Abstract
Background
Workplaces are key setting for health promotion, but very few investigations have focused on oral health promotion there. This study investigated the impact, acceptability, feasibility, and sustainability of workplace oral health promotion (WOHP) activities in the aged care sector.
Methods
A mix of approaches was used to explore the influence of the aged care working environment on staff oral health and related risk factors, assess WOHP acceptability and feasibility in the sector, identify the facilitators and barriers, and WOHP’s impact among aged care sector workers.
It comprised three sub-studies: the Community Project; the Aged Residential Care (ARC) Project; and the Aged Care Key Informants Project (hereafter, the KI Project). The first two were conducted as pre- and post-intervention studies, involving group educational sessions and oral health promotional resources, along with an additional clinical assessment and personalised education session in the ARC Project. Evaluation of the intervention projects involved questionnaires, with post-intervention interviews of a sub-sample of participants. Self-reported indicators for the intervention projects included oral health knowledge, values (OHVS), self-efficacy (OHSE), oral health-related quality of life (OHRQoL), oral health routine and risk factors. For the ARC Project, dental plaque, gingival appearance, calculus, and mobility scores were evaluated with a baseline and follow-up clinical assessment. The self-reported and clinical parameter changes were analysed with paired t-tests and McNemar test; effect sizes were also estimated.
The KI Project involved semi-structured interviews with members of key organisations associated with the aged care workforce, including oral health and health professionals, government and non-governmental organisations, aged care provider organisations, unions and other worker support organisations.
All interviews from the Community, ARC and KI Projects were audio-recorded and transcribed verbatim. Data were analysed thematically.
Findings and Conclusions
For the Community Project, 18 (62%) of an invited convenience sample of 29 aged care workers participated at baseline, with 14 (78%) followed-up. In the ARC Project, all staff working in two purposively-selected ARC facilities were invited to participate; 56 (90.3%) of the 62 assessed were followed-up. In the KI Project, 17 individuals were invited, of whom 14 (82%) participated.
Oral health promotion activities in the Community and ARC Projects were deemed both feasible and acceptable from the participants’ perspectives. This WOHP intervention achieved short-term impacts (improved staff oral health knowledge, values, self-efficacy, and oral health behaviours) and was perceived to improve the staff’s oral health awareness and skills that would also benefit their dependants and the organisation for which they work.
The interviews with study participants and key informants identified six factors as important for WOHP planning and implementation. These were: (i) organisation structure, needs and priorities; (ii) higher management contribution; (iii) resources (funding, facilities, human and time capacity); (iv) collaborators; (v) sustainability of the programme; and (vi) individual or target audience factors. Three main levels were reported as facilitators for and barriers to programme uptake: (i) individual factors (individual health needs, interests, past experience, personal commitment and socioeconomic background); (ii) organisation factors (management and peer encouragement, organisation workload and staff capacity; and (iii) programme factors (activities, location, time, communication, resources).