Using Role Substitution to Improve Oral Health in Care Homes: A Process Evaluation.

Background: The oral health of many older adults residing in care homes is poor and service provision is limited. Role substitution has been suggested as a potential model to improve service provision in this context and describes the reallocation of tasks from a dentist to other members of the dental team.

Objectives: To undertake a theoretically informed process evaluation alongside a pragmatic cluster-randomised controlled trial to determine whether the use of Dental Therapists and Dental Nurses could improve the oral health of dependent older adults in care homes in the UK.

Materials and methods: Semistructured interviews were held with 17 key stakeholders responsible for intervention delivery. Parallel observations were utilised during the intervention delivery phase in 22 homes. Both were conducted inductively using the main themes from the Promoting Action on Research Implementation in Health Services (PARIHS) framework to focus on intervention delivery and implementation.

Results: Stakeholders were receptive to the potential of using role substitution in this setting and saw this as a viable alternative to current practice. Partnership working was considered key, but was not always observed, and some care staff did not see oral health as their responsibility. The physical environment of the care home setting created a number of challenges, and sugary food and drinks were ubiquitous and formed an important part of the day-to-day structure within the home.

Conclusion: Although role substitution has the potential to meet the needs of dependent older people, a number of challenges exist in promoting oral health and delivering service provision.