Putting guidelines into practice: Using co‐design to develop a complex intervention based on NG48 to enable care staff to provide daily oral care to older people living in care homes

Abstract

Objectives:(1) Explore the challenges of providing daily oral care in care homes; (2) understand oral care practices provided by care home staff; (3) co-design practical resources supporting care home staff in these activities.Methods: Three Sheffield care homes were identified via the "ENRICH Research Ready Care Home Network," and three to six staff per site were recruited as co-design partners. Design researchers led three co-design workshops exploring care home staff's experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines in practice. The design researchers developed final resources to enable the use of these guidelines in-practice-in-context.Findings: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when residents adopt "refusal behaviours" and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate "refusal behaviours." Supporting resources need to "fit" within the complexities of practice-in-context. Conclusions:The provision of daily oral care practices in care homes is complex and challenging. The co-design process revealed care home staff have a "library" of context-specific practical knowledge and coping strategies. This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence-based guidelines.

Interventions supporting community nurses in the provision of Oral healthcare to people living at home: a scoping review

“…Overall, there is some evidence for patient, caregiver, parent and nurse knowledge of oral health being successfully improved through education interventions. The design of such education interventions for nurses in other community settings, such as care homes, has been found to be effective when a co-design methodology is used, involving collaborative efforts between researchers and nurses and ensuring that the complexity of the system in which the intervention will be used is considered [46]. The scarcity of implementation and process analyses in the papers included in this review may be representative of how traditional evaluations can underestimate or underrepresent the complexity of the system surrounding intervention delivery.…”

Evolution and development of methodologies in social and behavioural science research in relation to oral health

“…The practice of 'design' is used as research methods in such participatory endeavours and has begun to be applied within oral health (the STOP study). 144,147,148 One such example, yet to be published, is the development of a STroke friendly Oral health Promoting (STOP) toolkit to improve oral self-care practices after discharge from hospital stroke services using Experience-Based Co-Design (EBCD). 149 This project puts users (stroke survivors) at the centre of the design processes.…”

“…As such, the methods used attempt to narrow the gap between knowledge producers and knowledge users treating the knowledge and experience of all as equal. The practice of ‘design’ is used as research methods in such participatory endeavours and has begun to be applied within oral health (the STOP study) 144,147,148 …”

“…Another illustration of how co‐design could be employed in oral health research is to bridge the gap between clinical guidelines and putting evidence into practice 148 . The authors outline how they used an EBCD model 151 based on the UK Design Council's ‘Double Diamond’ Design process 152 to run a series of co‐design workshops using creative design methods 153 to develop a complex intervention based on NICE guidelines NG48 to enable care staff to provide daily oral care to older people living in care homes 147 .…”

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

“…The importance of context cannot be stressed enough and tailoring the interventions to account for the priorities and lived experience of the stakeholders is essential for their feasibility and implementation. [95][96][97][98] Using participatory research, co-design/coproduction can be very helpful in terms of revealing otherwise hidden and/or undervalued practical knowledge and coping strategies of those involved in delivering an intervention. 27 It helps take context into account at a more practical level and adapts an intervention so that it is relevant to the needs and realities of those it is primarily targeted towards, therefore making it potentially more applicable.…”