A Conceptual Model for Person-centred Oral Health Care Planning in Home Settings: Operationalising the World Health Organisation Global Oral Health Strategy in Home-Based Care
JessicaPerssonKylén1✉,2,3EmailJessica.persson-kylen@kau.se
SaraBjörns3,4
1Department of Health SciencesKarlstad University651 88KarlstadSweden
2Centre of Gerodontology, Public Dental ServiceRegion Västra Götaland402 33GothenburgSweden
3
A
Department of Preventive and Community Dentistry, Public Dental ServiceRegion Västra GötalandSweden4Department of Cariology, Institute of Odontology, Sahlgrenska AcademyUniversity of Gothenburg405 30GothenburgSweden
Jessica Persson Kylén1,2,3, Sara Björns3,4
1Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
2Centre of Gerodontology, Public Dental Service, Region Västra Götaland, 402 33 Gothenburg, Sweden
3 Department of Preventive and Community Dentistry, Public Dental Service, Region Västra Götaland, Sweden
4Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
Corresponding author address
Jessica Persson Kylén, Karlstad university, Department of Health Sciences, 651 88 Karlstad, Sweden
Jessica.persson-kylen@kau.se
Abstract
Background
As more people live longer with multiple chronic conditions, health systems should evolve toward integrated, adaptive, and collaborative models of care, driven by lifelong learning and innovation to meet the complex needs of ageing populations. Despite its critical role in healthy ageing, oral health is often overlooked in home-based care, and the lack of conceptual models in cross-sector contexts hinders integrated planning and healthy ageing. As such, the aim of the study is to propose a conceptual model for collaborative oral health care planning in home settings, grounded in person-centered care principles.
Methods
A participatory action research approach was employed over a seven-year period (2018–2025) in western Sweden. Mixed methods were applied across nine scientific studies, involving older adults and municipal and public dental care professionals in home care contexts. Iterative cycles of data collection and analysis were used to integrate subjective experiences, clinical assessments, and shared decision-making into a model for oral health care planning.
Results
A
A conceptual model for collaborative oral health care planning is proposed. The model supports a shift i) from treatment-focused interventions to oral health care planning embedded in everyday care ii) From viewing oral health in isolation, to seeing it as part of a person’s total health and life context iii) From focusing on disease, to promoting lifelong learning, health and resources.Conclusions
This model addresses fragmentation in oral health care planning by linking individual preferences with system-level structures. It offers a scalable framework aligned with global health policy, notably the WHO Global Strategy on Oral Health, and promotes innovation and integration in home-based care. By embedding oral health within person-centred care planning, the model offers actionable pathways for more equitable, sustainable, and collaborative ageing care.
Clinical trial number:
A
ClinicalTrials.gov NCT06310798. Registered on 13 March 2024.Keywords:
Interprofessional Collaboration
Digital Health
Oral Health Planning
Home Care
Co-Creation
Knowledge-to-Action
Shared Decision-Making
A
Introduction
Oral health is essential for healthy aging and a human right (1, 2), yet it remains marginalised in many health systems, particularly in community and home-based care for older adults. In response to this global challenge, the World Health Organization (WHO) has launched the Global Strategy on Oral Health 2023–2030, followed by a dedicated implementation guide that calls for countries to embed oral health into general health services using person-centred, system-integrated approaches supported by digital tools, lifelong learning, and intersectoral collaboration (2, 3). The strategy underscores the urgency of flexible care models suited to decentralised, fragmented welfare systems, where oral health often remains isolated from standard care planning. Despite alignment with WHO priorities, operational frameworks, especially for home-based contexts, are still scarce. Oral health continues to be sidelined in general healthcare, despite its well-established impact on systemic diseases like cardiovascular conditions and diabetes, and its essential role in preserving dignity, nutrition, and communication among older adults (4–11). The demographic shift toward an aging population with multiple chronic conditions presents complex challenges for healthcare systems (1).
