Factors that influence oral hygiene care with hospitalised stroke patients: a mixed methods study

Abstract

Purpose

Survivors of stroke experience poor oral health during and following hospitalisation. Health professionals consistently report that oral hygiene is complex. Interventions aiming to improve the delivery of oral hygiene care by health professionals rarely use a theoretically driven approach. This study reports the first phase in an intervention development and uses the action, actor, context, target, time (AACTT) framework and theoretical domains framework (TDF) to understand who needs to do what differently in the delivery of oral hygiene care with hospitalised stroke survivors.

Method

Mixed methods including analysis of oral health policies and clinical guidelines using the AACTT framework, focus group discussions using the TDF and audit of 60 medical records.

Results

Policies and guidelines lack specificity regarding what oral hygiene care is and who should be responsible. Health professionals have low beliefs in their capabilities and experience numerous contextual barriers. More than 40% of patients had no documented evidence of oral hygiene care.

Conclusion

This study used a theoretically driven approach to identify barriers and enablers to health professional delivery of oral hygiene care with stroke survivors. Interventions aiming to improve clinical practice should target beliefs about capabilities, improved access to resources and detailed oral hygiene clinical guidelines.

Implications for rehabilitation

• Survivors of stroke experience poor oral health which can contribute to further strokes, cardiovascular disease and mortality.

• Health care professionals report difficulties in delivering oral hygiene care to hospitalised stroke survivors and clinical guidelines lack detail regarding oral health assessments, interventions and training.

• Interventions aiming to improve the delivery of oral hygiene care should target health professional beliefs about their capabilities using strategies such as behavioural practice.

• Resources specific to oral hygiene care for more complex patients, including suctioning toothbrushes, should be readily accessible for health professional use.

• Clinical guidelines and policies on oral hygiene care should include detail about training content, assessments tools and how to adapt information for patients with complex impairments.

Keywords:

• Oral hygiene care
• clinical behaviours
• TDF
• AACTT
• barriers to practice
• stroke
• clinical guidelines
• implementation

Acknowledgements

The authors acknowledge the staff who participated in this study, including reviewing documents, focus group discussions and overall support of the project. We would also like thank the many students from the Melbourne Dental School at the University of Melbourne who have assisted in different aspects of the larger study over the past 3 years.

Disclosure statement

The authors have no conflict of interest to declare.