Abstract
Background
There is little knowledge about home care services personnel competencies and beliefs concerning oral healthcare for home-dwelling, dependent older adults. This study aims to map oral healthcare beliefs among home care services personnel, and have the following question: How do the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs?
Methods
A cross-sectional study among home care services personnel working with older people receiving home care services was conducted across four municipalities in south-eastern Norway. The questionnaire consisted of background information (gender, education level, years of work experience, training in oral healthcare, employment status) and the nursing Dental Coping Beliefs scale. Ethics approval for this study was obtained from the Norwegian Centre for Research Data.
Results
Two hundred and sixty-two homecare services personnel responded to the questionnaire, 16.5% males and 83.5% females; 40.5% had had training in oral healthcare. Home care services personnel believed that gum diseases and cavities can be prevented by dental flossing (61.4%) and toothbrushing (98.4%). 59% disagreed that preventing sickness and medicines from destroying teeth is impossible. However, the majority of the home care services personnel were uncertain about how oral mucosal disorders can be treated. Having more than three years of higher education was positively associated with being in higher quartiles of oral healthcare beliefs, and external locus of control, and having training in oral healthcare was positively associated with being in the lower quartiles of internal locus of control and self-efficacy dimensions. Males were more likely to be in the lower quartile of oral healthcare beliefs, which wasn’t positive.
Conclusion
In the population studied, the home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that home care services personnel need more education and training in oral healthcare.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
Background
Globally, including in Norway, the population of care-dependent older adults with complex health needs is increasing [1], and healthcare services are enduring change as a result of demographic changes and changing health needs [2]. In the coming decades, the demand for health services, such as home care services (HCS), is expected to increase, necessitating an expansion of home care employees’ responsibilities [3]. Norway like many other countries faces challenges with access to qualified healthcare personnel [4]. A larger need for qualified personnel in home care services and difficulties in recruiting qualified personnel, HCS has had to use unskilled personnel [4,5,6]. In 2020 a proportion of unskilled personnel working in HCS in Norway was almost 19% [6]. In Norway, the responsibility for providing HCS is delegated to the municipalities [7, 8] and is mainly publicly funded. The users of HCS differ in terms of age, diseases, and conditions. All individuals with special assistance need arising from illnesses or disabilities can apply for HCS in the municipality in which they are living or have temporary residency [8, 9]. In 2020, nearly 200,000 people were receiving help from HCS in Norway, 59% of whom were adults above the age of 67 years [10]. Care of older people in Norway is regulated by general legislation [9, 11], and many care-dependent older adults are not institutionalized, but rather, they live with supervision at home with assistance from HCS. Home care services personnel (HCS personnel) in Norway offer a range of services, such as somatic and psychiatric care, assistance in daily living, and user-controlled personal assistance, to mention some [9, 12]. HCS personnel are also responsible for different tasks such as wound care, administering medication, and daily personal hygiene, including oral healthcare [9, 12]. There are several professions with different levels of education working in Norwegian HCS such as registered nurses, social workers, assistant nurses, and those without any formal education [6]. Among the elderly people still living at home, there are many who are dependent on help for the basic necessities of life.
Today, there is a high proportion of older adult who keep their teeth for life [13, 14]. Many of these adults are care-dependent and need help from HCS to manage personal hygiene, including taking care of the oral hygiene [9, 11]. Due to impairments in general health such as reduced muscle strength, coordination, or cognitive impairment, these individuals will possibly present some challenges in maintaining daily oral hygiene [15]. According to the World Health Organization, oral health is a key indicator of overall health, well-being, and quality of life, and most oral diseases share modifiable risk factors with the leading noncommunicable diseases such as: cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Adequate oral function and absence of oral diseases are necessary to maintain good oral health [16].
