[What promotes and hinders integration of oral care in general care? Part 1. Vision, attitude and culture]

To identify facilitators and barriers to integrate oral health care into general healthcare for frail elderly, 41 participants from 10 different groups of (professional) caregivers and care-recipients (residents living at home and nursing home patients) in the east of the Netherlands were interviewed. They were asked about normative integration (vision, attitude, culture) at the macro (system), meso (organizational and interprofessional), and micro (patient care) level. After thematic analysis of the interviews, the results were refined on the basis of a workshop with 52 stakeholders. Subsequently, two main themes were identified: 1. a compartmentalized care culture in which oral healthcare and general healthcare are seen as two separate domains; 2. prioritization, awareness, and attitude towards oral healthcare integration. Barriers to integration are: low political attention (macro level); unclear responsibilities, hierarchical relationships, and lack of vision (meso level); poor awareness and low prioritization by healthcare providers and patients (micro level). Leadership (meso level), a supportive personality of individual caregivers, and ownership of patients (micro level) promote integration.