From Policy to Practice: Implementing Oral Health Policy in Nursing Home Care

In Belgium, the Oral Health Care Track (OHCaT) was developed in 2019 to support nursing homes in embedding an oral health policy. Despite increasing international attention to prevention and health promotion, including the WHO’s 2023 call to integrate oral health into broader health systems, implementation in nursing homes remains challenging. A mixed‑methods implementation research design was used. Between 2019 and 2026, 192 nursing homes participated. Cross‑tabulations and linear mixed models were applied to analyse organisational change over time. Qualitative data was collected from semi‑structured interviews with 67 stakeholders from 8 completed and 7 discontinued organisations and analysis of 160 organisational documents. Qualitative analyses were guided by the Consolidated Framework for Implementation Research (CFIR) and findings were integrated with quantitative results through triangulation. In total, 42 organisations completed the trajectory, 43 remain active, and 48 discontinued early, most often following COVID‑19 disruptions or turnover in management or internal coordinators. Nursing homes required on average 52 months to complete the OHCaT. No differences were observed in organisational size or legal structure between completed and discontinued organisations. Over time, completed organisations showed significant improvements in organisational embedding, including procurement policies (χ²=34.05,p<.001) and oral healthcare teams (χ²=12.35,p=.002). Preventive oral health plans increased from 15% to 97% (p<.001), and the proportion of residents receiving an annual dental visit increased from 14% to 58% (p<.001). OHCaT supports the development of a strong organisational foundation for oral health in nursing homes, which is essential for long–term anchoring in routine care. Early organisational effects are evident, while ongoing CFIR‑guided qualitative analyses will further clarify mechanisms influencing continuation, discontinuation, and sustainment.

Key messages

• This study shows how structured implementation support can strengthen organisational oral health policies in nursing homes and improve preventive care delivery.

• This work aligns with WHO goals by showing how oral health can be integrated into long‑term care systems through organisational policy implementation.