In a study among care-dependent older people in Sweden, Holmen et al. [17] found that there was a higher proportion of care-dependent elderly that had dental treatment needs compared with healthy older adults. An increasing number of dentate care-dependent elderly with complex needs required HCS personnel with a broader knowledge of oral healthcare [18]. The public dental health service (PDS) in Norway has an outreach responsibility towards home dwelling elderly receiving service from home care service. According to Norwegian law the DPS are obliged to provide the nursing staff with information which enables them to perform oral healthcare on the elderly [19]. An interdisciplinary approach and collaboration between these two health services is necessary in order to ensure that employees have sufficient oral health knowledge and that the elderly receive the assistance to which they are entitled [20]. HCS personnel who are younger and have less work experience have been demonstrated to require more training in oral health to properly assist the dependent elderly with oral health [21]. Despite positive attitudes toward oral health, earlier studies have revealed a lack of knowledge among HCS personnel working with the elderly [22, 23]. Knowledge about oral health of the care-dependent older person, and more focus on oral healthcare education has been noted to be necessary to practice better oral healthcare [24]. Moreover, in a systematic review, the barriers and facilitators for providing oral healthcare for care-dependent older adults were assessed from different stakeholders’ perspectives, and a lack of knowledge was identified as one of the main barriers to the provision of good oral healthcare [25].
There is little knowledge about home care services personnels’ oral healthcare beliefs in Norway. Therefore, this study aimed to map the oral healthcare beliefs among home care services personnel in Norway, and has the following question: How does the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs?.
Methods
Study population
The present study was a cross-sectional study among HCS personnel working with elderly in four municipalities in south-eastern Norway. A total of 893 HCS personnel representing different geographical areas were invited to participate. Both permanent and temporary employees, as well as part-time and full-time employees, were invited to participate.
The questionnaire and description of background variables
The questionnaire consisted of two parts, background information about the HCS personnel and the nursing Dental Coping Beliefs scale (nDCBS) [26]. Background information about the HCS personnel included gender, education level, years of work experience, and employment status. Employment status was defined as 100% position when working full time per year, whereas 0–50% and 51-99.9% as working part time per year. Education level was recorded in the following categories: no higher education (without any formal nursing education), student (nurse student or assistant nurse student), assistant nurse, social worker, or registered nurse (three years’ tertiary education), and master’s degree or higher. Work experience was categorized as < 5 years, 5–10 years, 11 − 2 0 years, 21–30 years, and > 30 years. Training in oral healthcare was assessed by the question “I received training in how I can help users with their oral healthcare,” with response alternatives (yes/no). The term users in this question refers to all users of HCS. If respondents answered “yes” to receiving training, an additional question about “where did you receive the training in oral healthcare?” was asked.
Nursing Dental Coping Beliefs scale (nDCBS)
The nDCBS was used to assess oral healthcare beliefs among HCS personnel working with older people in HCS. The DCBS was developed in the United States [27, 28] and was built on three behavioral psychology models: the Cognitive Behavioral model, Locus of Control, and Self-efficacy. A modified scale was later developed in 2005, which reduced the number of items to 28, and it is called the nursing DCBS [26].
The nDCBS we used consists of four dimensions: oral healthcare beliefs (OHCB), external locus of control (EL), internal locus of control (IL), and self-efficacy (SE). Seven items comprised each dimension. The responses were recorded with a five-point Likert scale, from 1 (“strongly agree”) to 5 (“strongly disagree”). For each dimension, it was possible to have a minimum sum score of 7 points and a maximum sum score of 35 points.
The Norwegian version of the nDCBS used in this study was first tested in 2020 in a pilot study conducted in Eastern Norway [29]. We followed the guidelines for translation of the questionnaire from Swedish to Norwegian using two independent translators with Norwegian as their first language [30]. The two translations were then compared and retranslated back to Swedish by two other translators with Swedish as their first language. After a minor linguistic adjustment, that questionnaire was used in this study.
Nettskjema, a software developed and operated by the University of Oslo, was used for designing the electronic questionnaire for data collection. The questionnaire was distributed by leaders of HCS in the four municipalities, who forwarded an Internet link to all employees. One reminder was sent to all leaders of HCS in the respective municipalities after two weeks. Because of a low response rate to the electronic questionnaire, additional data collection was conducted using paper questionnaires distributed at HCS staff meetings. The purpose of the survey was explained to the participants verbally and in writing, but they didn’t get explanation of each question. Participation was voluntary, and written consent was obtained before the questionnaire was completed. The responses were anonymous.
