Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour

Perceptions of patients towards oral health care in a spinal cord injury rehabilitation unit: A qualitative study

BACKGROUND

Individuals with spinal cord injuries (SCIs) are at an increased risk of poor oral health compared to the general population. However, little is known about the related barriers and facilitators experienced by these individuals within the hospital setting.

OBJECTIVES

Understand the oral health knowledge, attitudes and practices of people with SCIs, barriers and facilitators to managing their oral health, and recommendations to improve oral care at acute/rehabilitation hospital settings.

METHODS

Semi-structured interviews were conducted with 11 participants, from a major metropolitan hospital in Sydney, Australia. The interviews were thematically analysed.

RESULTS

Three themes were constructed. Participants believed that the onus was on them to manage their oral health. Individuals also had limited knowledge of its importance to general health, and placed a lower priority on oral health compared to other aspects of health. All participants identified a combination of factors, such as cost, time, resources and prior negative experiences, that contributed to the neglect of their oral care. Participants also discussed the need of support from the multidisciplinary team and family/carers to facilitate oral care and identified various appropriate oral health education formats.

CONCLUSION

This study highlighted some areas where oral health knowledge among people with SCIs could be improved. It also identified the need for oral health training for the multidisciplinary team, as well as carers, to better integrate oral care during rehabilitation in the hospital. The development of oral health interventions would need to utilise a co-design approach to best support clients and their carers to facilitate oral care self-management.

A systematic review of the theory of planned behaviour interventions for chronic diseases in low health-literacy settings

Background

Due to their chronicity, prolonged morbidity, and high mortality, chronic respiratory diseases (CRDs) pose a huge burden of disease globally, primarily among low- and middle-income countries. Most of these diseases can be controlled by early diagnosis and treatment, correct practice of medications, regular follow-up, and avoidance of risk factors, which involves a change in health behaviour among patients. The theory of planned behaviour (TPB) has been proven to be effective and has been used increasingly as a behavioural framework for designing and evaluating behaviour change interventions, although most such studies were on affluent populations and from the global north. We aimed to collate evidence of TPB-based behavioural interventions in low health literacy settings for its effectiveness and feasibility by conducting a systematic review (SR).

Methods

We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines in conducting and reporting this study. We selected interventional studies using at least two constructs of TPB for behaviour change in chronic disease patients and conducted in LMICs, used the PICO framework, and exported the retrieved studies through the Endnote software. We evaluated the studies using the Risk of Bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools.

Results

We retrieved and reviewed the titles and abstracts 4281 titles and abstracts, identifying 186 articles for further detailed screening. Eleven studies met the criteria for a standardised independent full-text screening by two authors and four were selected for narrative synthesis. All studies were from urban settings, with established feasibility and fidelity; all interventions were effective in changing health behaviour and TPB constructs and provided structured education to participants in the intervention group (either face-to-face and through group education). Three studies had some concerns/moderate risk of bias and one had high risk of bias.

Conclusions

All studies demonstrated effectiveness, feasibility, and fidelity of TPB interventions in LMIC settings, although most were of moderate quality. Further studies should gather definitive evidence and prove their feasibility and utility in LMICs.

Registration

PROSPERO CRD42018104890.

Investigating oral health-related quality of life in patients with ischaemic stroke in China

OBJECTIVE

The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model.

BACKGROUND

Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke.

MATERIALS AND METHODS

Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model.

RESULTS

Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL.

CONCLUSION

The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

Factors that influence oral hygiene care with hospitalised stroke patients: a mixed methods study

PURPOSE

Survivors of stroke experience poor oral health during and following hospitalisation. Health professionals consistently report that oral hygiene is complex. Interventions aiming to improve the delivery of oral hygiene care by health professionals rarely use a theoretically driven approach. This study reports the first phase in an intervention development and uses the action, actor, context, target, time (AACTT) framework and theoretical domains framework (TDF) to understand who needs to do what differently in the delivery of oral hygiene care with hospitalised stroke survivors.

METHOD

Mixed methods including analysis of oral health policies and clinical guidelines using the AACTT framework, focus group discussions using the TDF and audit of 60 medical records.

RESULTS

Policies and guidelines lack specificity regarding what oral hygiene care is and who should be responsible. Health professionals have low beliefs in their capabilities and experience numerous contextual barriers. More than 40% of patients had no documented evidence of oral hygiene care.

