In addition, the Greenhalgh model also underscores the importance of effective teaching strategies that take into account the local practice environment in develop-ing sustained improvements. The knowledge base among direct-caregivers is a significant variable con-tributing to poor oral hygiene practices in LTC.32 The need for new training strategies and ongoing support of direct-care staff that is more practice-oriented, “hands-on” instruction rather than traditional classroom teach-ing is well-recognized.33 In this project, information about oral health problems in frail elders and oral care procedures were disseminated using both mass media and interpersonal communication approaches as de-scribed in the DOI model to enhance staff knowledge, motivation and skill.