Statistical methods
Descriptive statistics in the form of frequency and percentage distributions were used to describe categorical variables. Education level was trichotomized into “no higher education” (unskilled / without any formal education), “< 3 years of higher education” (assistant nurse and students), and “≥ 3 years of higher education” (social worker, registered nurse, master’s degree or higher). The employment state was trichotomized into 0–50%, 51–99.9% and 100%. Years of work experience were trichotomized into < 5 years, 5–10 years, and ≥ 11 years of work experience.
The items in the nDCBS were grouped into four dimensions: Oral health care beliefs, External locus of control, Internal locus of control, and Self-efficacy, each with seven items. Sums of scores were obtained for each dimension, where high sum scores for the Oral health care beliefs and External locus of control dimensions indicated positive oral healthcare beliefs; for dimensions Internal locus of control and Self-efficacy, positive oral healthcare beliefs were indicated by low sum scores. The sums of scores were then divided into quartiles, with Q3 and Q4 representing high sum scores (positive beliefs for external locus of control and Oral healthcare beliefs), and Q1and Q2 representing low sum scores (positive beliefs for internal locus of control and Self-efficacy dimensions).
Proportions (%) with 95% confidence intervals (CI) were used to describe the distribution of participants’ background variables in each quartile. Differences across the quartiles were established from tests for trends of proportions in statistics software R.
The quartiles have a natural ordering, hence we tried to fit an ordered logistic regression to identify factors associated with being in different quartiles of each construct. However, the assumption of proportionality between the quartiles was violated for some independent variables. Therefore, we fitted generalized partial ordered logistic regression models using the Stata user command gologit2 (Stata Corp LLC version 17, College Station, Texas, USA). We obtained three equal proportional odds ratio (OR) estimates for variables that satisfied the proportionality assumption, whereas different OR estimates were obtained for variables that violated the proportionality assumption.
The adjusted generalized ordered logistic regression analyses were purposefully fitted to the data based on independent variables with P ≤ 0.20 in the unadjusted models. We also fitted models based on independent variables with P < 0.05 from the univariate analyses and used the Bayesian information criterion (BIC) to select the best model. The BIC states that the model with the smallest BIC among nested models is considered a better fit. The analyses were performed using Stata SE version 17, and statistical software R-4.2.1. The statistical significance level was set at a = 0.05.
Results
Characteristics of the study participants
Two hundred and sixty-two HCS personnel responded to the questionnaire (response rate, 29.3%). The majority were female (83.5%), and 9.2% were with no higher education, 44.8% were HCS personnel with ≥ 3 years of higher education. More than half (59.5%) stated that they did not receive any training in oral healthcare. Not all participants answered the questions about where they got training in oral healthcare, but most of them (42) who received training in oral healthcare stated that training was given under education; 30 HCS personnel stated that they received training from the HCS, and 26 from the Public Dental Services (PDS). There were 171 (65.2%) who had 10 years or less of work experience, and more than half of the participants were employed in 100% positions. All background characteristics are shown in Table 1.
Nursing dental coping beliefs scale
Table 2 shows the frequency distribution of responses in different dimensions of the nDCBS, and the results from Cronbach’s alpha (0.6038–6438) for each dimension. The frequency distribution of participants in each quartile are represented in the appendix (Table S1). The results from adjusted ordered logistic regression, and the background variables that were significantly associated with being in higher quartiles, are presented in Table 3.
Oral healthcare beliefs
The Oral health care beliefs dimension says something about the person’s perceptions of preventive oral health behavior [31]. As shown in Table 2, more than half of the HCS personnel were uncertain about the possibility of stopping gum disease when the disease had already started. Over 60% of respondents disagreed that patients would ask when oral healthcare assistance was needed, and a clear majority of HCS personnel disagreed that one should stop flossing and brushing if gums were bleeding. Most of the HCS personnel (93%) disagreed that visiting the dentist was only necessary when experiencing pain, and 61.5% disagreed that dentures were less troublesome than taking care of natural teeth. A larger proportion of HCS personnel did not agree that fluoride products were most suitable for children. As shown in Table 3 and Fig. 1, having ≥ 3years of higher education, was associated with higher Oral health care beliefs scores and the odds of being in the higher quartile were 2.12 times higher among those group. Analysis from Table 3 showed also that when compared with males, females were 3.37 times more likely to score higher and be in the higher quartile of Oral healthcare beliefs.