CONCLUSION

This study used a theoretically driven approach to identify barriers and enablers to health professional delivery of oral hygiene care with stroke survivors. Interventions aiming to improve clinical practice should target beliefs about capabilities, improved access to resources and detailed oral hygiene clinical guidelines.Implications for rehabilitationSurvivors of stroke experience poor oral health which can contribute to further strokes, cardiovascular disease and mortality.Health care professionals report difficulties in delivering oral hygiene care to hospitalised stroke survivors and clinical guidelines lack detail regarding oral health assessments, interventions and training.Interventions aiming to improve the delivery of oral hygiene care should target health professional beliefs about their capabilities using strategies such as behavioural practice.Resources specific to oral hygiene care for more complex patients, including suctioning toothbrushes, should be readily accessible for health professional use.Clinical guidelines and policies on oral hygiene care should include detail about training content, assessments tools and how to adapt information for patients with complex impairments.

Integrating oral care into nursing practice in care homes

This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.

Research on Factors Affecting Chinese College Students' Marriage Intention: Applying the Theory of Planned Behaviour

With the second demographic transition, the marriage rate in China has decreased annually. This reduction will have a key impact on national economic and social development. There is a need to investigate the factors that influence college students' marriage intentions, which can predict the development trend of marriage and family formation in China's future society to some extent. Previous studies focus on the extraction of college students' beliefs about marriage and love, whereas few studies have investigated how these beliefs affect marriage intention and marriage behaviour. Based on the theory of planned behaviour, this study aims to explore the impact of attitude towards behaviour, subjective norm, and perceived behavioural control on marriage intention; analysed the key predictors of college students' marriage intentions; and provided implications for pro-marriage policy. Using convenience sampling, data were obtained from 772 college students (mean age = 20.38 ± 2.38 years; 64.5% women) from three universities in China. Two types of questionnaires were designed to elicit salient beliefs and marriage intentions, respectively. Students' marriage intentions were positively correlated with attitude towards behaviour, subjective norm, and perceived behavioural control. Most participants were inclined to get married, and the marriage intention of women was significantly lower than that of men. The important beliefs and factors influence students' marriage intention included stereotypical gender identity, low fertility intention, weakened inter-generational transmission of traditional family ideas, materialisation of marriage, and negative information about marriage disseminated by the mass media. To promote college students' marriage intention, pro-marriage policies conducive to fertility, good economic prospects, more employment opportunities, positive publicity of marriage by the mass media are suggested to make, and it is necessary for universities to offer marriage and love courses to college students.

Perceptions of nurses and physicians on pay-for-performance in hospital: a systematic review of qualitative studies

AIMS

To systematically examine perceptions of nurses and physicians on pay-for-performance in hospital.

BACKGROUND

Pay-for-performance projects have proliferated over the past two decades, most systematic reviews of which solely focused on its effectiveness in primary healthcare and the physicians' or nurses' attitudes. However, systematic reviews of qualitative approaches for better examining perceptions of both nurses and physicians in hospital are lacking.

EVALUATION

Electronic databases were systematic searched with date from its inception to December 31, 2020. Meta-aggregation synthesis methodology and the conceptual framework of the Theory of Planned Behavior were used to summarize findings.

KEY ISSUES

A total of nine studies were included. Three major synthesized themes were identified: (1) perceptions of the motivation effects and positive outcomes (2) perceptions about the design defects and negative effects (3) perceptions of the obstacles in the implementation process.

CONCLUSION

To maximize the intended positive effects, nurses' and physicians' perceptions should be considered and incorporated into the project design and implementation stage.

IMPLICATIONS FOR NURSING MANAGEMENT AND RESEARCH

The paper gives enlightenment to nurse managers on improving and advancing the cause of nurses when planning for or evaluating their institutions' policies on pay-for-performance in the future research.

Effects of Self-Management Intervention Programs Based on the Health Belief Model and Planned Behavior Theory on Self-Management Behavior and Quality of Life in Middle-Aged Stroke Patients

Objectives

To study the effect of self-management intervention programs based on the health belief model and planned behavior theory on self-management behavior and quality of life in middle-aged stroke patients. Most of the intervention studies on the self-management of middle-aged stroke patients focus on traditional Chinese medicine nursing and continuous nursing, lacking theoretical support. In particular, there is a lack of interventions based on the integration of two or more theories.

Method

The middle-aged stroke patients were divided into the control group and the intervention group according to the disease area. A total of 70 patients were included, and 35 patients were included in the control group and the intervention group, respectively. The control group received routine neurological treatment and health education during hospitalization and continued to receive routine health education for 3 months after discharge. On this basis, the intervention group received an intervention program based on an integrated model of health beliefs and planned behavior theory, including 3 health education sessions during hospitalization and 3 months of postdischarge health education. A self-administered stroke general information questionnaire was used to collect basic information on patients' age, gender, and comorbidities. The Stroke Self-Management Behavior Rating Scale and Stroke-Specific Quality-of-Life Scale (SS-QOL) were used to evaluate the management behavior and quality of life of the patients in both groups before and after the intervention.

