Effectiveness of health promotion programs in improving oral health of older people in residential aged care facilities: Protocol for a Systematic Review
Authors: Aurlene Nesa , Ravichandran Sindhu , Bish Melanie , Tadakamadla Santosh Kumar 
Published: March 2023

Background Globally, there is a demographic transition with population age structures inverting increasing the number of older people relative to other age groups. Oral health in older people is found to be very poor as a result of several factors including deterioration in systemic health, cognitive impairments and limited ability to perform routine oral hygiene measures in addition to the process of ageing. This deterioration is exacerbated in older persons living in residential aged care facilities with most of them experiencing dental diseases that require complex dental treatment. Dental diseases are largely preventable with several health promotion interventions have been found to have varying degrees of success in residential aged care settings. Given the modifiable nature of risk factors involved in the occurrence of dental diseases, behaviour change interventions that target oral health behaviours are valuable in effecting behaviour change thereby leading to an improvement in oral health status among older people people in residential aged care facilities. However, currently there is a paucity of research that acts as an evidence base for designing and optimising behaviour change interventions in residential aged care settings. This systematic review will investigate the components of health promotion interventions associated with changes in oral health status among older people living in residential aged care facilities. Objective The aim of this study is to identify all oral health promotion interventions with a behavioural component designed and trialled for the improvement of oral health status in residential aged care facilities, and to identify the behaviour change techniques used in such interventions using the Behaviour Change Techniques Taxonomy Version 1 (BCTTv1). Methods/Design: This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. Randomized controlled trials and non-randomized intervention studies aimed at improving oral health status among older persons living in RACF’s will be included. MEDLINE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews (CDSR), EMBASE, PsycINFO, CINAHL and Web of Sciences will be screened for articles relevant to the review; Titles, abstract screening, full-text review and data extraction will be performed independently by two reviewers. Data will be recorded in a pretested form, any disagreements in screening or data extraction and coding will be resolved by discussion with a third reviewer. Risk of bias in randomized controlled trials will be assessed using the Cochrane Risk of Bias 2 (RoB2) tool, the Risk of bias in non-randomized studies of interventions (ROBINS-I) tool will be used for non-randomized studies. A narrative synthesis of the association between behavior change techniques and its effect on improving oral health outcomes in residential aged care facilities will be provided. Where the data is sufficiently homogenous, the data will be pooled and statistically analysed. Discussion This review will be of value to older persons residing in residential aged care facilities, health care professionals and policy makers.. The conclusions of this review will be used to design an appropriate intervention with effective behavior change techniques to improve oral health status among older people in residential aged care facilities in rural Victoria. Systematic Review Registration: PROSPERO reference: CRD42022375632