External locus of control
The External locus of control dimension represents respondents’ beliefs in external factors as ones that affect prevention of oral health diseases (factors beyond one’s control) [32]. The majority of the HCS personnel did not agree that if both parents had bad teeth, brushing and flossing would not help. Furthermore, they did not agree that a dentist was the only one who could prevent cavities and gum diseases. More than half of the HCS personnel (59.4%) disagreed on the question “It is not possible to prevent sickness and medicines from destroying teeth”. As many as 72% of those who responded did not agree that one method of brushing was just as effective as any other, and the majority did not agree that teeth fell out as one got older. Sixty-seven (26%) HCS personnel were uncertain about the claim that tooth loss was a normal part of growing old. Results obtained from the generalized ordered logistic regression model showed that having higher education was associated with being in the higher quartiles of EL (result did not reach statistical significance) (Table 3). The model predicted a 21.1% chance of being in Q4 for those with higher education compared with 13% for those without any formal education (Fig. 1).
Internal locus of control
The Internal locus of control dimension represents respondents’ beliefs in the possibility of preventing oral health diseases by one’s own actions (controlling one’s own life) [32]. As shown in Table 2, the majority of HCS personnel agreed that cavities and gum disease could be prevented. They also agreed that dental flossing and tooth brushing could help prevent cavities. The respondents agreed that the patients wanted help with oral care (69.5%). On the question of whether their patients ate better if they had a healthy and clean mouth, 88.8% agreed. 72% agreed that teeth could be preserved for a lifetime.
Not having training in oral healthcare significantly increased the likelihood of getting a higher score and being in a higher quartile of Internal locus of control by 1.89 times (Table 3). HCS personnel who were trained in oral health had 38.2% chance of being in Q1 of Internal locus of control compared with 24.7% who were not trained in oral health (Fig. 2).
Self-efficacy
Self-efficacy refers to a person’s belief in their own ability to cope with challenges and achieve success, or the respondents’ belief in their “ability to achieve goals” [33]. Most of the HCS personnel agreed that they expected fewer dental problems if respondents brushed and flossed correctly. They also agreed that they knew how to prevent oral candidiasis (77.2%). Less than half of respondents were uncertain about how different oral mucosal disorders could be treated, and almost two-thirds believed that they could successfully remove plaque to prevent cavities and gum diseases. The majority (79.2%) believed that more facts about dental disease could make them practice better oral health.
Not having higher education and not having training in oral healthcare significantly increased the likelihood of being in higher quartiles of Self-efficacy, which is not positive of this dimension (Table 3). Furthermore, 34.7% of those who were trained in oral health were more likely to be in Q1 compared with 24.3% in the untrained group (Fig. 2).
Discussion
The present study mapped the oral healthcare beliefs among HCS personnel and identified several factors associated with their beliefs in oral health. To our knowledge, this is the first study on that topic to be published in Norway.
The current study found that most HCS personnel have positive beliefs about oralhealth and, how to prevent gum diseases, dental caries, and oral yeast infections. There were more uncertainties on whether sickness and medicine can destroy teeth, and how to treat oral mucosal disorders. Receiving oral healthcare training and a higher level of education seem to have a significant effect on HCS personnel being in the higher quartiles of External locus of control and Oral health care beliefs, and the lower quartiles of Self-efficacy, which means positive beliefs.
In our study, while HCS personnel, knew what was important to prevent oral diseases, there were still little knowledge about impact of age, diseases, and medication on oralhealth (External locus of control). The majority of HCS personnel seemed to have positive beliefs about gum disease and tooth cavities being preventable; similar results have been shown in an earlier study in Finland [24]. HCS personnel agreed that patients eat better if they have a healthy, clean mouth. Previous studies have shown that oral healthcare is an important aspect of patients’ comfort and maintenance of dietary intake [34]. HCS personnel in our study were aware that to prevent dental problems, good oral hygiene is important. HCS personnel with oral health training were more confident that what they did could prevent oral diseases. Despite knowing that certain actions, such as brushing your teeth, prevent cavities and gum diseases (Internal locus of control), they were unsure if they could remove plaque correctly (Self-efficacy). They felt that they could overestimate the effect of external factors on oral health ( External locus of control) and were unsure whether tooth loss is a normal part of aging, and that if both parents had bad teeth, brushing and flossing would not help which may be due to lack of knowledge or personal experience with dental disease [21] Our findings are in agreement with findings from other healthcare personnel studies [21, 23, 35, 36].
