A framework to guide oral healthcare at long-term care facilities in the eThekwini district


  • S Balwanth Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, South Africa. https://orcid.org/0000-0003-2991-399X
  • S Singh Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, South Africa, Private Bag X54001




oral healthcare, conceptual framework, interventions, oral health promotion, long term care facility


Oral healthcare is an important aspect of the general healthcare of individuals residing in long-term care (LTC) facilities. However, it is often neglected in these settings and contributes to oral health disparities and oral diseases among residents. The World Health Organization promotes the reduction of health disparities and diseases through health promotion as an ethical obligation. The utilization of frameworks to promote oral health provides a structured approach to the design, implementation, and evaluation of
oral health promotion programs. This study proposed a framework to guide the development, implementation, and review of an oral health promotion intervention, so as to ensure that a systematic and evidence-based approach is used for the delivery of oral health promotion activities. The framework comprised three stages: needs analysis, implementation and review of an oral health intervention, which was guided by the Precede-Proceed model and Intervention mapping. The empirical aspect involved a
4-phased mixed method exploratory study, based on action research and the plan-act-observe-reflect cycle, which illustrated how the framework was operationalized. The oral health intervention indicated positive outcomes with regard to knowledge and attitudes among caregivers.
The framework incorporated the key components that influenced oral health provision at LTC facilities.


Download data is not yet available.


Metrics Loading ...

Author Biography

S Singh, Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, South Africa, Private Bag X54001


World Health Organization. Promoting oral health in Africa. Prevention and control of oral diseases and noma as part of essential noncommunicable disease interventions [Homepage on the internet]. 2016 [cited 2023 April 02]. Available from https://apps.


Waisel D. Vulnerable populations in healthcare. Curr Opin Anaesthesiol. 2013; 26(2): 186–92.https://doi.org/10.1097/ACO.0b013e32835e8c17. PMID: 23385323.

Chalmers JM, King PL, Spencer AJ, Wright FA, Carter KD. The oral health assessment tool-validity and reliability. Aust Dent J. 2005; 50(3): 191-9. https://doi.org/10.1111/j.1834-7819.2005.tb00360.x. PMID: 16238218.

de Mello ALF, Cia SF, Erdmann A L, Brondani M. Oral health care in long-term care facilities for elderly people in southern Brazil: a conceptual framework. Gerodontology. 2010; 27: 41–46. https://doi.org/10.1111/j.1741-2358.2009.00280.x.

Stancic I, Petrovic M, Popovac A, Vasovic M, Despotovic N. Caregivers’ attitudes, knowledge and practices of oral care at nursing homes in Serbia. Vojnosanit Pregl. 2016:73(7): 668-673. https://doi.org/10.2298/VSP141001065S. PMID: 29314800.

Petrovski M, Terzieva-Petrovska O, Kovecevska I, Minovska A, Ivanovski K., Papakoca K.. Oral health education of staff in long-term care institutions. Balkan Journal of Dental Medicine. 2019; 23(2): 63–67. https://doi.org/10.2478/bjdm 2019-0012.

Jeng WL, Wang TM, Cher TL, Lin CS, Jeng HJ. Strategies for oral health care for people with disabilities in Taiwan. Journal of Dental Sciences. 2009; 4(4):165–172. https://doi.org/110.1016/S1991-7902(09)60022-2.

Liu HY, Chen JR, Hsiao SY, Huang ST. Caregivers’ oral health knowledge, attitude and behavior toward their children with disabilities. Journal of Dental Sciences. 2017; 12(4): 388–395. https://doi.org/10.1016/j.jds.2017.05.003.

Weeks J & Fiske J. Oral care of people with disability: a qualitative exploration of the views of nursing staff. Gerodontology. 1994; 11(1): 13–17. https://doi.org/10.1111/j.1741-2358.1994.tb00097

Zenthöfer A, Rammelsberg P, Cabrera T, Hassel AJ. Increasing dependency of older people in nursing homes is associated with need for dental treatments. Neuropsychiatr Dis Treat.2014; 2(10): 2285–90. https://doi.org/10.2147/NDT.S71184. PMID: 25506220; PMCID: PMC4259561.

de Villiers K.. Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infect Dis Poverty. 2021; 10(19). https://doi.org/10.1186/s40249-021-00804-9.

Braine T. More oral health care needed for ageing populations. Bulletin of the World Health Organization.2005; 83(9): 646–647. https://apps.who.int/iris/handle/10665/269481. PMID 16211153; PMCID: PMC2626334.

Bhayat A & Chikte U. Human resources for oral health care in South Africa: A 2018 update. International Journal of Environmental Research and Public Health. 2019; 16(10). https://doi.org/10.3390/ijerph16101668.

de Mello AL & Erdmann AL. Investigating oral healthcare in the elderly using Grounded Theory. Rev Lat Am Enfermagem. 2007; 15(5): 922–8. https://doi.org/10.1590/s0104-11692007000500007. PMID: 18157443.

World Health Organization. Ottawa Charter for health promotion [Homepage on the internet].1986 [cited 2023 April 02]. Available from https://www.who.int/teams/health-promotion/enhanced-well-being/first-global-conference.

Muirhead V, Bedos C, Feine J. Theoretical frameworks in oral health promotion: A conceptual review. Journal of Dental Education. 2013; 77(4): 391–407.

Bastani P, Mohammadpour M, Ghanbarzadegan A, Rossi-Fedele G, Peres MA. Provision of dental services for vulnerable groups: A scoping review on children with special health care needs. BMC Health Services Research. 2021; 21: 1302. https://doi.org/10.1186/s12913-021-07293-4.

Kumar J, Dasu, R. A conceptual framework for improving oral health among older adults: Application of the spectrum of prevention strategies. Journal of the California Dental Association. 2019;47(4): 257–263. https://doi.org/10.1080/19424396.2019.12220778.

