title: Effect of an oral healthcare protocol in nursing homes on care staffs' knowledge and attitude towards oral health care: a cluster-randomised controlled trial.
abstract: OBJECTIVE
  To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses' and nurses' aides' oral health-related knowledge and attitude.
  
  
  METHODS
  A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses' aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation.
  
  
  RESULTS
  At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009).
  
  
  CONCLUSIONS
  The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses' aides. In contrast, no significant improvements could be demonstrated in attitude.
authors.affiliation: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium.|BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands.|Community Dentistry and Oral Public Health, Dental School, Ghent University, Ghent, Belgium.
authors.forename: Barbara
authors.identifier: http://orcid.org/0000-0003-3490-0114
authors.initials: B
authors.lastname: Janssens
authors.affiliation: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium.|BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands.|Community Dentistry and Oral Public Health, Dental School, Ghent University, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: De Visschere
authors.affiliation: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium.|Birkhoven Zorggoed, Amersfoort, The Netherlands.|University of Applied Sciences, Utrecht, The Netherlands.|Department of Oral Function and Prosthetic Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: van der Putten
authors.affiliation: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium.|Department of Oral Function and Prosthetic Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.|Naarderheem, Vivium Zorggroep, Huizen, The Netherlands.
authors.forename: Kersti
authors.initials: K
authors.lastname: de Lugt-Lustig
authors.affiliation: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium.|Caphri, Departments of Family Medicine and Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.affiliation: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium.|BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands.|Community Dentistry and Oral Public Health, Dental School, Ghent University, Ghent, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Vanobbergen
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D002985:Clinical Protocols; D016321:Dental Care for Aged; D004506:Education, Nursing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009726:Nurses; D009728:Nursing Assistants / Q000193:education; D009735:Nursing Homes; D011795:Surveys and Questionnaires
keywords: attitude; education; gerodontology; knowledge; nursing homes; oral health