Almost 41% of HCS personnel answered “agree” or “I don’t know” to the statement that “it is not possible to prevent sickness and medication from destroying teeth.” Edman & Wårdh [21] have argued in their study that this may be due to a lack of knowledge and wrong perceptions of oral diseases. Lack of knowledge about the treatment of different oral mucosal disorders and how to correctly remove plaque may prevent HCS personnel from helping the users with for instance teeth brushing. One possible explanation may be that the HCS personnel has not received sufficient instructions, practice, and support in tooth brushing for care-dependent older adults [37]. An increasing number of dentate care-dependent elderly with complex needs requires HCS personnel with a broader knowledge of oral healthcare [18]. At the same time, shortage of qualified HCS personnel has resulted in more unqualified personnel working in HCS with users who require a lot of expertise [38]. HCS personnel need knowledge about oral health to manage older people’s oral healthcare. The performance of oral healthcare is affected by oral health beliefs, which in turn, are affected by how much education the individual has about oral health [26, 39]. HCS personnel believe that they need more training on oral diseases to give better help with oral healthcare to the elderly. In our study, having training in oral healthcare was associated with being in the lower quartiles of Internal locus of control and Self- efficacy, and those with oralhealth training had more confidence on their action will be important to prevent oral health diseases, these results are in line with results from other studies showing that HCS personnel need oral healthcare training [23, 40, 41] and more knowledge about oral diseases, as well as practice, to gain more confidence in how to prevent oral diseases [21, 24, 35, 36]. Our study showed that having more education improved oral health beliefs and was associated with being in higher quartiles in the dimensions OHCB and External locus of control, and in the lower quartile of Internal locus of control. Some earlier studies show that more education does not necessarily lead to better oral healthcare behavior among HCS personnel [23]. Even so, knowledge can influence their beliefs about consequences and their abilities, which can influence their behavior [24, 25]. However, previous studies have indicated that there is a gap between knowledge and practice in HCS personnel beliefs about the oral healthcare of the dependent elderly [42]. In the Oral health care beliefs dimension, being male was associated with being in the lower quartile; a study from Sweden supports our findings [21].
More than half of HCS personnel lack training in oral healthcare. This is not unique to Norway as studies from other countries have shown similar results [39, 43, 44]. This is despite oral health training being included in the curriculum of the education system, and the PDS having responsibility for collaborating with the municipality to provide training sessions or courses for employees of HCS once per year [9, 45]. Among those who had training in oralhealth only 26 participants answered they have received training from PDS. Notably, HCS personnel do not always attend the training sessions. This could be because of a high workload or low priorities for oral health [40]. There are HCS personnel with different levels of education working in the HCS, our results showed that education level had a positive association with having positive oral health beliefs and the fact that one in five of HCS personnel in Norway are unskilled, the HCS and PDS must ensure that knowledge about oral health is implemented and the competence of HCS personnel is good enough to cope with the tasks they encounter in the working day. A study conducted by Mehl et al. [37] exploring the quality and quantity of oral healthcare in educational programs for auxiliary nurses in Norway concluded that the education program for oral health training was insufficient, and students did not have enough knowledge of oral healthcare to qualify them for future work in healthcare.
Years of work experience did not have an impact on oral healthcare-related beliefs, as no significant difference in any dimension was detected in our study. Previous studies have shown that working conditions, HCS personnel’ health perspectives, cultural differences [36], and personal experiences with oral diseases [21] all influence how HCS personnel approach the oral healthcare of older people.
