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Clinical Oral Investigations

, Volume 23, Issue 3, pp 979–993 | Cite as

Barriers and facilitators for provision of oral health care in dependent older people: a systematic review

  • Gerd GöstemeyerEmail author
  • Sarah R. Baker
  • Falk Schwendicke
Review

Abstract

Objectives

Provision of oral health care (OHC), including oral hygiene (OH) or oral/dental treatment, to dependent older people (DOP) is frequently insufficient. We aimed to assess barriers and facilitators perceived by different healthcare professionals towards providing OHC to DOP.

Materials and methods

A systematic review was performed. Studies reporting on knowledge, attitudes, and beliefs acting as barriers and facilitators for provision of OHC were included. One database (PubMed) was searched and data extraction independently performed by two reviewers. Thematic analysis was used and identified themes translated to the domains and constructs of the theoretical domains framework (TDF) and aligned with the domains of the behavior change wheel (BCW). Analyses were stratified for the two target behaviors (providing oral hygiene and providing oral/dental treatment) and according to different stakeholders’ perspective. For quantitative analysis, frequency effect sizes (FES) were calculated.

Results

In total, 1621 articles were identified and 41 (32 quantitative, 7 qualitative, 2 mixed method) studies included. Within these 41 studies, there were 7333 participants (4367 formal caregivers, 67 informal caregivers, 1100 managers of care, 1322 dentists, 340 DOP). Main barriers for providing OH were “lack of knowledge” (FES 65%, COM-B domain: capability, TDF domain: knowledge) and “patients refusing care” (62%, opportunity, environmental context and resources). Main facilitators were “OHC training/education” (41%, capability, skills) and “presence of a dental professional” (21%, opportunity, environmental context and resources). Main barriers for provision of dental treatment were “lack of suitable facilities for treatment/transportation of patients” (76%) and “patients refusing care” (53%) (both: opportunity, environmental context and resources). Main facilitators were “regular visiting dentist” (35%) and “routine assessment/increased awareness by staff” (35%) (both: opportunity, environmental context and resources).

Conclusions

A number of barriers and facilitators for providing different aspects of OHC were identified for different stakeholders.

Clinical relevance

Our findings help provide the evidence to develop implementation strategies for providing high-quality systematic OHC to DOP.

Registration

This review was registered at Prospero (CRD42017056078).

Keywords

Elderly Barriers Facilitators Oral hygiene Dental care Qualitative studies 

Abbreviations

NOS

Newcastle-Ottawa Scale

TDF

theoretical domains framework

COM-B

capability, opportunity, motivation, and behavior model

OHC

oral healthcare

OH

oral hygiene

DOP

dependent older people

FES

frequency effect size

BCW

behavior change wheel

Notes

Acknowledgements

We appreciate the support of Prof. Gabriele Meyer (Martin-Luther-Universität Halle-Wittenberg, Germany) for her useful comments on our study and the manuscript.

Funding

This study was funded by the authors and their institutions.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

784_2019_2812_MOESM1_ESM.docx (652 kb)
ESM 1 (DOCX 651 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Operative and Preventive DentistryCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  2. 2.School of Clinical DentistryUniversity of SheffieldSheffieldUK

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