127 A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder Introduction Since the World Health Organization emphasized that oral health is integral and essential to general health and wellbeing [1,2], oral health has improved in the general population; however, vulnerable patients are an exception to this [3]. For instance, poor oral health in patients with a psychotic disorder may lead to poor self-image, low self-esteem, decreased self-confidence, social phobia, loneliness, depression, and suicidal intent; these people are ashamed and are afraid to go outside, and therefore, participate less in society [4,5]. Epidemiological studies showed that the lifespan of patients with a psychotic disorder is shorter than that of the general population without mental illness. The gap in mortality was estimated to be a 15–25 year shortened life expectancy in patients diagnosed with a (severe) mental illness, including in countries where the quality of healthcare is acknowledged to be good [6,7]. An unhealthy lifestyle is an important cause of the gap in mortality. Several studies among patients with (severe) mental illness showed that oral health and oral-health-related quality of life are substandard within the unhealthy lifestyle domain [8–13]. Inadequate oral health self-management, a lower tooth-brushing frequency, a lack of motivation for proper oral hygiene, and poor psychosocial functioning are known as other barriers to adequate oral health in this patient group [14–17]. From a holistic perspective [18], supporting the general health of patients with a psychotic disorder, including oral health, is one of the tasks of a mental health nurse (MHN), which is one of the main health professions at the forefront of everyday care services [13,19]. MHNs indicate that they hesitate to take action and would like to be more attentive in this area [13]. MHNs state that they lack the relevant expertise, and there is a lack of practical interventions for MHNs to use when supporting patients regarding oral health. Happell et al. [19] discussed the importance of this topic being included on the agenda in mental health organizations, which are often only focused on psychiatric and psychological problems. One of the barriers reported was that when patients express concerns regarding their physical health, these concerns tend to be given little importance by the healthcare professional [19]. Furthermore, MHNs in general have to provide more input on needs and barriers in mental health services. 5
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