Myung Sook Park; Smi Choi-Kwon

doi:10.4040/jkan.2011.41.5.684

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Original Article
The Effects of Oral Care Education on Caregivers’ Knowledge, Attitude, & Behavior toward Oral Hygiene for Elderly Residents in a Nursing Home: Myung Sook Park¹, Smi Choi-Kwon²; Journal of Korean Academy of Nursing 2011;41(5):684-693.
DOI: https://doi.org/10.4040/jkan.2011.41.5.684
Published online: October 12, 2011

¹Assistant professor, Department of Nursing Science, Sun Moon University, Asan, Korea

²Professor, College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea

¹Assistant professor, Department of Nursing Science, Sun Moon University, Asan, Korea

²Professor, College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Address reprint requests to : Choi-Kwon, Smi College of Nursing, Research Institute of Nursing Science, Seoul National University, 28 Yoengun-dong Jongro-gu, Seoul 110-744, Korea Tel: +82-2-740-8830 Fax: +82-2-745-8017 E-mail: smi@snu.ac.kr

• Received: February 1, 2011 • Revised: February 17, 2011 • Accepted: October 24, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
To investigate the effects of oral care education on knowledge, attitudes & behavior of caregivers in oral care and oral hygiene for residents in nursing homes.
Methods
In this quasi-experimental study, the intervention group (n=27) of residents received oral care from intervention group caregivers (n=28) who had received 6 weeks of oral care education. The control group (n=27) of residents received usual oral care from control group caregivers (n=26). Data on knowledge, attitude, and behavioral change in oral health care by the caregivers and plaque index & halitosis of the residents were collected. Data were analyzed using SPSS WIN 16.0.
Results
1) Scores on caregivers’ knowledge (p<.001) and behavior (p<.001) for oral care were higher in the intervention group 6 and 12 weeks. The caregivers’ attitude (p<.001) score for oral care was higher in the intervention group 12 weeks. 2) The plaque index (p=.004) and halitosis (p=.002) of the nursing home residents were lower in the intervention group than the control group at 6 and 12 weeks.
Conclusion
Oral care education programs for caregivers are effective in improving the oral hygiene of elderly residents in nursing homes through enhancement of caregiv-ers’ knowledge, attitude, and behavioral change.
Keywords: Oral hygiene; Nursing homes; Aged; Education; Caregivers

Table 1.

Oral Health Care Education Program for Caregivers in this Study

Oral Care Education Programme for Caregivers
Week	Purpose	Contents	Time	Methods
1st	To increase knowledge and to recognize the importance of oral care	• The importance of oral care	30 min	Lecture using slides & oral care education material
		• Normal tooth & oral cavity
		• Oral diseases
		• Oral health problems with aging Influence of oral diseases on systemic health
		• Influence of oral diseases on systemic health • Prevention of decay & gingivitis
		• Prevention of decay & gingivitis
		• Strategies for residents who have behavioral problems
2nd	To improve knowledge & skills in oral care	• Oral health assessment	60 min	Lecture 20 min Practice 40 min
		• Effective oral care for natural teeth & denture
		• Oral care in the case of full dependence using teeth manikin & oral hygiene materials
3rd	To increase skill & self confidence in effective tooth brushing	• Practice in tooth brushing	10 min	Individual hands-on training
4th	To confirm the practice of denture care	• Practice in denture cleansing & storage	10 min	Individual hands-on training
5th	To increase skill & self confidence in handling cognitive impaired residents	• Practice in handling residents who have behavioral problem	10 min	Individual hands-on training
5th
6th	To increase ability in handling oral hygiene materials	• Practice in dental flossing & interdental brushing	10 min	Individual hands-on training

Table 2.

