Background: Many people residing in nursing or residential care homes (also called long-term care facilities) live with physical or cognitive difficulties. Staff working in these environments often help residents (particularly those with more advanced dementia) with their personal care needs, including maintaining mouth care and health. Poor oral health is associated with many difficulties, including increased risk of respiratory problems, pain and discomfort. Yet, concerns have been raised that staff may not have the knowledge and skills to effectively support residents with oral care and health.
Objectives: The overall aim is to summarize existing research, share this with care home staff, residents and their families and friends, and health care professionals, and work to address how to promote mouth care for residents, particularly when a resident resists support with this aspect of care.
Methods: The partnership approach of NICHE-Leeds (https://niche.leeds.ac.uk/) involves researchers, care home staff, residents and their family and friends working together throughout the research stages to achieve equality and engagement. This ensures all partners input into the research focus (question), how the problem area will be addressed (design and methods), reported (results) and translated for practice (impact). Participatory research methods are appropriate for this purpose as they are underpinned by four principles: (1) co-operation (working "with' people); (2) participation (rather than separation and/or competition); (3) equality (mutual respect and valuing all contributions); and (4) co-production (working together and recognising different forms of knowledge). A question by a member of staff "How can I help residents with their mouth care, particularly when they resist this care?" prompted the current project.
Results: There were four research "cycles'. Cycle one explored existing literature to develop accessible guidance on strategies that staff could use to support residents to maintain and improve oral care, particularly when a resident may resist such care. Cycle two built on this review to determine knowledge levels within the care team. This highlighted deficiencies in staff knowledge, skills and competence for providing mouth care and their need for training. Cycle three identified strategies to develop staff understanding and knowledge. Cycle four brought together experts from nursing, dentistry, behaviour change, systematic reviews, and care homes research to develop a grant application to progress this work further, which was awarded funding. This stage of the project includes an overview of reviews of interventions to encourage staff to promote "mouth minutes' for residents, and a scoping review of barriers and facilitators. We will describe how partners were involved in the literature review process, and future partnership steps to elaborate on the research findings towards innovative strategies to support mouth care promotion by staff.
Conclusion: We provide an example of the processes undertaken in a participatory research project, bringing together science and practice to improve an essential area of care. Using participatory research approaches in this setting can allow the effective translation of uncertainties in care and practice into questions that can be addressed by research, leading to meaningful outcomes for those living and working in care homes.