| Summary: | 博士 === 國立成功大學 === 健康照護科學研究所 === 102 === Cerebral Vascular Accidents (CVA) affects basic oral functions and can contribute to oral health problems. Family caregivers support stroke survivors at home but receive little oral care training for the family caregiver role. Therefore, the CVA survivors experience a poorer oral health when discharge from hospital to community.
The aim of this study was to evaluate the effectiveness of a home-based oral care training program (HOCP) on knowledge, attitudes, self-efficacy and practice behaviors for family caregivers of stroke survivors, to assess the determine the relationship between knowledge, attitudes, self-efficacy and practices behavior related to oral care training promoting factors among family caregivers attending home-based training program, to evaluate the effectiveness of a home-based oral care for stroke survivor with tongue coating (TC), dental plaque (DP) and symptoms of respiratory infection (SRI), and to investigated the factors that affect outcome indicator of stroke survivors.
Single-blind randomized controlled trial was conducted over 2 months in home-based settings in Taiwan. Between September, 2012 and February, 2013, the data were collected from 94 family caregivers of stroke survivors randomized to two groups. Forty-eight stroke survivors and their family caregivers received home-based oral care training. Forty-six stroke survivors and family caregivers received routine oral care. Data were collected through self-administered questionnaire addressing aspects of knowledge, attitude, self-efficacy and practices behavior of oral care training factors in family caregiver of CVA survivors. The outcome measures of tongue coating, dental plaque and symptoms of respiratory infection of CVA survivor were assessed by the Winkel tongue coating index (WTCI), plaque index (PI) and Symptoms of Respiratory Infection (SRI) scale at baseline, one and two months using analysis with Mixed Model to determine differences between intervention and comparison group outcomes. All data were analysed using the Statistical Package for the social Sciences edition 19.0.
The outcome indicator of self-efficacy and oral care behaviors continued to improve. When the groups were compared, the results showed statistically significant differences in oral care knowledge, self-efficacy and behavior outcome variables between the intervention and comparison groups over time. The findings demonstrated that the intervention group had more knowledge (t = 8.80, p 〈 .001), greater self-efficacy (self-efficacy: t = 3.53, p 〈 .01), and better oral care behavior (t = 11.93, p 〈 .001) than the comparison group at one and two months, with statistically significant differences in oral care knowledge, self-efficacy and behavior outcome over time. The treatment interaction effect was significant for caregivers’ behavior of oral care at one and two months of the intervention for both groups. A positive correlation was found between AOC, self-efficacy and BOC. Linear regression modeling revealed that at two months for the intervention group, knowledge and self-efficacy predicted attitude, attitude predicted self-efficacy and behavior, and self-efficacy was a significant predictor of behavior.
Poor oral hygiene and an overall neglect of oral care practices were observed at baseline for CAV survivors. Reductions in TC scores and DP were significantly in the intervention group receiving the home-base oral care training program compared to the routine oral care group (p 〈.001). The total TC scores showed significantly more change in the experimental group compared to the comparison group over time (t = -13.98, p 〈 0.01). These results indicated that stroke survivors in the experimental group had significantly lower DP total scores compared to the comparison group (t = -9.21, p 〈 0.01). The SRI scores were not significantly different between the two groups (t = -0.99, p 〉 0.05). The process indicators with BOC was the predict factor for TC (t =-2.428, p 〈 0.05) and DP (t =--2.197, p 〈 0.05) of outcome indicators.
Evidence has shown that a home-based oral care training program can achieve significant improvement in oral care knowledge, attitude and self-efficacy among family caregivers with stroke survivors, sufficient to empower them to modify oral care practices behavior in the home health care environment. A home-based oral care training program also has a beneficial effect on oral health of stroke survivors as measured by TC and DP scores. The effect on SRI requires further longitudinal study. The health care providers should emphasize the importance of home-based oral care and provide adequate oral care education to the family caregivers of stroke survivors. A home-based oral care training program should be implemented for family caregivers when stroke survivors are discharged home.
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