Most older adults receive care in ordinary home settings rather than long term care (12). This makes municipal home care a significant area for preventive everyday actions (1, 2). However, oral health remains insufficiently integrated into home care practice (13–15). This is due to fragmented responsibilities, unclear professional roles, and a lack of shared planning models across care systems (13, 16, 17). The disconnect between policy goals and practical oral health care delivery highlights the need for person-centred models that incorporate psychosocial and contextual realities. Grounded in a rights-based ethic, such frameworks prioritize individual agency, preferences, and life circumstances alongside clinical concerns (18, 19). Research shows that older adults in home care wish to participate in decisions regarding their oral health (20). Moreover, higher chronological age is a known risk factor for losing regular dental care contact (21). This indicates that aspects of oral health need to be integrated in care processes outside of dental care clinics. Therefore, this article approaches oral health care planning in home settings as a complex intervention. Complex interventions involve multiple, interacting elements such as professionals from different professions and organisations and older adults and significant others with heterogenous needs (20, 22, 23). These interventions require theoretical grounding to ensure systematic implementation and evaluation (24). For this, conceptual models serve as important tools in this process, offering structured ways to understand how different elements interact to produce desired outcomes (25).
In line with person-centered care principles, oral health care planning refers to a structured, collaborative process that integrates oral health into the broader planning of care for each older adult (26, 27). It involves shared goal-setting, role negotiation, and follow-up between dental professionals, care staff, and older adults themselves. Moreover, the complex needs of the ageing population indicates that new professionals and non-professionals need to collaborate in new ways, and for this learning is essential (1, 28–30). Despite WHO’s call for integration, there is no operational, home-care-specific model that (i) unites municipal and dental logics, (ii) embeds structured shared decision-making, and (iii) specifies digital/documentation requirements. Therefore, this study proposes a conceptual model for collaborative oral health care planning in home settings, grounded in person-centred care principles.
A
The model bridges policy and practice by embedding oral health care planning into municipal home care settings through co-design, cross-sector collaboration, and digital facilitation.Additionally, the model is mapped to WHO strategic objectives, ensuring relevance to broader public health priorities.
Study Design
This study was conducted within a collaborative infrastructure involving multiple universities, municipal care organizations, public dental services, older adults and significant others in western Sweden. The research was grounded in pluralist participatory action research (PAR) methodology (31, 32), enabling iterative integration of theoretical development and practical implementation. Through PAR older adults and practitioners were included not only as informants but also as co-designers. This study follows the Standards for Reporting Qualitative Research (SRQR) to ensure transparency and methodological rigour (33).
Setting and Participants
Strategic interventions were implemented through a collaborative infrastructure linking universities, municipal care, and public dental services in western Sweden. Both authors served as project managers within this infrastructure, which aimed to promote healthy ageing through an integrated oral health perspective. Guided by the principles of expansive learning (34–36), the process emphasised open-ended exploration of social dilemmas, as for example cross-organisational and multiprofessional oral health care planning, rather than predefined problems or solutions.
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Participants were recruited through the infrastructure through purposive sampling to ensure diversity in age, health status, and professional roles. A
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Informed consent was obtained from all participants in accordance with ethical guidelines. Between 2018 and 2021, six registered dental hygienists were embedded as non-clinical strategic partners within five municipal care organisations. A
These professionals engaged in monthly cross-sector meetings focused on strategic oral health planning. In parallel, co-designed educational initiatives were developed with nurses and nursing assistants, including workshops, in-service training, and follow-up sessions tailored to the oral health needs of frail older adults.A
Further outputs included a collaborative model for oral health assessment in home care and the development of a digital platform to support integrated documentation and communication across organisational boundaries.Interventions
Fig. 1
describes the iterative interventions conducted during a seven-year period (2018–2025).
Figure 1. The multiple interventions conducted within the collaborative infrastructure between universities, older adults, municipal and dental care organisations.
Based on an overall collaborative infrastructure with a theoretical base in expansive learning (35) and person-centered care (18) the following interventions have been conducted:
1.
Collaborative meetings on a strategic basis involving municipal and dental care staff (n = 217 meetings).
2.
Co-designing implementation of oral assessments in municipal care, including the development of a course and workshop regarding oral health assessments in home health care. Participants in the course were nurses and nursing assistants (n = 1215 personnel). Implementation strategies also included workshops for reciprocal learning and common follow ups between municipal care personnel and registered dental hygienists (n = 59 units within long-term and home care).
3.
Oral care cards exploration involved quality assurance of a legally regulated paper-based oral health care planning tool (‘oral care card’) within municipal care (37), and also an exploration of user experiences related to the usability and integration of oral care cards. This included nurses, nursing assistants, significant others, dental professionals, managers and senior advisors within municipal and dental care and researchers within nursing and oral health care domain.
