Shared working model for person-centred collaboration (GAPA)
Short description
Oral health is an important part of health and quality of life, particularly for older people with extensive care needs. Today, many people are ageing while retaining their own teeth, which places new demands on how oral health can be supported in everyday care and support services. At the same time, oral health is often weakly integrated into home healthcare and home care services.
The GAPA project focuses on how oral health can become a natural part of care and support for frail older people living at home. How can oral health be integrated into existing ways of working without becoming an additional task? How do complex, co-created interventions work in practice? And how can older people, relatives and staff work together to contribute to sustainable solutions? These are examples of the questions explored in the project.
Background
An increasing number of older people today retain their own teeth, often in combination with chronic conditions, long-term medication use and reduced functional capacity. This changes the conditions for oral health and places new demands on how care and support are organised. Despite this, oral health remains weakly integrated into home healthcare and home care services, even when care needs are extensive and involve multiple professions and organisations.
Traditional dental research has often focused on delimited clinical outcomes, which does not fully capture the complexity of everyday life for frail older people. Complex interventions instead recognise oral health as part of broader care and support systems, where implementation, collaboration and organisational conditions are crucial for effectiveness and sustainability.
The project takes its point of departure in this systems perspective and aligns with the WHO Global Strategy on Oral Health, with a focus on integration, equity and person-centred approaches.
Aims and objectives
The overall aim of the study is to develop and evaluate a more coherent and sustainable approach to oral health for frail older people receiving home healthcare, in which dental care is integrated into ordinary care and support processes.
The study has two overarching objectives:
• to evaluate the implementation and effects of a complex intervention for frail older people in home healthcare through a practice-based cluster randomised controlled trial, guided by the Consolidated Framework for Implementation Research (CFIR)
• to examine how such an approach translates the WHO strategy on oral health into practice
Methods
The study will start in 2026 in Västra Götaland and will be conducted within the Public Dental Service in collaboration with municipal home care services. A total of 480 frail older people living in ordinary housing will be included, together with assistant nurses and registered dental hygienists in twelve municipalities.
The intervention is co-created with older people, relatives and professionals to ensure adaptation to both individual needs and organisational conditions.
Outcomes include both clinical measures and aspects such as participation, staff confidence in their competence, and organisational readiness to integrate oral health into everyday care. A mixed-methods process evaluation will analyse implementation, contextual factors and variation between municipalities.
Results and conclusion
Early experiences indicate that integrating oral health into everyday care is feasible but associated with organisational and practical challenges. Conditions vary between municipalities depending on working methods, collaboration and local structures.
The study demonstrates that value is not created solely through traditional clinical outcomes, but also through improved collaboration, increased confidence among staff and greater participation for older people. Overall, the project contributes knowledge on how oral health can be more sustainably integrated into home healthcare and care services through person-centred, equitable and system-oriented approaches.