Homogeneity Test of General Characteristics of Caregivers

Characteristics	Intervention group (n=28)	Control group (n=26)	χ² or t	p
Characteristics	n (%)		χ² or t	p
Gender
F	28 (100)	25 (96.2)	1.10	.481*
M	0	1 (3.8)
Education level (yr)
7-12	23 (82.1)	16 (61.6)	1.88	.171
>12	5 (17.9)	10 (38.5)
Type of occupation
Nurse or nurse aid	3 (10.7)	4 (15.4)	0.26	.699*
Care aid	25 (89.3)	22 (84.6)
Employment condition
Permanent position	3 (10.7)	4 (15.4)	0.26	.699*
Contract worker	25 (89.3)	22 (84.6)
Job satisfaction
High	11 (39.3)	13 (50.0)	0.63	.584
Moderate	17 (60.7)	13 (50.0)
The experience of
oral care education	12 (42.9)	16 (61.5)	0.09	.775
Yes	16 (57.1)	10 (38.5)
No
	M±SD	M±SD
Age (yr)	50.19±5.04	48.92±6.72	-0.77	.446
Experience in LTC (months)	20.81±19.58	37.92±58.15	1.45	.154

SD=Standard deviation; LTC=Long-term care facility; *Fisher’s exact test.

Table 3.

Homogeneity Test of General Characteristics of Nursing Home Residents

Characteristics	Intervention group (n=27)	Control group (n=27)	χ² or t	p
Characteristics	n (%)		χ² or t	p
Gender
M	10 (37.0)	16 (59.3)	2.67	.173
F	17 (63.0)	11 (40.7)
Education (yr)
0-6	23 (85.2)	19 (70.4)	1.17	.327*
>7	4 (14.8)	8 (29.6)
Underlying disease
Dementia	15 (55.5)	10 (37.0)	0.30	.285
CVD	10 (37.0)	15 (55.5)	1.86	.275
PD	5 (18.5)	0	5.51	.051*
DM	11 (40.7)	8 (29.6)	0.73	.569
Musculoskeletal disease	5 (18.5)	5 (18.5)	0.00	1.0
The ability in oral care
Independent	7 (25.9)	13 (48.2)	3.09	.091
Dependent	20 (74.1)	14 (51.8)
	M±SD	M±SD
Age (yr)	78.71±5.44	79.18±6.69	0.31	.757
No. of medication drugs	5.30±3.51	5.87±3.51	0.62	.537
No. of drugs related to dry mouth	2.01±1.70	2.03±1.62	0.08	.935
Dry mouth	1.10±0.81	0.74±0.83	-1.54	.130
ADLs	47.73±30.32	64.41±35.32	1.58	.070
MMSE-KC	13.40±6.23	16.01±4.43	1.77	.083
Number of teeth	17.73±7.70	14.87±8.42	-1.25	.216

*Fisher’s exact test.

SD=Standard deviation; CVD=Cerebrovascular disease; PD=Parkinson’s disease; DM=Diabetes mellitus; ADLs=Activities of daily living; MMSE-KC= Mini-mental state examination in the Korean version of CERAD assessment packet.

Table 4.

Knowledge, Attitude & Behavior Score for Oral Health Care in Caregivers

	Time	Intervention group (n=28)	Control group (n=26)	t	p	Source	F	p
	Time	M±SD		t	p	Source	F	p
Knowledge	Baseline	26.64±3.42	27.85±4.15	1.17	.249	Group	8.62	.005
	6 weeks	32.96±4.27	28.81±3.69	-3.81	<.001	Time	40.75	<.001
	12 weeks	33.61±3.76	28.96±3.38	-4.76	<.001	Group*Time	13.92	<.001
Attitude	Baseline	41.79±3.52	43.30±2.21	2.00	.051	Group	0.17	.682
	6 weeks	42.89±3.36	43.76±2.93	1.02	.313	Time	5.70	.004
	12 weeks	46.07±3.85	42.85±2.61	-3.18	.002	Group*Time	10.44	<.001
Behavior	6 weeks	7.25±2.96	0.81±0.69	-10.80	<.001	Group	564.46	<.001
	12 weeks	15.79±2.41	1.08±0.80	-29.65	<.001	Time	188.66	<.001
						Group*Time	166.29	<.001

SD=Standard deviation.