Results

Before the intervention, there was no statistically significant difference between the two groups in terms of self-management score, quality of life total score, and scores of each dimension (P > 0.05). At different periods after the intervention, the total score of self-management, total score of quality of life, and scores of each dimension were significantly higher in both groups than before the intervention (P < 0.05). In particular, the self-management and quality of life scores of the intervention group were higher than those of the control group at 1 and 3 months after the intervention (P < 0.05).

Conclusion

The self-management intervention scheme based on the integrated model of health belief and planned behavior theory is beneficial to improve the self-management ability and quality of life of stroke patients. It provides basis for clinical nurses to further improve the self-management ability and quality of life of stroke patients. Our findings may also serve as a reference for caregivers in other countries to improve the self-management and quality of life of stroke patients.

A preliminary study on applying holistic health care model on medical education behavioral intention: a theoretical perspective of planned behavior

BACKGROUND

This study aimed to apply the theory of planned behavior to identify the medical education behavioral intention of holistic healthcare on teachers and students who influence the medical and healthcare profession, as a revised future direction for hospitals to continue to implement holistic healthcare.

METHODS

This cross-sectional study was performed from April to May 2020. A questionnaire survey was conducted with the clinical teachers and students of the medical and healthcare profession in an individual Taiwan hospital as study subjects, based on judgmental sampling, and the study tool was a structured questionnaire.

RESULTS

A total of 360 valid samples were collected, 105 clinical teachers (29.2%) and 255 students (70.8%). Demographic variables were significantly different between clinical teachers (mean = 3.91) and students (mean = 3.73) (p = 0.023). Post hoc analysis regarding work experience found that those with work experience < 2 years (mean = 3.94) had higher results than those with 6-10 years (mean = 3.61) (p = 0.019). The results of multiple regression analysis indicate that the factors affecting medical education behavioral intention are subjective norm (t = 3.571, p < 0.001) and perceived behavioral control (t = 11.870, p < 0.001).

CONCLUSIONS

With respect to medical education behavioral intention, clinical teachers and students are affected by the subjective norm and perceived behavioral control. It is recommended that, in the curriculum of holistic medical education, designing holistic medical education teaching templates and check forms can encourage clinical teachers to re-examine their beliefs in teaching, learning, and knowledge. The results of this study allow the advocator to consider from a broader view making policies of and promoting the platform of holistic healthcare on medical education. It is recommended that future researchers conduct research, investigation, and analysis on other stakeholders.

Introducing Standardized Assessment and Management of Oral Cares in a Rehabilitation Unit: Patient Outcomes and Experiences

PURPOSE

The aim of this study was to improve patient oral hygiene outcomes in a rehabilitation unit by implementing a nursing education package and oral hygiene assessment tool.

DESIGN

A case-control design with 50 rehabilitation patients was performed.

METHODS

Nursing staff received education and training in applying the Modified Oral Health Assessment Tool. Clinician assessment of patient oral hygiene occurred on admission and at days 5-7. Each patient reported their perceptions of oral hygiene and comfort prior to hospitalization, while in the hospital, and after transfer to the rehabilitation unit.

FINDINGS

Oral hygiene rating scores improved significantly from admission to the rehabilitation unit to days 5-7 (p = .00). The mean score of patient perceived cleanliness improved from hospital admission to admission to the rehabilitation unit.

CONCLUSION

Oral hygiene was improved following admission to a rehabilitation unit with a consistent and individualized approach to oral hygiene.

CLINICAL RELEVANCE

The introduction of a consistent and individualized approach to oral hygiene demonstrates positive patient outcomes and high patient acceptance.

Miswak users' behavior model based on the theory of planned behavior in the country with the largest Muslim population

Background

Maintaining proper oral hygiene has an influence on oral health. Religious obedience may influence individual behavior. According to Islamic religious guidance, as recommended by an Islamic role model, it is obligated to maintain oral health and the recommended tool to use is miswak.

Purpose

To describe miswak users’ behavior based on the theory of planned behavior.

Subjects and methods

The population of this study was the students of As-Salafi Al-Fitrah Islamic Boarding School who used miswak regularly and were healthy physically and mentally. One hundred and nine samples were chosen randomly and asked to complete a semi-open and a closed-ended questionnaire.

Results

Perceived behavioral control had the most dominant influence toward improving intention with β=0.211 and p<0.05. In contrast, attitude and subjective norms had less influence toward improving intention with β=0.190 and p>0.05, and β=0.164 and p<0.0001, respectively. Meanwhile, perceived behavioral control showed direct correlation toward action in model parameter with β=0.445 and p<0.0001.

Conclusion

Perceived behavioral control is the most dominant predisposing factor in increasing intention and attitude of miswak use.