Behavior change techniques in a care partner–assisted oral health intervention for people with mild dementia: A secondary mixed-methods analysis

Abstract Background and Objectives Oral hygiene declines early in mild dementia (MD), yet few interventions specify which behavior change techniques (BCTs) drive improvement. We examined the use of BCTs in relation to oral health outcomes in a care-partner–assisted intervention for persons living with MD. Research Design and Methods Using a secondary convergent mixed-methods design, we analyzed the coaching arm of a three-arm randomized trial. Seventeen dyads (persons living with MD-care partners) completed four coaching sessions (68 coaching session transcripts). Seventeen BCTs were specified for use in the coaching manual. Transcripts were double-coded to denote frequency of BCTs used. Changes in the Gingival Index (GI) of persons living with MD between pre- and post-intervention were categorized as Stable/Worsened, Improved, or Meaningfully Improved. BCT frequencies were compared across these categories and integrated with qualitative data using joint displays. Results The most frequently used BCTs were reviewing behavior goals, problem solving, behavioral instruction, and prompts/cues. Two unspecified BCTs (action planning and emotional/relational support) were also commonly used. Meaningfully Improved dyads showed coordinated routines, greater autonomy for persons living with MD, and flexible BCT adaptation; Improved dyads used iterative action planning; Stable/Worsened dyads relied more on coach-led BCTs with limited adaptation. Care partners most often delivered prompts/cues and problem-solving, whereas persons living with MD engaged in goal setting and skill acquisition. Discussion and Implications While planned instructional BCTs established a necessary foundation, adaptive elements (e.g., action planning and relational support) proved essential for integrating oral care into daily life and achieving meaningful health improvement.