Table 5.

Plaque Index & Halitosis of Nursing Home Residents

	Time	Intervention group (n=27)	Control group (n=27)	t	p	Source	F	p
	Time	M±SD		t	p	Source	F	p
Plaque index	Baseline	47.9 (22.6)	44.0 (26.4)	-0.55	.568	Group	2.17	.147
	6 weeks	34.7 (18.8)	43.9 (26.6)	1.48	.145	Time	3.49	.038
	12 weeks	30.6 (19.2)	48.8 (25.6)	2.96	.005	Group*Time	6.09	.004
Halitosis	Baseline	1.23 (1.17)	1.01 (1.05)	-0.71	.481	Group	2.38	.129
	6 weeks	0.64 (1.02)	1.04 (1.37)	1.21	.233	Time	5.37	.006
	12 weeks	0.19 (0.52)	1.07 (1.05)	3.92	<.001	Group*Time	6.64	.002

SD=Standard deviation.

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The Effects of Oral Care Education on Caregivers’ Knowledge, Attitude, & Behavior toward Oral Hygiene for Elderly Residents in a Nursing Home

J Korean Acad Nurs. 2011;41(5):684-693. Published online October 12, 2011

DOI: https://doi.org/10.4040/jkan.2011.41.5.684

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The Effects of Oral Care Education on Caregivers’ Knowledge, Attitude, & Behavior toward Oral Hygiene for Elderly Residents in a Nursing Home

Oral Care Education Programme for Caregivers
Week	Purpose	Contents	Time	Methods
1st	To increase knowledge and to recognize the importance of oral care	• The importance of oral care	30 min	Lecture using slides & oral care education material
		• Normal tooth & oral cavity
		• Oral diseases
		• Oral health problems with aging Influence of oral diseases on systemic health
		• Influence of oral diseases on systemic health • Prevention of decay & gingivitis
		• Prevention of decay & gingivitis
		• Strategies for residents who have behavioral problems
2nd	To improve knowledge & skills in oral care	• Oral health assessment	60 min	Lecture 20 min Practice 40 min
		• Effective oral care for natural teeth & denture
		• Oral care in the case of full dependence using teeth manikin & oral hygiene materials
3rd	To increase skill & self confidence in effective tooth brushing	• Practice in tooth brushing	10 min	Individual hands-on training
4th	To confirm the practice of denture care	• Practice in denture cleansing & storage	10 min	Individual hands-on training
5th	To increase skill & self confidence in handling cognitive impaired residents	• Practice in handling residents who have behavioral problem	10 min	Individual hands-on training
5th
6th	To increase ability in handling oral hygiene materials	• Practice in dental flossing & interdental brushing	10 min	Individual hands-on training

Characteristics	Intervention group (n=28)	Control group (n=26)	χ² or t	p
Characteristics	n (%)		χ² or t	p
Gender
F	28 (100)	25 (96.2)	1.10	.481*
M	0	1 (3.8)
Education level (yr)
7-12	23 (82.1)	16 (61.6)	1.88	.171
>12	5 (17.9)	10 (38.5)
Type of occupation
Nurse or nurse aid	3 (10.7)	4 (15.4)	0.26	.699*
Care aid	25 (89.3)	22 (84.6)
Employment condition
Permanent position	3 (10.7)	4 (15.4)	0.26	.699*
Contract worker	25 (89.3)	22 (84.6)
Job satisfaction
High	11 (39.3)	13 (50.0)	0.63	.584
Moderate	17 (60.7)	13 (50.0)
The experience of
oral care education	12 (42.9)	16 (61.5)	0.09	.775
Yes	16 (57.1)	10 (38.5)
No
	M±SD	M±SD
Age (yr)	50.19±5.04	48.92±6.72	-0.77	.446
Experience in LTC (months)	20.81±19.58	37.92±58.15	1.45	.154

