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Peer-reviewedCC BY 4.0BMC Oral Health

Protocol for the GAPA person-centred dental care at home intervention: a substudy within a cluster randomised controlled trial in Swedish home care

  • Jessica Persson Kylén1,2,3
  • Sara Björns3,4,5
  • Anna Adolfsson6,7
  • Ulrika Lindmark1
  • Catharina Hägglin2,3,8
  • Annica Almståhl9
  • Henrik Imberg10,11
  • Martin Lundegard7
  • Sofia Torstensson7
  • Elisabeth Söder7
  • Kerstin Karlén2,7
  • Ann-Christine Baar3
5 more authors
  • Sven Persson Kylén12
  • Anna Bogren13
  • Carina Fjällman14
  • Björn Klinge15,16
  • Helle Wijk2,17,18,19
19 affiliations
  1. 1Department of Health Sciences, Karlstad University, Karlstad, 651 88 Sweden
  2. 2Centre for a DEMentia-friendly Society with A person-centred Mindset, Institute of Health and Care Science, The Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden
  3. 3Centre for Person-Centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  4. 4Department of Preventive and Community Dentistry, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
  5. 5Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30 Sweden
  6. 6Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30 Sweden
  7. 7Department of Research and Development, Public Dental Care, Region Västra Götaland, Gothenburg, Sweden
  8. 8Department of Behavioural and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30 Sweden
  9. 9Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30 Sweden
  10. 10Statistiska Konsultgruppen Sweden AB, Gothenburg, Sweden
  11. 11Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  12. 12R&D Department, Primary Health Care, Regionhälsan, Region Västra Götaland, Vänersborg, 462 35 Sweden
  13. 13Department of Odontology, Umeå University, Umeå, 901 87 Sweden
  14. 14Department of Health Sciences, University West, Trollhättan, 461 86 Sweden
  15. 15Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
  16. 16Department of Dental Medicine, Division of Oral Diseases, Karolinska Institutet, Stockholm, Sweden
  17. 17Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, Gothenburg, 405 30 Sweden
  18. 18Quality and Patient Safety Unit, Sahlgrenska University Hospital of Gothenburg, Gothenburg, 413 45 Sweden
  19. 19Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, 412 96 Sweden
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Abstract

Background: Oral health is essential to healthy ageing and closely linked to well-being, social participation, and quality of life. Frail older adults are at high risk of oral diseases, yet oral health is often insufficiently integrated into home care. Care staff frequently report limited competence and unclear routines, while older adults wish to participate actively in decisions about their oral health. GAPA Person-Centered Dental Care @ Home (Dental PCC@Home) is a co-designed model developed with older adults, significant others (informal caregivers), municipal care staff, and dental professionals. This substudy evaluates if Dental PCC@Home will promote oral health, participation, and self-determination among older adults living with complex care needs.

Methods: Dental PCC@Home is embedded within the parent GAPA cluster randomised controlled trial. Decisions about dental care are guided by a patient decision aid and discussion of needs expressed by the older adult or identified by care staff. Participation in the substudy is voluntary. Eligible intervention-group participants are offered a patient decision aid to support decisions about whether and how to receive dental care, followed by one of four pathways: online dental consultation, mobile home dental care, a dental clinic visit, or declining dental care. Eligible control-group participants receive standard care. Oral health and quality-of-life assessments are conducted at baseline and at six and twelve months; cognitive function is assessed at baseline only. Co-primary outcomes are changes in oral health status (ROAG) and oral health-related quality of life (GOHAI) from baseline to twelve months. General health-related quality of life (EQ-5D-5 L) is a secondary outcome. Quantitative analyses will account for clustering and repeated measurements. Semi-structured interviews with older adults, significant others, and care staff will explore experiences of care, decision-making, and implementation and will be analysed using qualitative content analysis.

Discussion: This project will generate evidence on a new cross-organisational model designed to improve access to oral health care for frail older adults living at home. By integrating dental care into existing care processes and offering flexible care pathways, the model has the potential to strengthen autonomy, reduce inequalities, promote health and, when indicated, address oral diseases earlier in home care. The findings may inform future practice, policy development, and person-centred approaches to oral health in ageing populations.

