Interprofessional collaboration on oral health for frail home-dwelling older people: a focus group study exploring the perspectives of home nurses, home care aides and cleaning aides

Background Older adults are at increased risk of deteriorating oral health, while dental attendance often declines over time among frail, home-dwelling older people (FHOP), leading to a substantial burden of untreated oral disease. Interprofessional collaboration is considered crucial in addressing oral health problems in ageing populations, with potential contributions from primary care professionals (e.g., home nurses, home care aides) and non-health professionals (e.g., cleaning aides). However, little is known about (a) the current engagement of these professionals in FHOPs’ oral health and (b) the needs and barriers they encounter in interprofessional collaboration. Therefore, this study aims to (a) explore the current oral health engagement of home nurses, home care aides, and cleaning aides – collectively referred to as home care workers (HCWs) - in FHOPs’ oral health, and (b) identify perceived needs and barriers to interprofessional collaboration in this context. Methods Between February and December 2023, seven focus groups were conducted in Flanders, Belgium: two with home nurses, two with home care aides, two with cleaning aides, and one mixed group, involving 50 participants in total. Discussions were analysed using a reflexive thematic approach. Results HCWs’ engagement in FHOPs’ oral health is limited. Most participants recognise their potential role, but multiple barriers exist, including limited knowledge, time constraints, low oral health awareness and prioritisation among FHOP and HCWs, oral health being a sensitive topic, intimacy of assisting with brushing, and FHOPs’ resistance to accept help. Quality of relationships with FHOP was a facilitator. Participants recommended integrating oral health into intake procedures, providing informative leaflets, and offering additional training. Barriers to interprofessional collaboration included financial structures and unclear role responsibilities. Conclusions This study provides novel insights into HCWs’ engagement in and collaboration on FHOPs’ oral health and underscores the need for coordinated action at multiple levels to enable HCWs to realise their potential role and to improve interprofessional collaboration: e.g., enhancing awareness and knowledge (micro level), increasing prioritisation and establishing guidelines (meso level), organising oral health campaigns and reorganising financial structures (macro level).