Decisional needs for older adults, home health care nurses and dental hygienists during team-based oral health assessments in ordinary home settings - a qualitative study

• Published in: BMC geriatrics Vol. 24; no. 1; pp. 779 - 13
• Main Authors: Persson Kylén, Jessica, Björns, Sara, Hägglin, Catharina, Grönbeck-Lindén, Ingela, Piper, Laurence, Wårdh, Inger
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23-09-2024; BioMed Central; BMC
• Subjects: Adults; Aged; Aged patients; Aged, 80 and over; Ageing; Aging; Analysis; Care and treatment; Clinical Medicine; Collaboration; Decision Making; Dental care; Dental Hygiene; Dental Hygienists - psychology; Expansive learning; Female; Group work in education; Health aspects; Health care; Health planning; Home Care Services; Home health care; Humans; Klinisk medicin; Knowledge; Male; Medical care; Medical personnel; Medicin och hälsovetenskap; Methods; Middle Aged; Municipalities; Needs analysis; Needs assessment; Nurses; Nurses, Community Health - psychology; Older people; Oral Health; Oral hygiene; Oral hälsa; Patient Care Team; Patient-centered care; Planning; Qualitative Research; Quality of life; Shared decision-making; Team learning approach in education; Work-integrated learning; Sweden; Work-integrated learning; Ageing; Dental care; Expansive learning; Oral health; Health planning; Shared decision-making
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-024-05367-6

Participation by all actors involved in health planning is a prerequisite for person-centred care and healthy ageing. Understanding the multiple knowledge needs and the values that shape oral health assessments in home settings is important both to enable participation in oral health planning and to contribute to healthy ageing.
The aim of this study was to investigate decisional needs during oral health assessments in ordinary home settings from the perspectives of older adults, home health care nurses and dental hygienists.
Data was collected in ordinary home settings through 24 team-based oral assessments and 39 brief, semi-structured interviews including older adults (n = 24), home health care nurses (n = 8) and dental hygienists (n = 7). Data was analysed using content analysis with a deductive approach. The analysis was guided by the Ottawa Decision Support Guide.
The analysis revealed that all participants considered participation in decision-making important but until now, older adults might not have participated in making decisions regarding oral health issues. The older adults considered participation important because the decisions had a strong impact on their lives, affecting their health. The professionals considered decision-making important for knowing what step to take next and to be able to follow up and evaluate previous goals and treatments. Organizational and personal barriers for shared decision-making among home health care nurses and dental hygienists were identified. Of the 24 older adults, 20 had different oral health conditions that objectively indicated the need for treatment. An initial important decision concerned whether the older adult wanted to make an appointment for dental care, and if so, how. Another decisional conflict concerned whether and how assisted oral care should be carried out.
It is important for key participants in ordinary home settings to participate in interprofessional teams in home health care. To further anchor this in theory, conceptual models for professionals from different care organizations (municipal care, dental care) need to be developed that also involve older adults as participants. Future research could bridge theory and practice by including theories of learning while exploring interorganizational oral health planning in home settings.