Oral health and cancer screening in long-term care nursing facilities: Motivation and opportunity as intervention targets.

Abstract

The objective of this study is to propose empirically and conceptually supported interventions that might increase the capability and opportunity to provide of oral hygiene care and oral cancer screening in long-term nursing care facilities. Improving the oral health in the older adult population is a priority of the Healthy People 2020 initiative. Poor oral health disproportionably affects older populations, which indicates lower participation in regular oral health care (OHC) that includes screening and early detection of oral cancer. A rigorous recruitment protocol yielded a purposive sample of nursing home Administrators and Directors of Nursing who participated in nine discrete focus groups (n=34) in several regions of Massachusetts. Interview data were integrated with a conceptual framework of the Health Belief Model and the "capability," "opportunity," "motivation" and "behavior" of the COM-B system to identify potential interventions to increase oral health and oral cancer screening. We used NVivo to identify conceptual themes related to potential intervention targets. Participants identified several impediments to oral hygiene and cancer screening in the context of the conceptual model. High barriers, low opportunities and low motivation were themes identified as potential targets for intervention. Our findings suggest that the intervention likely to increase OHC and consequently oral cancer screening include: training certified nurses' aides using dental students and volunteers; educating family members about OHC and oral cancer screening, and increasing oral cancer awareness.