Pre- and post-training evaluation of dental efficacy and activation measures in carers of adults with disabilities in South Australia - a pilot study

Abstract

The aim of this pilot study was to train carers to provide oral care for adults with disabilities and to evaluate the training programme. Forty-one carers of 103 care recipients from three disability organisations in South Australia were trained in providing oral care for adults with disabilities (April 2013-April 2014). The training included an oral presentation and practical session by a special needs dentist on completing oral health assessments (OHA), developing oral healthcare plans, providing oral hygiene care and assessing the need for dental referral. Continued support was provided via home visits by dental hygienists for the first 2 months and a dentist visit at 3 months. At 6 months, agreement on OHAs between the dentist and trained carers was assessed. Pre- and post-training questionnaires (at 6 months) collected information on dental behaviours of carers and psychosocial factors: carer activation measure-knowledge (CAM-Knowledge), carer activation measure-skills (CAM-Skills), carer activation measure-confidence (CAM-Confidence) and carer dental efficacy (CDE) items (carer diligence, self-efficacy and priority). Post-training (among 16 retained carers), there were significant increases in the mean scores of CAM-Knowledge and CAM-Confidence, but not for CAM-Skills (paired-samples t-tests, α = 0.05). Per cent agreement of CDE items varied little between questionnaires. Carer-dentist agreement on OHAs was generally high with kappa values ranging from 0.63 for the assessment of gums to 1.0 for the assessment of tongue, roof of mouth, denture and dental pain. Further, carers were able to assess the need for referral of their care recipients' oral health similar to the dentist. These findings suggest that with combined theoretical and practical training and continued support, non-dental professionals like carers can improve their knowledge and confidence in providing oral care for adults with disabilities. However, the findings of this pilot study need to be confirmed by further research in a larger study.

Oral health-related quality of life improves in employees with disabilities following a workplace dental intervention

“…However, there was anecdotal evidence of some improvements. Other studies have highlighted the challenges in changing oral health behaviours for this subpopulation (Binkley, Johnson, Abadi, Thompson, Shamblen et al, 2014;Pradhan, Keuskamp & Brennan, 2015), and more intensive efforts would likely be required than were employed in this study. For the general population, systematic reviews of the evidence for oral health promotion effectiveness have not been definitive.…”

“…At one month and two months a dental hygienist provided group oral health education to the employees. The dental hygienist had attended an oral health training program provided by AP to carers of people with disabilities (Pradhan, Keuskamp & Brennan, 2015). The oral health education included toothbrushing behaviours using a demonstration model, reinforcement of healthy diet and the importance of regular dental visiting, in a simple language that could be understood by the employees.…”

“…Yet this remains the only identified group in the Plan for which there no national population-based data, probably due to both its heterogeneity and difficulties with access to individuals and their consent. Oral health knowledge among this group and their carers is also documented as relatively poor (Pradhan, 2013;Pradhan, Keuskamp & Brennan, 2015).…”

Education/Training Interventions to Improve Oral Health of Adults with Intellectual Disability

“…Four experimental studies examined the impacts of education/training interventions for carers [ 23 , 34 , 35 , 36 ]. Pradhan et al (2016) measured the knowledge, confidence, and skills and dental efficacy of 41 participant carers who had received education or training in oral health for 103 adults with intellectual disability.…”

What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

“…Six articles surveyed the opinions of carers of people with intellectual disabilities in relation to assessing, monitoring and promoting health 37‐42 and one was a systematic review of this topic 43 . The remaining 23 oral hygiene interventions included in the review were of populations other than those with intellectual disabilities only, elderly people 44‐56 , people with dementia 57‐62 or people with disabilities (physical, mixed or unspecified) 63‐66 . The remaining articles were reviews and qualitative studies on the topic of providing oral hygiene care to others 67‐81 .…”