It is important, regardless of educational level, that HCS personnel have the knowledge and confidence needed to help care-dependent elderly users of HCS. Educational institutions, municipalities, and the PDS are all responsible for ensuring and facilitating HCS personnel’ acquisition of the knowledge required to meet the challenges of an increasingly older population dependent on assistance to keep their teeth. Oral healthcare education is important, and it influences how HCS personnel practice oral healthcare for older people. More education and oral health training are required for HCS personnel so that they are able to provide the necessary oral healthcare for older HCS users.
Study limitations
Of the 893 HCS personnel working across four different municipalities that were included in the study, only about one-third responded to the survey. The low response rate might lead to bias because the beliefs of nonrespondents of the target population might differ from those of respondents. Therefore, the findings should be taken with care considering the implications for health services research. This is not unique to our study, as prior research has revealed response rates of 20–75% [21, 22, 34]. The low rate of participation can be explained by the fact that oral healthcare is not a high priority among HCS personnel [26, 46]. This might be due to a lack of time allotted for this topic and busy schedules. Another explanation could be that the COVID-19 pandemic caused extraordinary conditions in the healthcare system, requiring more health personnel. As a result, participating in research projects was not a priority. In addition, two of the four municipalities that participated in the survey were in the process of reorganizing HCS during the data collection. In our study, we had low Cronbach’s alpha values (0.6038–0.6438). One of the possible explanations for low consistency could be the heterogeneous group of respondents, who had different levels of education. Edman & Wårdh [21] have also questioned whether low consistency could be because there are several different levels of education among the participants. Another limitation of this study is that a questionnaire was used, and the possibility of a socially complacent answer and the social desirability phenomenon must be taken into account. Theres also a possibility that the respondent didn’t know if the subject of the questions was for them or for an older adult. The strength of this study is, to the best of our knowledge, the first to investigate oral healthcare beliefs among HCS personnel in Norway, and we have used nursing dental Coping Belief Scale, and the result can be compared with previous studies.
Conclusions
The home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that HCS personnel need more education and training in oral healthcare. Additional studies are needed to investigate more about the routines for providing good oral healthcare for elderly users of HCS in Norway.
Availability of data and materials
The dataset used in the current study is available from the corresponding author on reasonable request.
Abbreviations
- HCS:
-
Home care services
- nDCBS:
-
nursing Dental Coping Beliefs scale
- IL:
-
Internal locus of control
- EL:
-
External locus of control
- SE:
-
Self-efficacy
- OHCB:
-
Oral healthcare beliefs
- CI:
-
Confidence intervals
- Q:
-
Quartiles
- OR:
-
Odds ratios
- BIC:
-
Bayesian information criterion
- POR:
-
Proportional odds ratios
References
Aging and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 2 June 2022.
Kringos DS. Building primary care in a changing Europe. In. vol. 38. Copenhagen: European Observatory on Health Systems and Policies; 2015.
Genet N, Boerma W, Kroneman M, Hutchinson A, Saltman RB. Home care across Europe: current structure and future challenges. In: WHO; 2012.
Time to Act. The personnel in a sustainable health and care service. In. Edited by Services MoHaC. www.regjeringen.no; 2023.
Services MoHaC. The Coordination Reform,Proper treatment – at the right place and right time In. Edited by Services MoHaC. www.regjeringen.no; 19.06. 2009.
Ingeborg Rasmussen MBHoMSM. Tapere og vinnere i den kommunale helse- og omsorgstjenesten. In. nsf.no: Norsk Sykepleierforbund. Accessed 20 Sept 2023.
Munkejord MC, Schönfelder W, Eggebø H. Voices from the North: stories about active ageing, everyday life and home-based care among older people in Northern Norway. New Challenges to Ageing in the Rural North A Critical Interdisciplinary Perspective. 2019.
Act on municipal health and care services etc. (Health and care services act). https://lovdata.no/dokument/NL/lov/2011-06-24-30. Accessed 11 Apr 2023.
Forskrift Om kvalitet i pleie- og omsorgstjenestene for tjenesteyting etter lov av 19. November 1982 Nr. 66 om helsetjenesten i kommunene Og etter lov av 13. Desember 1991 nr. 81 om sosiale tjenester m.v. https://lovdata.no/forskrift/2003-06-27-792
Municipal health care service. https://www.ssb.no/helse/helsetjenester/statistikk/sjukeheimar-heimetenester-og-andre-omsorgstenester. Accessed 12 Dec 2021.
