Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 7.
doi: 10.1111/ger.70012. Online ahead of print.

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

Annie Hendry  1 , Sarah R Baker  2 , Gerry McKenna  3 , Georgios Tsakos  4 , Ivor Chestnutt  5 , Craig Smith  6 , Ciaran O'Neill  3 , Alison Jenkins  7 , Rachel Evans  7 , Saif Sayeed Syed  4 , Michelle Harvey  3 , Anup Karki  8 , Kirstie Moons  9 , Fiona Sandom  9 , Michael Donaldson  10 , Caroline Lappin  11 , Karen Shepherd  12 , Lorraine Morgan  12 , Paul R Brocklehurst  8
Affiliations

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

Annie Hendry et al. Gerodontology. .

Abstract

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.

Keywords: care home residents; complex interventions; implementation; oral health; process evaluation; randomised controlled trials.

PubMed Disclaimer

References

    1. R. Macey, A. Glenny, T. Walsh, et al., “The Efficacy of Screening for Common Dental Diseases by Hygiene‐Therapists: A Diagnostic Test Accuracy Study,” Journal of Dental Research 94 (2015): 70S–78S, https://doi.org/10.1177/0022034514567335.
    1. P. Brocklehurst, Z. Hoare, C. Woods, et al., “Dental Therapists Compared With General Dental Practitioners for Undertaking Check‐Ups in Low‐Risk Patients: Pilot RCT With Realist Evaluation,” Health Services and Delivery Research 9, no. 3 (2021): 1–118, https://doi.org/10.3310/hsdr09030.
    1. N. P. Monaghan and M. Z. Morgan, “What Proportion of Dental Care in Care Homes Could Be Met by Direct Access to Dental Therapists or Dental Hygienists?,” British Dental Journal 219, no. 11 (2015): 531–534, https://doi.org/10.1038/sj.bdj.2015.919.
    1. G. McKenna, F. Allen, M. Schimmel, and F. Müller, “Who's Picking Up the Bill?,” Gerodontology 32, no. 3 (2015): 161–162, https://doi.org/10.1111/ger.12205.
    1. A. J. Karki, N. Monaghan, and M. Morgan, “Oral Health Status of Older People Living in Care Homes in Wales,” British Dental Journal 219, no. 7 (2015): 331–334, https://doi.org/10.1038/sj.bdj.2015.756.

LinkOut - more resources