4.
Co-designing of a new work-model for the use of the oral care cards.
5.
Co-designing of a digital platform to support the new work-model and replace the paper-based oral care cards intended to support documentation, communication, and shared decision-making across organizational boundaries.
6.
Iteratively testing the new work-model and the digital platform.
The interventions were designed to foster shared learning and to test components of the emerging conceptual model in real-world settings.
Data collection
We employed a mixed-methods design encompassing qualitative interviews, group interviews, structured assessments, and document analysis. Data collection spanned multiple levels: micro-, meso- and macrolevel. The numerous interventions have contributed to nine scientific studies – six published and three submitted, one PhD thesis, and one Swedish report (20, 22, 38–46). The studies involved qualitative and quantitative methods (47) whereas the following data collection described represent the core of the studies:
A
A
1.
Semi-structured interviews (n = 60) with older adults, significant others, dental professionals, and care staff explored experiences and barriers to collaboration and integrated care for healthy ageing with an included oral health perspective.
2.
Joint oral health assessments including older adults, registered dental hygienists and nurses in home health care were documented using a standardized protocol (n = 24 teams of one older adult, one home health care nurse and one registered dental hygienist).
3.
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Individual and group interviews were conducted to explore oral care cards, which is a Swedish oral health care planning tool. Participants (n = 60) was significant others, managers in home health care and public dental care, senior advisors, municipal and dental care professionals.4.
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Meeting protocol from collaborative meetings with local head nurses and managers within municipal organisations (n = 217) and municipal registered dental hygienists provided contextual insights into learning processes.Data Analysis
These studies were analysed using thematic analysis, guided by a four-step approach by Lewis et al. (48). The process included:
1.
Identifying key discussion points and implications from each sub-study.
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Synthesizing findings through iterative dialogue between the authors.
3.
Abstracting overarching themes and conceptual insights.
4.
Constructing a preliminary conceptual model grounded in empirical data.
The development of the conceptual model was iterative and inductive.
Results
A
The conceptual model for collaborative oral health care planning in home-based settings was developed through a seven-year participatory research process, involving iterative analysis of interventions and participant experiences. The model (Fig. 2) is structured around a central shared care process and seven contextual determinants, designed to support person-centred planning by aligning stakeholders across disciplinary and organisational boundaries.Fig. 2
Conceptual model for collaborative person-centered oral health care planning in home setting.
Core Participants and Shared Care Process
The model features three primary participants: the older adult, the dental professional, and the nurse. These roles span distinct organisational systems with differing management structures, documentation practices, and funding mechanisms. Inspired by Sweden’s legally mandated dental care remuneration programme—where frail older adults receive annual oral assessments at home by a registered dental professional and a nursing assistant (37), the model reflects real-world care configurations.
The shared care process also serves as a collaborative infrastructure for learning and coordination among participants (40). It comprises three iterative phases, ideally guided by the older adult, with all participants actively involved:
The shared care process also serves as a collaborative infrastructure for learning and coordination among participants (40). It comprises three iterative phases, ideally guided by the older adult, with all participants actively involved:
A
1.
Subjective Health: This phase begins with the older adult’s self-perception of overall health, fostering a holistic approach and establishing a trust-based alliance among team members (49).
2.
Oral Health as evaluated by experts: Oral health is assessed using a shared language accessible to all participants. While each participant brings expertise in different aspects of care, the dental professional may guide the assessment process. A validated tool that all participants can comprehend, such as ROAG (50) is recommended to ensure clarity and shared understanding. Without this, uncertainty around needs may compromise subsequent planning.
3.
Decision-Making and Action Strategy: This phase emphasises mutual learning and shared decision-making, particularly when multiple care options exist (51). It supports collaborative planning tailored to individual needs and values.
Contextual Framing and Determinants
The model uses the metaphor of a house to represent the home as the primary site of care, with contextual determinants visualised as structural components (Fig. 2). Arrows illustrate the dynamic learning environment, where knowledge both shapes and is shaped by context (40). Common goals and follow-up mechanisms across organisational boundaries foster collaboration and provide direction (43, 45). However, each organisation interprets concepts such as healthy ageing differently, influenced by regulatory, financial, and institutional frameworks (20, 38, 43). These divergent values must be explicitly acknowledged and negotiated to enable effective collaboration.