Trial registration: ClinicalTrials.gov NCT06310798. Registered on March 13, 2024.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-10340-3.

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Cite

BibTeXRIS
BibTeX
@article{kylen2026protocol,
  title = {{Protocol for the GAPA person-centred dental care at home intervention: a substudy within a cluster randomised controlled trial in Swedish home care}},
  author = {Jessica Persson Kylén and Sara Björns and Anna Adolfsson and Ulrika Lindmark and Catharina Hägglin and Annica Almståhl and Henrik Imberg and Martin Lundegard and Sofia Torstensson and Elisabeth Söder and Kerstin Karlén and Ann-Christine Baar and Sven Persson Kylén and Anna Bogren and Carina Fjällman and Björn Klinge and Helle Wijk},
  journal = {BMC Oral Health},
  year = {2026},
  month = nov,
  doi = {10.1186/s12903-026-10340-3},
  url = {https://doi.org/10.1186/s12903-026-10340-3},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Protocol for the GAPA person-centred dental care at home intervention: a substudy within a cluster randomised controlled trial in Swedish home care
AU  - Jessica Persson Kylén
AU  - Sara Björns
AU  - Anna Adolfsson
AU  - Ulrika Lindmark
AU  - Catharina Hägglin
AU  - Annica Almståhl
AU  - Henrik Imberg
AU  - Martin Lundegard
AU  - Sofia Torstensson
AU  - Elisabeth Söder
AU  - Kerstin Karlén
AU  - Ann-Christine Baar
AU  - Sven Persson Kylén
AU  - Anna Bogren
AU  - Carina Fjällman
AU  - Björn Klinge
AU  - Helle Wijk
PY  - 2026
DA  - 2026/11/03
JO  - BMC Oral Health
DO  - 10.1186/s12903-026-10340-3
UR  - https://doi.org/10.1186/s12903-026-10340-3
AB  - Background: Oral health is essential to healthy ageing and closely linked to well-being, social participation, and quality of life. Frail older adults are at high risk of oral diseases, yet oral health is often insufficiently integrated into home care. Care staff frequently report limited competence and unclear routines, while older adults wish to participate actively in decisions about their oral health. GAPA Person-Centered Dental Care @ Home (Dental PCC@Home) is a co-designed model developed with older adults, significant others (informal caregivers), municipal care staff, and dental professionals. This substudy evaluates if Dental PCC@Home will promote oral health, participation, and self-determination among older adults living with complex care needs.  Methods: Dental PCC@Home is embedded within the parent GAPA cluster randomised controlled trial. Decisions about dental care are guided by a patient decision aid and discussion of needs expressed by the older adult or identified by care staff. Participation in the substudy is voluntary. Eligible intervention-group participants are offered a patient decision aid to support decisions about whether and how to receive dental care, followed by one of four pathways: online dental consultation, mobile home dental care, a dental clinic visit, or declining dental care. Eligible control-group participants receive standard care. Oral health and quality-of-life assessments are conducted at baseline and at six and twelve months; cognitive function is assessed at baseline only. Co-primary outcomes are changes in oral health status (ROAG) and oral health-related quality of life (GOHAI) from baseline to twelve months. General health-related quality of life (EQ-5D-5 L) is a secondary outcome. Quantitative analyses will account for clustering and repeated measurements. Semi-structured interviews with older adults, significant others, and care staff will explore experiences of care, decision-making, and implementation and will be analysed using qualitative content analysis.  Discussion: This project will generate evidence on a new cross-organisational model designed to improve access to oral health care for frail older adults living at home. By integrating dental care into existing care processes and offering flexible care pathways, the model has the potential to strengthen autonomy, reduce inequalities, promote health and, when indicated, address oral diseases earlier in home care. The findings may inform future practice, policy development, and person-centred approaches to oral health in ageing populations.  Trial registration: ClinicalTrials.gov NCT06310798. Registered on March 13, 2024.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-10340-3.
SN  - 1472-6831
ER  -