Barriers and Facilitators for Provision of Oral Health Care in Dependent Older People: a Systematic Review

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).