A theoretical analysis (41) revealed epistemological differences in decision-making between dental and general health care. Dental care often follows a linear, one-directional model, whereas general health care embraces iterative, dynamic processes. Recognising these differences is essential for integrating learning and decision-making into oral health planning (52).
Ageing is experienced uniquely by each person, and values are shaped by prior knowledge and experiences. Collaborative planning must therefore accommodate diverse perspectives. In several interventions, participants agreed on the importance of oral health, but their reasons varied (38, 39). For example, in a decisional needs assessment involving 24 older adults, 20 were identified as at risk of poor oral health (20). Yet none expressed interest in visiting a dental clinic, preferring care at home, which indicates the need for planning that respects individual preferences and lived experiences.
Operational Challenges and Determinants
Within the collaborative infrastructure, practical challenges emerged in implementing oral assessments in home care. Despite managerial support, planning meetings revealed a lack of basic tools, such as torches and mouth mirrors, within municipal care, exposing a gap between strategic intentions and operational realities (45). This underscores the importance of aligning resources, roles, and responsibilities to ensure quality care delivery. The WHO strategy similarly emphasises community-based care and patient autonomy, advocating for services designed around individual and community needs.
Over time, registered dental hygienists within the collaborative infrastructure worked with municipal care professionals to identify prerequisites for safer and more effective oral assessments (45). This collaboration reinforced the value of follow-up as a mechanism for continuous learning (40, 45). Additionally, documentation must be embedded within everyday systems used by both municipal and dental care providers, whereas integrated and tailored information emerged as important. Language should be adapted to ensure accessibility for all participants (22, 39). Moreover, effective cross-organisational collaboration depends on structured coordination and communication. In absence of communication channels, frustration arose—for instance, a nurse expressed concern over the lack of feedback from dental professionals regarding home care patients (20, 40). To address such gaps, shared digital platforms (44) and joint strategic planning (43, 45) are recommended.
The resulting model offers a framework for person-centred, digitally facilitated coordination, shared decision-making, and integrated care pathways tailored to the realities of home-based settings.
Discussion
A
This study introduces a novel conceptual model for oral health care planning in home-based settings, grounded in person-centred care, co-design, and integrated systems thinking. The model reconceptualises oral health care planning as an multiprofessional and relational process embedded in everyday care. The model was developed through participatory action research (31) and underscore the importance of shifting from a pathogenic, treatment-oriented paradigm to one that emphasizes health promotion, learning, shared responsibility, and iterative planning.A central contribution to theory regarding oral health care planning is the importance of recognising all participants, not only professionals but also older adults, as active contributors to knowledge and practice. Traditionally, older adults might have been positioned as passive recipients of care (53, 54). However, the model presented here, challenge this notion by using the heterogenic base of older adults as a resource for knowledge which can contribute to valuable knowledge during the oral health care planning. In the context of home-based oral health assessments, older adults demonstrated a capacity to influence care planning by articulating their preferences, routines, and challenges (38, 40, 46). Their contributions were not merely anecdotal; they provided essential contextual insights that shaped the direction and content of care. This active engagement reflects a shift toward a more dialogical and participatory model of care, where knowledge is co-designed through interaction.
Findings underscore the home as a site of epistemic authority, where older adults feel empowered to articulate needs, negotiate routines, and shape care trajectories, challenging traditional clinic-based hierarchies. As Molony describe (55) being in a familiar environment can be empowering for older adults. As in this project the home as arena for oral health care planning appeared to empower older adults to take initiative—demonstrating oral health care practices, questioning recommendations, and highlighting what mattered most to them. In doing so, they not only shaped the care process but also contributed to the creation of the care context itself (56).
Thus, older adults were not simply adapting to professional input; they were actively reshaping the care model by bringing forward knowledge that had previously been underutilized or overlooked. This underscores the importance of designing oral health care planning processes that are not only person-centred in principle but also structurally inclusive of older adults’ voices and experiences.
To our knowledge, this is the first conceptual model in dentistry to integrate shared decision-making, context-sensitive learning, and interorganisational planning into a unified oral health care planning process (41). For example, existing models focus on single treatments or diseases and often conceptualize decision-making as confined to the clinical encounter, with limited attention to the broader social and relational contexts in which care is delivered. In contrast, the oral health care planning model draws inspiration from person-centered care traditions in nursing and social work, where planning is seen as a dynamic and ongoing process embedded in the patient’s life world (51). By introducing the concept of translation between professional logics, the model offers a novel lens for understanding and facilitating interprofessional collaboration. It offers a scalable framework for service redesign that is applicable to decentralised welfare systems internationally and aligned with the WHO Global Strategy on Oral Health 2023–2030 (2).
