Developing interventions to promote oral cancer screening and oral health in nursing homes

More than 41,000 Americans will be diagnosed with oral cancer in 2013. Oral cancer disproportionately affects those over age 65 because older adults have the lowest screening rates for almost all cancers including oral cancer. Approximately 25% of patients with oral cancer die because of delayed diagnosis and treatment. The population of nursing home residents is at the highest risk for oral cancer, and yet has the lowest screening rates. The NIDCR-funded pilot study reported here integrates the Health Belief Model, Transtheoretical Model and Implementation Science in its conceptual framework. The study population includes nursing home administrators and clinical directors, who are the key personnel with oversight responsibilities for oral health and oral cancer screening in long term care facilities. Ten focus groups were conducted across Massachusetts with 35 participants. Findings provide consistent evidence that the intent to provide oral health care to nursing home residents is greater than the actual delivery. The theoretical model aided in framing the findings to target specific areas for future intervention strategies including: increasing knowledge about oral cancer risk, motivating family members to advocate, increasing motivation and self-efficacy among staff, and reframing regulatory demands. Findings indicate that the frontline staff who provide daily oral health care to residents must be the ultimate target of interventions.