Vabø M, Christensen K, Jacobsen F, Trætteberg HD. Marketisation in Norwegian eldercare: Preconditions, trends and resistance. In G. Meagher, & M. Szebehely, editors, Marketisation in Nordic Eldercare: A research report on legislation, oversight, extent and consequences. 2013:163–202.
Holm SG, Mathisen TA, Sæterstrand TM, Brinchmann BS. Allocation of home care services by municipalities in Norway: a document analysis. BMC Health Serv Res. 2017;17(1):673–673.
Åstrøm AN, Ekback G, Ordell S, Gulcan F. Changes in oral health-related quality of life (OHRQoL) related to long-term utilization of dental care among older people. Acta Odontol Scand. 2018;76(8):559–66.
Hugoson A, Koch G, Göthberg C, Helkimo AN, Lundin S-A, Norderyd O, Sjödin B, Sondell K. Oral health of individuals aged 3–80 years in Jönköping, Sweden during 30 years (1973–2003). II. Review of clinical and radiographic findings. Swed Dent J. 2005;29(4):139-55.
Ástvaldsdóttir Á, Boström AM, Davidson T, Gabre P, Gahnberg L, Sandborgh Englund G, Skott P, Ståhlnacke K, Tranæus S, Wilhelmsson H, et al. Oral health and dental care of older persons—A systematic map of systematic reviews. Gerodontology. 2018;35(4):290–304.
Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Br Dent J. 2016;221(12):792–3.
Holmén A, Strömberg E, Hagman-Gustafsson M-L, Wårdh I, Gabre P. Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease. Gerodontology. 2012;29(2):e503–11.
Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P, Roots A. Ten principles of good interdisciplinary team work. Hum Resour Health. 2013;11(1):19–19.
Lov om tannhelsetjenesten (tannhelsetjenesteloven). https://lovdata.no/dokument/NL/lov/1983-06-03-54. Accessed 16 Nov 2021.
Willumsen T, Karlsen L, Næss R, Bjørntvedt S. Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Gerodontology. 2012;29(2):e748–55.
Edman K, Wårdh I. Oral health care beliefs among care personnel working with older people – follow-up of oral care education provided by dental hygienists. Int J Dent Hyg. 2022;20(2):241–8.
Wårdh I, Jonsson M, Wikström M. Attitudes to and knowledge about oral health care among nursing home personnel - an area in need of improvement. Gerodontology. 2012;29(2):e787–92.
Garrido Urrutia C, Romo Ormazábal F, Espinoza Santander I, Medics Salvo D. Oral health practices and beliefs among caregivers of the dependent elderly. Gerodontology. 2012;29(2):e742–7.
Pihlajamäki T, Syrjälä AM, Laitala ML, Pesonen P, Virtanen JI. Oral health care-related beliefs among Finnish geriatric home care nurses. Int J Dent Hygiene. 2016;14(4):289–94.
Göstemeyer G, Baker SR, Schwendicke F. Barriers and facilitators for provision of oral health care in dependent older people: a systematic review. Clin Oral Investig. 2019;23(3):979–93.
Wardh I, Sorensen S. Development of an index to measure oral health care priority among nursing staff. Gerodontology. 2005;22(2):84–90.
Wolfe GR, Stewart JE, Hartz GW. Relationship of dental coping beliefs and oral hygiene. Community Dent Oral Epidemiol. 1991;19(2):112–5.
Wolfe GR, Stewart JE, Maeder LA, Hartz GW. Use of Dental Coping beliefs Scale to measure cognitive changes following oral hygiene interventions. Community Dent Oral Epidemiol. 1996;24(1):37–41.
Dalbak ETG. Kunnskaper og oppfatninger om munnhelse hos ansatte i hjemmesykepleien. In.: VID vitenskapelig høgskole Studiested Diakonhjemmet,; 2020.
Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth. 2017;11(5):S80–9.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.
Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr. 1966;80(1):1–28.
Meichenbaum D. Cognitive-behavior modification: an integrative approach. New York: Plenum; 1977.
