Background: Maintaining oral hygiene is essential for preventing health complications and preserving quality of life among older adults, yet consistent oral care remains difficult to implement in long-term care settings. Peer Leader strategies may facilitate the adoption and continuation of evidence-based oral care practices. This study evaluated the impact of a Peer Leader strategy on implementing a novel oral care method among older adults in a long-term care facility. Methods: A mixed-methods study was conducted over 16 weeks in seven long-term care wards in Japan (May–September 2022). Oral health was assessed using the Oral Health Assessment Tool–Japanese version (OHAT-J) at baseline and at 4, 8, and 16 weeks; oral cleanliness was specified a priori as the primary outcome, and additional OHAT-J sub-items were summarized descriptively. Adherence to gel care (three times daily) was tracked using a checklist. Semi-structured interviews were conducted post-intervention with select Peer Leaders (n = 6) and nurses (n = 4) to explore experiences related to implementation, perceived effects, and challenges. Quantitative data were analyzed descriptively and inferentially, and qualitative data were analyzed thematically. Results: Adherence to gel care remained high (94–96%) throughout the study period, and OHAT-J scores significantly improved at 4, 8, and 16 weeks compared with baseline (p < .001). Qualitative analysis identified four themes related to Peer Leader activities, effects of introducing gel care, future expectations, and implementation challenges. Peer Leader support enhanced nurses’ skills, confidence, and motivation, while visible improvements in participants’ oral conditions reinforced continued practice. However, contextual challenges related to workload, patient cooperation, and family involvement were also identified. Conclusion: Implementing gel-based oral care in long-term care facilities improved participants’ oral health and was maintained through high adherence, with Peer Leaders supporting nurses’ skills, confidence, and motivation. Long-term sustainability requires standardized guidelines, structured education for nurses and families, and multi-level organizational support. These findings provide practical guidance for effectively implementing and sustaining oral care interventions in long-term care settings.
Sakai et al. (Thu,) studied this question.