Characteristics	Intervention group (n=27)	Control group (n=27)	χ² or t	p
Characteristics	n (%)		χ² or t	p
Gender
M	10 (37.0)	16 (59.3)	2.67	.173
F	17 (63.0)	11 (40.7)
Education (yr)
0-6	23 (85.2)	19 (70.4)	1.17	.327*
>7	4 (14.8)	8 (29.6)
Underlying disease
Dementia	15 (55.5)	10 (37.0)	0.30	.285
CVD	10 (37.0)	15 (55.5)	1.86	.275
PD	5 (18.5)	0	5.51	.051*
DM	11 (40.7)	8 (29.6)	0.73	.569
Musculoskeletal disease	5 (18.5)	5 (18.5)	0.00	1.0
The ability in oral care
Independent	7 (25.9)	13 (48.2)	3.09	.091
Dependent	20 (74.1)	14 (51.8)
	M±SD	M±SD
Age (yr)	78.71±5.44	79.18±6.69	0.31	.757
No. of medication drugs	5.30±3.51	5.87±3.51	0.62	.537
No. of drugs related to dry mouth	2.01±1.70	2.03±1.62	0.08	.935
Dry mouth	1.10±0.81	0.74±0.83	-1.54	.130
ADLs	47.73±30.32	64.41±35.32	1.58	.070
MMSE-KC	13.40±6.23	16.01±4.43	1.77	.083
Number of teeth	17.73±7.70	14.87±8.42	-1.25	.216

	Time	Intervention group (n=28)	Control group (n=26)	t	p	Source	F	p
	Time	M±SD		t	p	Source	F	p
Knowledge	Baseline	26.64±3.42	27.85±4.15	1.17	.249	Group	8.62	.005
	6 weeks	32.96±4.27	28.81±3.69	-3.81	<.001	Time	40.75	<.001
	12 weeks	33.61±3.76	28.96±3.38	-4.76	<.001	Group*Time	13.92	<.001
Attitude	Baseline	41.79±3.52	43.30±2.21	2.00	.051	Group	0.17	.682
	6 weeks	42.89±3.36	43.76±2.93	1.02	.313	Time	5.70	.004
	12 weeks	46.07±3.85	42.85±2.61	-3.18	.002	Group*Time	10.44	<.001
Behavior	6 weeks	7.25±2.96	0.81±0.69	-10.80	<.001	Group	564.46	<.001
	12 weeks	15.79±2.41	1.08±0.80	-29.65	<.001	Time	188.66	<.001
						Group*Time	166.29	<.001

	Time	Intervention group (n=27)	Control group (n=27)	t	p	Source	F	p
	Time	M±SD		t	p	Source	F	p
Plaque index	Baseline	47.9 (22.6)	44.0 (26.4)	-0.55	.568	Group	2.17	.147
	6 weeks	34.7 (18.8)	43.9 (26.6)	1.48	.145	Time	3.49	.038
	12 weeks	30.6 (19.2)	48.8 (25.6)	2.96	.005	Group*Time	6.09	.004
Halitosis	Baseline	1.23 (1.17)	1.01 (1.05)	-0.71	.481	Group	2.38	.129
	6 weeks	0.64 (1.02)	1.04 (1.37)	1.21	.233	Time	5.37	.006
	12 weeks	0.19 (0.52)	1.07 (1.05)	3.92	<.001	Group*Time	6.64	.002

Table 1. Oral Health Care Education Program for Caregivers in this Study

Table 2. Homogeneity Test of General Characteristics of Caregivers

SD=Standard deviation; LTC=Long-term care facility; *Fisher’s exact test.

Table 3. Homogeneity Test of General Characteristics of Nursing Home Residents

*Fisher’s exact test.

Table 4. Knowledge, Attitude & Behavior Score for Oral Health Care in Caregivers