the barriers leading to difficulties in performing or receiving daily oral care. These barriers were related to the patients, their service providers, or the environment in which care is being delivered.Conclusions This study described the major factors affecting the oral health of patients after stroke, which can offer a starting point for developing effective oral care interventions for them.

Measurement properties, interpretability and feasibility of instruments measuring oral health and orofacial pain in dependent adults: a systematic review.

BACKGROUND: Dependent adults have been shown to have a greater experience of oral health deterioration and orofacial pain. This is partly because their non-dental caregivers may not easily identify oral health problems and orofacial pain experienced by them. Thus, this systematic review aimed to investigate measurement properties, interpretability and feasibility of instruments assessing oral health and orofacial pain in dependent adults, which can be used by the non-dental caregivers to establish oral care plans for those who are dependent upon them. METHODS: Seven bibliographic databases were searched: MEDLINE, Embase, CINAHL, CENTRAL, HTA, OATD and OpenGrey. Citations and reference lists of the included studies were also manually searched. Two authors independently screened titles and abstracts, and then full texts. A quality assessment of included studies was conducted independently by two authors using the COSMIN Risk of Bias checklist. The best evidence synthesis method was used to synthesise results from different studies for each measurement property per measurement instrument by integrating the overall rating for each measurement property per measurement instrument with its quality level of evidence. RESULTS: Nineteen eligible studies were included, which reported the development, measurement properties' evaluation, interpretability and feasibility of nine oral health and three orofacial pain measurement instruments. Methodological quality of the included studies ranged from very good to inadequate. None of the identified measurement instruments has been adequately and comprehensively tested. CONCLUSIONS: While several measurement instruments were identified in this systematic review, more evidence is needed to be able to more comprehensively evaluate these instruments. Among those identified, the OPS-NVI demonstrated sufficient construct validity, while the OHAT and the THROAT demonstrated sufficient reliability. These instruments therefore have potential for future use with more confidence once other measurement properties, interpretability and feasibility have been sufficiently tested and evaluated.