199 The Development of an Oral Health Nursing Tool in Patients with a Psychotic Disorder larger toolkit, the brochure with an awareness screener was found to be feasible and could contribute to the sensitisation and knowledge of oral health among MHNs. The results indicate that MHNs will engage with the brochure’s content and intend to take action to change their behaviour around patients’ oral health. This suggests that the brochure with its awareness screener could help MHNs progress from pre-contemplation (stage 1) and contemplation (stage 2) to preparation (stage 3) and action (stage 4), according to Prochaska and DiClemente’s behavioural change model [22]. Furthermore, implementation within organisations is indispensable as the next step of the Prochaska and DiClemente behavioural change model (step 5) [22] so that MHNs will adhere to their change of behaviour. Here, it is important to note that insufficiently implemented interventions are less effective, causing MHNs to regress to their previous behaviours. The Fogg behavioural model [37] states that people can only achieve behavioural change when three elements are present simultaneously: motivation, ability, and a trigger. This means that when MHNs are motivated to actively change, as shown in this study, they need a trigger, which is something or someone that encourages individuals to act when their motivation is high but their ability is low. These triggers could be innovators or early adopters [38] who prompt action by modelling the behaviour, making it easier for others to initiate. MHNs could be those facilitators when they take professional leadership. In the literature, professional leadership is defined in terms of personal leadership, such as being proactive, being a role model, taking initiative, being self-reflective, showing assertiveness or courage, and focusing on good cooperation [39]. The question of how MHNs can take a professional leadership role and take responsibility for their role is highly relevant in this regard [21]. On the one hand, this starts with sensitisation, knowledge, responsibility for acting, and actual implementation, and the brochure provides a foundation for this purpose. On the other hand, it also requires individuals who demonstrate professional leadership to actively engage with the brochure, specifically concerning the topic of oral health. To improve ability, the suggested clinical lesson should be developed in an easy and accessible way to make it a worthwhile investment in terms of both content and time [37]. The adequate implementation of interventions in organisations is a highly relevant issue but was not within the scope of this study. Regarding the expected effects, definitive statements cannot be made, but the research can be continued to explore this further. 6
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