JMIR Publications

ABSTRACT

Background:

Poor oral health is common in nursing home residents, and healthcare professionals report numerous barriers when it comes to provision of oral care for care-dependent elderly, e.g.: lack of oral health knowledge/skills, care resistant behaviors (CRB) in residents, lack of adequate oral care routines, insufficient systems for documentation of issues related to oral health, a high workload and unclear responsibilities. To overcome these barriers, an intervention named SmartJournal has been developed to assist health personnel in preserving the older patient's oral health. SmartJournal is a digital tool with three components: one for documentation of oral hygiene routines, one for monthly oral health assessment and one for learning about geriatric oral care. An updated framework for research on complex interventions has been used to guide the various phases in the development of the SmartJournal intervention. The present paper focuses on the evaluation phase.

Objective:

This study aims to assess: 1) the effectiveness of SmartJournal usage in enhancing nursing home caregivers' capability, opportunity, motivation and routines related to oral care, and 2) whether SmartJournal usage results in improved oral health for nursing home residents.

Methods:

A cluster randomized controlled trial (C-RCT) will be employed to assess impacts of SmartJournal usage as specified under objectives. Nursing homes located in Rogaland, Norway, will be recruited and randomly assigned to an intervention- and a control group. The intervention group will be provided with tablets containing SmartJournal and support from project staff, while the control group will continue with existing oral care routines. The intervention will last for 12 weeks. Measurements will be performed in both groups at baseline, 3 months and 9 months and include: 1) a survey assessing caregivers' capability, opportunity, motivation and routines related to oral care, and 2) assessment of oral health status in residents using mucosal-plaque score (MPS) as a primary outcome measure. Analyses will include descriptive statistics and statistical techniques to look for changes and differences in the study variables within and between the intervention- and the control group throughout the study period. Associations between study variables will also be investigated.

Results:

Recruitment of nursing homes for the intervention- and control group was completed in February 2023. Recruitment of individual participants (i.e., nursing home residents and caregivers) is ongoing and baseline measurements are performed consecutively. Results are expected to be ready for analyses from fall 2024.

Conclusions:

This study will add to the research on how improved oral care and -health may be obtained in nursing homes and other caring facilities. The results can also inform development and implementation of other digital tools aiming to enhance healthcare services offered to care-dependent people. Finally, SmartJournal may have potential as a learning tool in educational programs for nurses and other healthcare professionals. Clinical Trial: Trial registration was completed 01/23/2023 through the U.S. National Library of Medicine Clinica.Trials.gov website. (Identifier: NTC05724043).