Oral Health Intervention in Hemodialysis Patients

The Effect of Oral Care Education and Reminder Cards on Patients Receiving Hemodialysis Treatment: A Quasi-experimental Study

Preserving dental health in patients undergoing hemodialysis is crucial for enhancing quality of life. Nonetheless, interventions pertaining to oral health have not been adequately studied. The impact of a simultaneous intervention comprising oral health education and reminder cards remains ambiguous. The findings help to examine the effect of oral health interventions on the levels of oral health and chronic disease adherence in patients receiving hemodialysis treatment. The use of oral care education, reminder cards, and checklists related to oral health can prevent the neglect of oral care.

Study Overview

• Status: Completed
• Conditions: Age ≥ 18 Years Old; Receiving HD Treatment at Least 6 Months; Having no Hearing, Visual, or Speech Impairment; Performing Self-oral Care
• Intervention / Treatment: Other: Oral health education

Detailed Description

Preserving dental health in patients undergoing hemodialysis is crucial for enhancing quality of life. Nonetheless, interventions pertaining to oral health have not been adequately studied. The aim is to investigate the impact of oral care education and reminder cards concerning oral health on the oral health and illness adaptation of persons undergoing hemodialysis. The study employed a quasi-experimental design with a single group, utilising pre-test and post-test measurements. The study included 82 individuals (aged ≥ 18 years) receiving treatment in the hemodialysis units of two different hospitals in Turkey. Sociodemographic and clinical information was obtained from medical records. The "Adaptation to Chronic Illness Scale" and the "Oral Assessment Guide" were employed to assess oral health and illness adaptation. A one-week intervention was conducted, using daily oral health reminder cards following oral care teaching. A significant difference was found between the mean oral health and illness adaptation levels in the pre-test (15.51±2.67; 84.37±9.14, respectively) and post-test (12.61±3.83; 86.26±9.66, respectively) scores (p=0.00). Oral health and treatment adherence were better after the use of oral care education and reminder cards (p=0.00). Daily tooth brushing frequency was a common factor influencing oral health and chronic disease adherence levels (p<0.05). The mean scores for oral health and illness adaptation were moderately and negatively correlated before and after the intervention (sırasıyla r=-0.46, r=-0.52; p<0.01). The findings help to examine the effect of oral health interventions on the levels of oral health and chronic disease adherence in patients receiving hemodialysis treatment. The use of oral care education, reminder cards, and checklists related to oral health can prevent the neglect of oral care.

• Study Type: Observational
• Enrollment (Actual): 82

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Çanakkale, Turkey (Türkiye), 17100
    • Department of Nursing, Faculty of Health Sciences, Canakkale Onsekiz Mart University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The population consisted of 115 individuals who applied to the hemodialysis unit of a research and practice hospital located in a city centre for hemodialysis treatment between July and October 2024. No sample selection was performed, and 82 (71.30%) patients on hemodialysis who met the inclusion criteria of the research were included in the sample.

Description

Inclusion Criteria:

• being 18 years of age or older,
• receiving HD treatment three or four times a week for at least 6 months,
• having no hearing, visual, or speech impairment,
• having no diagnosis of malignancy,
• performing self-oral care,

Exclusion Criteria:

• Patients who refused to participate in the study,
• did not meet the inclusion criteria,
• did not consent to an oral examination,

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

experimental group; Experimental: arm description experimental Arm Description: The socio-demographic and descriptive characteristics and disease adaptation levels included in the survey form were answered through face-to-face interviews. Participants' oral health was assessed. Oral care education was provided. Disease adaptation levels and oral health were assessed one week after the education.

Other: Oral health education; After the pre-test application, one-on-one oral care education, lasting an average of 15 minutes, was conducted for each participant. The content of the education included: oral health in adults; the consequences of poor oral hygiene; points to consider for oral health; demonstration of the brushing technique; coping with care-resistant behaviors; and how to use the oral health reminder card and checklist.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Oral Assessment Guide	The guide allows for the assessment of voice, swallowing, lips, tongue, saliva, mucous membrane, gums, and teeth/dentures. The OAG supports the creation of an oral care protocol for patients with impaired oral mucous membranes. Each change related to oral health is scored between 1 and 3 points, and these scores are summed to obtain the total score. Scores obtainable from the OAG range from 8 to 24. A score between 8 and 14 indicates a "risk of impairment in the oral mucous membrane," while a score between 14 and 24 indicates "impairment in the oral mucous membrane." According to the OAG, a low score indicates good oral health, whereas high scores suggest poor oral health. A light source and a tongue depressor for each participant were used when evaluating oral health.	one weeks
Oral Health Reminder Card	The card contains a total of 10 items regarding what should be paid attention to in daily oral health and was prepared based on the literature. The reminder cards were 10x15 cm in size, and participants were asked to place these cards somewhere visible in their homes. The reminder cards were not taken back.	one weeks
Oral Health Checklist	This form contains the items listed on the Oral Health Reminder Card. Participants were asked to implement the items on the checklist and mark them as applied. Participants had the opportunity to evaluate whether they performed the oral health items every day over a one-week period.	one weeks
Adaptation to Chronic Illness Scale	The scale comprises 25 items across three subdomains, including physical, social, and psychological adjustment. The scale is designed as a 5-point Likert scale (with 1 = Strongly Disagree and 5 = Completely Agree). Items 5, 6, 12, 17, 19, 20, 24, and 25 are reverse scored. Maximum score that can be obtained from the scale is 125. Higher scores from the subdomains or the entire scale are indicative of the fact that the patients' level of adaptation to the disease is also high. The Cronbach's Alpha value of the scale is 0.88 for the entire scale.	one weeks

Collaborators and Investigators

• Sponsor: Çanakkale Onsekiz Mart University
• Collaborators: The Scientific and Technological Research Council of Turkey
• Investigators: Principal Investigator: SEVDA ATEŞ, Associate Professor, Canakkale Onsekiz Mart University

Study record dates

Study Major Dates

• Study Start (Actual): June 3, 2024
• Primary Completion (Actual): July 3, 2024
• Study Completion (Actual): October 3, 2024

Study Registration Dates

• First Submitted: March 5, 2026
• First Submitted That Met QC Criteria: March 5, 2026
• First Posted (Actual): March 10, 2026

Study Record Updates

• Last Update Posted (Actual): March 12, 2026
• Last Update Submitted That Met QC Criteria: March 10, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: adherence; nursing; hemodialysis; oral health; oral care
• Additional Relevant MeSH Terms: Environment and Public Health; Health Services; Health Care Facilities Workforce and Services; Preventive Health Services; Health Education; Public Health Dentistry; Health Education, Dental
• Other Study ID Numbers: COMU-SBF-SA-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Because patient data should not be shared during the ethics committee approval process.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No