Testing the Guiding Lifelong Oral Health Wellness Program for mental health consumers.

GLOW: Guiding Lifelong Oral Health Wellness The intervention includes 1. Group oral health education – o Content overview • Understanding the connection between oral health and overall systemic health • Exploring how oral health can impact diseases such as diabetes, cardiovascular diseases and respiratory conditions • Discussing the etiology and progression of dental caries and periodontal disease, and preventive measures to avoid these common oral health issues • Demonstrating proper techniques for brushing, flossing and cleaning dentures • Summarising by discussing the importance of dental check-ups for early detection and treatment of dental problems o Education Delivery • An oral health professional will lead the session using engaging PowerPoint presentations and informative video links • The session will accommodate up to 10 consumers, ensuring a conducive learning environment • Duration: Approximately 45 minutes o Strategies for attendance: • Schedule sessions at convenient times for participants • Sending reminders via nursing staff either via text messages or phone calls on the day before the session • Offer small incentives, such as oral hygiene kits to encourage participation • Collaborate with mental health professionals to promote the sessions and emphasize the importance of oral health 2. Oral health assessment and advice o Assessment (will be conducted by Oral Health Therapists) • The validated Oral Health Assessment Tool (OHAT) is used to evaluate the lips, tongue, gums and oral tissues, saliva, natural teeth, dentures, oral cleanliness and dental pain. The assessment takes approximately 10 minutes. o Plaque Disclosure ( will be conducted by Oral Health Therapists) • A tri-Plaque ID gel is applied to disclose the level of plaque on participants' teeth, following the Silness and Loe Index o Personal Advice (will be provided by Oral Health Therapists) • Based on the assessment results and plaque disclosure, tailored advice will be provided to participants 3. The GLOW program (commences after the education and oral health assessment) o Plaque Disclosing provider: • The Tri-Plaque ID gel will be provided by the Oral Health Services o Toothbrushing and Flossing Demonstration • Demonstration will be performed using a hands-on approach where professionals will provide step-by-step instructions and assist participants in brushing their teeth using in-mouth demonstration and flossing during the session, offering guidance on correct techniques. o Nightly reminders for oral care • A nightly reminder will be provided through mental health clinicians on the wards each evening. Clinicians will deliver the reminder during their routine medication rounds, which occur after dinner. This reminder will encourage participants to complete their oral care routine. The clinicians will also keep a record of whether participants complete their oral care routine each night. This record will be used to monitor the establishment of a routine. o Mode of review at weeks 4 and 8 • Reviews at week 4 and week 8 will be conducted in person. An oral health professional will visit the wards to perform follow-up assessment, disclosing and reinforce brushing o Strategies for assessing and monitoring adherence • Records from mental health clinicians – mental health clinicians will keep a nightly record of whether participants complete their oral care routine – to track daily adherence to oral care routine and provide support • Review during weeks 4 and 8 – At weeks 4 and 8, follow-up reviews will be conducted. During these reviews, the oral care routine will be discussed with participants, and they will be encouraged to continue their oral care practices – to evaluate progress and reinforce the importance of maintaining the oral care routine • Readiness for Oral Health Routine (ROHR) questionnaire – participants will complete the ROHR questionnaire to evaluate their motivation and competency in maintaining their oral care routine – to gauge participants’ motivation and readiness for the oral health routine • Progress tracking: Plaque levels will be assessed using disclosing gel during 4 and 8-week reviews – to monitor changes in oral hygiene, track adherence to recommended practices and evaluate the effectiveness of the oral care routine. 4. Study Design o Non-randomised study • In this non-randomised study, group allocation is determined by the clinical setting. Participants at the mental health hospital are allocated to the intervention group. Participants with mental health conditions living independently in the communities are assigned to the comparison group. This approach is used to evaluate the program's effectiveness. 5. Focus group (mental health consumers) o Aim – explore participants’ perceived facilitators and challenges in establishing a regular oral hygiene routine o Participants – intervention group and comparison group. Participation is voluntary – individuals will be invited to join based on their interest and willingness to share their experience o Facilitators – the focus groups will be conducted by an experienced member of the research team o Size of each group – each focus group will consist of 6-8 participants to have 2-3 focus groups. o Selection process – participants will be informed about the focus group during the 8th-week review. Those interested will be selected based on voluntary participation. Information including the purpose of the focus group, format and time commitment (45 minutes) will be provided to potential participants. o Focus group interview – It explores mental health consumers’ experiences and perceptions regarding in-mouth toothbrushing demonstrations and nightly reminders as part of an oral health intervention. It aims to understand how these components influenced their toothbrushing techniques, confidence, routine adherence and overall well-being, while so identify additional strategies and external factors impacting their oral health practices