Kemmis S, McTaggart R. The action research planner, 3rd edn, Geelong: Deakin University Press, 1988.

Rose S, Spinks N, Canhoto A. Management research: Applying the principles [Homepage on the internet]. 2015 [cited 2023 March 15]. Available from https://yuli elearning.com/pluginfile.php/4364/mod_resource/content/1/Action Research.pdf.

Mills G. ‘Reconnaissance’, in Action Research: A guide for the teacher researcher, 2nd edn, Merrill Prentice Hall: Pearson Education, Columbus, Ohio, 2003.

Johnson A. A Short Guide to Action Research, 4th edn, Pearson Education, Minnesota, Mankato, 2012.

Mertler C, & Charles C. Introduction to education research, 6th edn, Pearson Education, Boston, 2006.

Wright J, Williams R, Wilkinson J. Development and importance of health needs assessment. BMJ. 1998; 316(7140): 1310–3. https://doi.org/10.1136/bmj.316.7140.1310.

Morrison K.. What training needs analysis is and how it can benefit your organization [Homepage on the internet]. 2019 [cited 2023 March 21]. Available from https://elearningindustry.com/training-needs-analysis-benefit-organization.

CFI Team. Social justice [Homepage on the internet]. 2022 [cited 2023 February 08]. Available from https://corporatefinanceinstitute.com/ resources/esg/social-justice/

Eadie D, & Schou L. An exploratory study of barriers to promoting oral hygiene through carers of elderly people. Community Dental Health. 1992; 9: 343–348. PMID: 1486522

Balwanth S. & Singh S, Oral healthcare provision at long-term care facilities in eThekwini: Perspectives of coordinators. Afr J Prm Health Care Fam Med. 2023; 15(1): 3884. https:// doi.org/10.4102/phcfm.

Balwanth S & Singh S. Caregivers’ knowledge, attitudes, and oral health practices at long-term care facilities in KwaZulu-Natal. Health SA Gesondheid.2023; 28(0): 2147. https://doi.org/10.4102/ hsag.v28i0.2147

Deci E L, & Ryan R M. Intrinsic motivation and self-determination in human behavior, New York: Plenum Press,1985. http://dx.doi.org/10.1007/978-1-4899-2271-7

Deverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, Tunis SR. Stakeholder participation in comparative effectiveness research: Defining a framework for effective engagement. Journal of Comparative Effectiveness Research. 2012; 1(2): 181–194. https://doi.org/10.2217/cer.12.7. PMID: 22707880; PMCID: PMC3371639.

Fernandez ME, ten Hoor GA, van Lieshout S, Rodriguez SA., Beidas RS, Parcel G, Ruiter RA, Markham CM, Kok G. Implementation mapping: Using intervention mapping to develop implementation strategies. Public Health Education and Promotion. 2019; 7:158. https://doi.org/10.3389/fpubh.2019.00158.

Petersen PE, & Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology. 2005; 33(2): 81–92. https://doi.org/10.1111/j.1600-0528.2004.00219.x. PMID: 15725170.

Gregory ME, Bryan JL, Hysong SJ, Kusters IS, Miltner RS, Stewart DE, Polacek N, Woodard LD, Anderson J, Naik AD, Godwin KM. Evaluation of a distance learning curriculum for interprofessional quality improvement leaders. Am J Med Qual.2018; 33:590–7. https://doi.org/10.1177/ 1062860618765661. Epub 2018 Mar 26. PMID: 29577735.

Bonnes SL, Ratelle JT, Halvorsen,AJ, Carter KJ, Hafdahl LT, Wang AT, Mandrekar JN, Oxentenko AS, Beckman TJ, Wittich CM. Flipping the quality improvement classroom in residency education. Acad Med. 2017; 92(1):101–7. https://doi.org/10.1097/ACM.0000000000001412. PMID: 27680317.

Hafford-Letchfield T, Dayananda A & Collins D. Digital storytelling for interprofessional collaborative practice to develop quality and service improvements. Soc Work Educ. 2018; 37(5): 1-9. https://doi.org/10.1080/02615479.2018.1484087

Century J, Rudnick M, & Freeman C. A framework for measuring fidelity of implementation: A foundation for shared language and accumulation of knowledge. Am J Eval. 2010; 31: 199–218. https://doi.org/10.1177/1098214010366173.

Balwanth S, Singh S. A pre- and post-test assessment of an oral health intervention: caregivers’ knowledge and attitudes at long-term care facilities in the eThekwini district, KwaZulu-Natal. South African Dental Journal. 2023, 79(4),190-5.

Lago JD, Fais LMG, Montandon A AB, Pinelli LAP. Educational program in oral health for caregivers on the oral hygiene of dependent elders. Revista de Odontologia da UNESP (SciELO). 2017; 46(5): 284–291.https://doi.org/10.1590/ 1807-2577.23916.

Teixeira P, Carraça EL, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: a systematic review. Int J Behav Nutr Phys Act. 2012; 9(78). https://doi.org/10.1186/1479-5868-9-78.

Simpson D. A framework for implementing sustainable oral health promotion interventions. J Public Health Dent. 2011; 71(s1): S84–S94. https://doi.org/10.1111/j.1752-7325.2011.00234.x.

Crane P & Richardson L. Reconnect action research kit, [Homepage on the internet]. 2000 [cited 2023 March 24]. Available from https://eprints.qut.edu.au/29347/1/Reconnect_AR_Kit_2000_%282%29.PDF




How to Cite

Balwanth, S., & Singh, S. (2024). A framework to guide oral healthcare at long-term care facilities in the eThekwini district. South African Dental Journal, 79(03), 157–163. https://doi.org/10.17159/sadj.v79i03.16930