Costello T, Coyne I. Nurses’ knowledge of mouth care practices. Br J Nurs. 2008;17(4):264–8.
Glassman P, Miller C, Wozniak T, Jones C. A preventive dentistry training program for caretakers of persons with disabilities residing in community residential facilities. Spec Care Dentist. 1994;14(4):137–43.
Andersson K, Furhoff A-K, Nordenram G, Wårdh I. Oral health is not my department’ perceptions of elderly patients’ oral health by general medical practitioners in primary health care centres: a qualitative interview study. Scand J Caring Sci. 2007;21(1):126–33.
Mehl AE, Ellingsen ØG, Kjeksrud J, Willumsen T. Oral healthcare education of future nursing personnel and auxiliary nurses. Gerodontology. 2016;33(2):233–9.
Flodgren GM, Bidonde J, Berg RC. Impact of a high proportion of unskilled personnel on quality of care and patient safety in the healthcare services: a systematic review. Impact of a high proportion of unskilled personnel on quality of care and patient safety in the healthcare services. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health NIPH; 2017.
Sigurdardottir AS, Geirsdottir OG, Ramel A, Arnadottir IB. Cross-sectional study of oral health care service, oral health beliefs and oral health care education of caregivers in nursing homes. Geriatr Nurs. 2022;43:138–45.
Wårdh I, Berggren U, Hallberg LRM, Andersson L, Sörensen S. Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments. Acta Odontol Scand. 2002;60(1):13–9.
Delgado A. Professional caregivers’ oral care practices and beliefs for elderly clients aging in place. J Dent Hyg. 2015;89(6):426.
Wårdh I, Andersson L, Sörensen S. Staff attitudes to oral health care. A comparative study of registered nurses, nursing assistants and home care aides. Gerodontology. 1997;14(1):28–32.
Adams R. Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. J Adv Nurs. 1996;24(3):552–60.
Fitzpatrick J. Oral health care needs of dependent older people: responsibilities of nurses and care staff. J Adv Nurs. 2000;32(6):1325–32.
National guidelines for good clinical practices in dental health services. https://www.helsedirektoratet.no/veiledere/god-klinisk-praksis-i-tannhelsetjenesten/God%20klinisk%20praksis%20i%20tannhelsetjenesten%20%E2%80%93%20Veileder%20(fullversjon).pdf?download=false. Accessed 16 Sept 2023.
Wardh, Hallberg LRM, Berggren U, Andersson L, Sorensen S. Oral health care - A low priority in nursing - In-depth interviews with nursing staff. Scand J Caring Sci. 2000;14(2):137–42.
Acknowledgements
The authors would like to thank all the HCS personnel who responded to the questionnaire, and the PDS, Innlandet County, Norway, for contributing to the implementation of the project. Thanks to Kristin Lund Forren for help collecting the data.
Funding
The study is a part of the Connecting Oral and home health care services (CORAL) project, which is funded by the Norwegian Research Council (301517).
Author information
Authors and Affiliations
Contributions
HIH EASH, and VEA collected data. HIH analyzed the data and wrote the manuscript. EASH, RH, and VEA contributed to study concept, design, methodology and drafting of the manuscript. RSR contributed to drafting of the manuscript. IM analyzed the data and contributed to draft the manuscript. ETD translated nDCBS into Norwegian and carried out a pilot study. All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study was a questionnaire study, Regional Ethic Committee (REC) south-east has concluded that the study does not require approval in accordance with the Health Research Act § 10 (case reference: 32692) because the manuscript does not report on or involve the use of any animal or human data or tissue; it only needs approval from the Norwegian Center for Research Data (Sikt, former NSD). Thet Norwegian Centre for Research Data reviewed the project and found it legally compliant regarding handling participants personal information (297462). The participants gave their written informed consent before completing the questionnaire. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Hassan, H.I., Ansteinsson, V.E., Dalbak, E.T. et al. Oral healthcare beliefs among home care services personnel; a cross-sectional study in south-eastern Norway. BMC Health Serv Res 24, 1090 (2024). https://doi.org/10.1186/s12913-024-11534-7
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12913-024-11534-7