Integration with Existing Literature
The findings align with previous research emphasizing the need for integrated and person-centered care for older adults (2, 4, 9).
A
However, this study extends the literature by offering a concrete framework for how such integration can be operationalized in the context of oral health. The model resonates with calls for complex interventions that are responsive to the realities of home care, where multiple participants, shifting needs, and contextual constraints must be navigated simultaneously (23).Practical Implications
Practically, the model serves as both a planning tool and a learning infrastructure. It supports care teams in structuring collaboration, aligning goals, and adapting interventions over time. Importantly, it does not seek to impose a unified logic across professions but instead facilitates mutual understanding through translation and dialogue. This approach acknowledges the value systems and decision-making practices of different participants, including older adults themselves, and promotes care that is both respectful and effective.
Distinct from treatment planning—which is typically clinician-driven and focused on individual interventions (57, 58) —oral health care planning in home settings is relational, iterative, and embedded in daily life contexts (46). This reframing position oral health as an integrated component of the broader care system. The concept of oral health care planning seeks to bridge this gap—between personnel and professional logics, between older adults, home care and dentistry, and between theory and practice. It offers a dynamic, contextual, and person-centered model for collaboration in complex home care settings, contributing to the development of sustainable and equitable oral health care for older adults.
The model also has implications for education and policy. It can inform the design of interprofessional training programs and guide the development of policies that support integrated oral health care in community settings. By embedding oral health within the broader care system, the model contributes to more equitable and sustainable care for aging populations.
Strengths and Limitations
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A strength of this study is its participatory and iterative design, which enabled real-world testing and refinement of the model. The use of mixed methods and the inclusion of multiple groups enhanced the model’s relevance and applicability. Nonetheless, the study is limited by its context-specific nature; the findings are based on interventions conducted within a Swedish municipal care and public dental care setting and may not be directly transferable without contextual adaptation. However, key components of the model, such as co-design and context-sensitive planning, may be applicable to other publicly financed health systems facing similar structural fragmentation. Finally, the long-term impact of the model on oral health outcomes and system-level effects remains to be evaluated.Future Research
Future research should focus on testing the model in diverse care contexts and with larger populations. Longitudinal studies are needed to assess its impact on oral health outcomes, care quality, and interprofessional collaboration. Further theoretical development could explore how the model interfaces with digital tools, decision aids, and policy frameworks. There is also potential to adapt the model for use in other domains of care where similar challenges of fragmentation and professional boundaries exist.
Declarations
Ethics approval and consent to participate
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All studies underpinning the development of this conceptual model were conducted in accordance with the Declaration of Helsinki and received approval from the Swedish Ethical Review Authority (Dnr: 2020–04724; 119 − 14; 2022-03928-01; 2025-03612-01). In these studies, participants received written and verbal information, its voluntary nature, and procedures for data handling and confidentiality. A
Written informed consent was obtained from all participants prior to data collection.Consent for publication
Not applicable.
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Data Availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Competing interests
The authors declare that they have no competing interests.
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Funding
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This research was funded by the Health Promotion Research Funding (VGFOUREG-937918, VGFOUREG-966932), Region Västra Götaland, Sweden and the Local Research and Development Board of Göteborg and Södra Bohuslän (VGFOUGSB-942302), Region Västra Götaland, Sweden.A
Author Contribution
Both authors, Jessica Persson Kylén and Sara Björns, participated equally in the conception, execution, and writing of the study.
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Acknowledgement
The authors gratefully acknowledge the contributions of all older adults, their relatives, and the clinicians who participated in the co-design process.
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We also wish to thank the municipal partners, board members, and colleagues from Innovationsplattformen, Public Dental Service Region Västra Götaland, Gothenburg university, Karlstad University and University West in Sweden for their invaluable support. This work was made possible through the collective insight, commitment, and reflections shared by those involved, which together formed the foundation for the development of the conceptual model.Electronic Supplementary Material
Below is the link to the electronic supplementary material
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