International journal of nursing studies advances · 2026
Committing to oral care support for older people living in long-term residential care settings: A theoretically informed scoping review of enablers and barriers influencing care staff behaviours.
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Spilsbury Karen, Csikar Julia, Devi Reena, Vinall-Collier Karen, Jordao Magda, Wright Judy, Thompson Carl, Griffiths Alys Wyn, Wilson Paul, Feenan Edna, Winterburn Karen, Earnshaw Sharon, Douglas Gail V A
Аннотация
BACKGROUND: Poor oral health among older people living in long-term residential care is associated with serious health consequences and reduced quality of life. Oral health commonly deteriorates in these settings and is often attributed to care staff workload pressures and limited oral health knowledge and skills. However, practice colleagues in our established UK care home and science partnership told us that a range of factors support and hinder them with oral care provision.
OBJECTIVE: To identify and synthesise the individual (micro), organisational (meso) and wider social and political (macro) factors that influence oral care provision for older people living in long-term residential care.
DESIGN AND METHOD: A scoping review was undertaken. Search strategies were developed by information specialists and study selection involved independent screening by two reviewers using predefined eligibility criteria. Data synthesis was informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
DATA SOURCES: Systematic searches were conducted in February 2022 and updated in March 2026. Searches included CINAHL, Web of Science Core Collection, Embase, MEDLINE, APA PsycInfo, Google Scholar and relevant grey literature sources.
FINDINGS: Sixty-three studies (reported in 86 publications) were included. The most frequently reported influences on staff behaviours were in the COM-B 'opportunity' domain: environmental context and resources, and social influences. Staff knowledge and skills were important determinants of capability, while beliefs about consequences influenced motivation. Key enablers included training, oral health champions, supportive leadership, assessment and monitoring systems, and collaborative relationships between care staff, residents, relatives and dental professionals. Key barriers included staffing shortages, workload pressures, limited time, inadequate training, low organisational prioritisation of oral care, and restricted access to external dental services. Interpersonal relationships were central to effective oral care provision.
CONCLUSIONS: Oral care provision is influenced by a complex interplay of factors at the individual, organisational and policy levels and cannot be attributed solely to care staff. While workforce pressures and limited training are important, staff knowledge, skills and behaviours must be understood within a broader organisational and system context. Interventions should extend beyond technical training to address emotional labour, relational dynamics and structural constraints. The COM-B and TDF frameworks provide a robust foundation for designing multi-component, context-sensitive interventions that reflect the realities of long-term care environments.
PROTOCOL REGISTRATION: Open Science Framework https://doi.org/10.17605/OSF.IO/STRKW.
TWEETABLE ABSTRACT: 'Mouth minutes' matter. Poor oral care in care homes affects older adults' health & quality of life. Our theory informed scoping review maps barriers/enablers for oral care provision in this setting. It's about more than technical skill #OralHealth #CareHomes #NICHELeeds @IJNS.
OBJECTIVE: To identify and synthesise the individual (micro), organisational (meso) and wider social and political (macro) factors that influence oral care provision for older people living in long-term residential care.
DESIGN AND METHOD: A scoping review was undertaken. Search strategies were developed by information specialists and study selection involved independent screening by two reviewers using predefined eligibility criteria. Data synthesis was informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
DATA SOURCES: Systematic searches were conducted in February 2022 and updated in March 2026. Searches included CINAHL, Web of Science Core Collection, Embase, MEDLINE, APA PsycInfo, Google Scholar and relevant grey literature sources.
FINDINGS: Sixty-three studies (reported in 86 publications) were included. The most frequently reported influences on staff behaviours were in the COM-B 'opportunity' domain: environmental context and resources, and social influences. Staff knowledge and skills were important determinants of capability, while beliefs about consequences influenced motivation. Key enablers included training, oral health champions, supportive leadership, assessment and monitoring systems, and collaborative relationships between care staff, residents, relatives and dental professionals. Key barriers included staffing shortages, workload pressures, limited time, inadequate training, low organisational prioritisation of oral care, and restricted access to external dental services. Interpersonal relationships were central to effective oral care provision.
CONCLUSIONS: Oral care provision is influenced by a complex interplay of factors at the individual, organisational and policy levels and cannot be attributed solely to care staff. While workforce pressures and limited training are important, staff knowledge, skills and behaviours must be understood within a broader organisational and system context. Interventions should extend beyond technical training to address emotional labour, relational dynamics and structural constraints. The COM-B and TDF frameworks provide a robust foundation for designing multi-component, context-sensitive interventions that reflect the realities of long-term care environments.
PROTOCOL REGISTRATION: Open Science Framework https://doi.org/10.17605/OSF.IO/STRKW.
TWEETABLE ABSTRACT: 'Mouth minutes' matter. Poor oral care in care homes affects older adults' health & quality of life. Our theory informed scoping review maps barriers/enablers for oral care provision in this setting. It's about more than technical skill #OralHealth #CareHomes #NICHELeeds @IJNS.