Title: Caring Optimally: promoting effective Mouth MInuTes in care homes (COMMIT Study)
Funder: Department of Health and Social Care

Abstract: Our ongoing work with people living and working in care homes has guided the development of this proposed research._x000D_ _x000D_ The teeth and gums of older people living in care homes are often in poor condition even though there have been many studies looking into how to maintain mouth care for this population. It is clear that there are problems in implementing the findings. Work is needed, therefore, to find out how to get research into practice. Good mouth health not only helps with eating and speaking but also helps people to feel good about themselves. Poor mouth health, on the other hand, might decrease a person’s quality of life and play a part in life-threatening problems, such as chest infections. In addition, it can distress family and friends to witness their relative (or friend) with ‘dirty’ teeth and may increase concern about other missed care. Our research will investigate this important area of personal care with a view to developing practical solutions to improve oral care in care homes. _x000D_ _x000D_ Care home staff have many duties during their working day, so mouth health may not get as much time as is needed. Many care home residents need help from staff because often they are unable to carry out, and sometimes resist, personal care (including mouth care) due to their physical and/or mental health and abilities. Care home staff may not always have the skills, knowledge and understanding to be able to provide adequate oral care. This research aims, in partnership with care homes, to find out how best to keep residents’ mouths healthy by supporting staff to promote, in their day-to-day work, effective ‘mouth minutes’ for care for residents. _x000D_ _x000D_ In Phase 1 we will review existing research evidence and then work with care home staff, residents and families to consider what might work best from their perspectives and experiences. We will look specifically at:_x000D_ • what has been shown to work in some care homes to help keep residents’ mouths healthy;_x000D_ • what factors get in the way of care staff helping to keep mouths healthy;_x000D_ • what factors might make it easier; and_x000D_ • what might help influence staff to engage in this area._x000D_ _x000D_ While most of the evidence will be on oral care provision in care homes, there might be important lessons from other care settings (e.g. hospices). We will use a theoretical approach (the theoretical domains framework) to help us better understand this area and the influences on staff behaviour and to capture elements related to organisational constraints. This will enable us to identify potential areas to target for behaviour change._x000D_ _x000D_ In Phase 2 we will ‘co-produce’ (with care home residents, relatives and staff, as well as external staff with a role in promoting oral health in care homes) a simple guide which will bring together past research findings and practical input from the care homes to determine the best ways to spend valuable mouth minutes on residents’ care and to help care staff choose what fits best with them and each resident’s needs. We will also determine (with people living and working in care homes) what, if any, future research needs to be developed to address this important area of care. _x000D_ _x000D_ The main contribution of this work is its focus on an enduring issue for care home residents (oral care) and a key strength of the team is our existing relationships and ways of working in partnership with the sector to address and offer practical solutions for important aspects of care in care homes.

Lay abstract: Background: Poor oral health of residents in care homes is an issue globally but despite there being a wealth of both primary research and systematic reviews of this topic, oral care in this setting remains a concern. _x000D_ _x000D_ Aim: to develop theory- and research-informed guidance for care homes to promote staff behaviours to improve oral health (committing to effective ‘mouth minutes’) in care home residents. _x000D_ _x000D_ Methods: This will be an 18-month study in two phases principally using rigorous evidence synthesis, with qualitative methods to promote stakeholder consultation and engagement. _x000D_ PHASE 1: INVESTIGATION of key issues, needs and challenges associated with improving oral care in care homes. Two reviews will be undertaken: (i) an overview of reviews of the effects of interventions used by care home staff to maintain or improve oral care for residents and strategies that target staff behaviours to promote oral care interventions; and (ii) a scoping review of barriers and enablers for effective oral care in care homes. Both reviews will use appropriate methodological guidance: (i) Cochrane guidance for undertaking overviews of reviews and (ii) a six-stage framework for undertaking a scoping review. One comprehensive literature search will identify studies published in the last decade in any language. Medline, Embase,Cochrane Library, CINAHL, PsycINFO, Epistemonkos1, and Web of Science Core Collection. Further completed and ongoing reviews will be identified in JBI Register of Systematic Reviews, International HTA Database, NIHR Journals Library and PROSPERO. Unpublished literature will be identified in Social Care Online, Web of Science Conference Indexes and organisation websites e.g. Care Quality Commission. Review findings will be explored in focus groups of stakeholders to identify resonance and relevance of the review findings for stakeholder groups; and additional issues stakeholders consider pertinent for improving oral care for care home residents. _x000D_ PHASE 2: DEVELOPMENT of guiding principles and logic model for promoting oral care in care homes. Phase 1 findings will be organised using the Theoretical Domains Framework and developed for presentation and discussion within 3 UK-wide stakeholder engagement events to review and refine these two outputs - guiding principles and a logic model. An online approach will be used for sense-checking the interpretation of these stakeholder discussions and the two outputs derived. Further, this approach will be used to confirm wider generalisability._x000D_ _x000D_ Importance: Broad stakeholder engagement and co-production methodology will develop guiding principles with immediate utility for the care home sector across the UK. These will identify in a user-friendly way a suite of key features for maintaining or improving oral care in this setting, summarising and highlighting what is already known about context-specific staff behavioural issues, needs and challenges. Additionally, the logic model derived within this project will provide the theoretical and empirical foundations for future intervention studies, offering a way of visualizing the underlying theory of what works, why and how, as well as the interactions between the constituent parts that maintain and/ or improve oral care in care homes. Our work is novel and timely to address this important area of care and to promote quality of life and care for people living in care homes and quality of work for those providing care to this population.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: ORAL AND GASTROINTESTINAL