title: Barriers and facilitators in providing oral health care to nursing home residents, from the perspective of care aides-a systematic review protocol.
abstract: BACKGROUND
  Unregulated care aides provide up to 80 % of direct resident care in nursing homes. They have little formal training, manage high workloads, frequently experience responsive behaviours from residents, and are at high risk for burnout. This affects quality of resident care, including quality of oral health care. Poor quality of oral health care in nursing homes has severe consequences for residents and the health care system. Improving quality of oral health care requires tailoring interventions to identified barriers and facilitators if these interventions are to be effective. Identifying barriers and facilitators from the care aide's perspective is crucial.
  
  
  METHODS
  We will systematically search the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We will include qualitative and quantitative research studies and systematic reviews published in English that assess barriers and facilitators, as perceived by care aides, to providing oral health care to nursing home residents. Two reviewers will independently screen studies for eligibility. We will also search by hand the contents of key journals, publications of key authors, and reference lists of all the studies included. Two reviewers will independently assess the methodological quality of the studies included using four validated checklists appropriate for different research designs. Discrepancies at any stage of review will be resolved by consensus. We will conduct a thematic analysis of barriers and facilitators using all studies included. If quantitative studies are sufficiently homogeneous, we will conduct random-effects meta-analyses of the associations of barriers and facilitators with each other, with care aide practices in resident oral health care, and with residents' oral health. If quantitative study results cannot be pooled, we will present a narrative synthesis of the results. Finally, we will compare quantitative findings to qualitative studies to identify hypothesized associations or effects not yet tested quantitatively.
  
  
  CONCLUSIONS
  This review will advance the development of effective strategies for improving quality of oral health care and highlight gaps in research on barriers and facilitators to providing oral health care to nursing home residents, as perceived by care aides.
  
  
  BACKGROUND
  PROSPERO CRD42015032454.
authors.affiliation: Knowledge Utilization Studies Program (KUSP), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada. mhoben@ualberta.ca.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hoben
authors.affiliation: West China College of Stomatology, Sichuan University, Sichuan, China.
authors.forename: Huimin
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Tianyuan
authors.initials: T
authors.lastname: Xiong
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Angelle
authors.initials: A
authors.lastname: Kent
authors.affiliation: School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Kobagi
authors.affiliation: School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Minn N
authors.initials: MN
authors.lastname: Yoon
mesh_terms: D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D003752:Dental Health Services / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006299:Health Services for the Aged / Q000600:supply & distribution*; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D012107:Research Design; D000078202:Systematic Reviews as Topic
keywords: Barriers and facilitators; Care aides; Nursing homes; Oral health care; Quality improvement; Quality of care