Prioritising Strategies to Strengthen Domiciliary Oral Care for Older Adults in Malaysia: A Stakeholder Co-Creation Study.

INTRODUCTION: Domiciliary oral care services (DOMS) are important for older adults who are frail, homebound or dependent on others for access to care. In Malaysia, implementation remains limited despite growing oral health needs in an ageing population. This study aimed to co-create and prioritise practical strategies to strengthen DOMS for older adults in Malaysia. METHODS: A qualitative participatory co-creation design was used. Twelve purposively selected stakeholders from academia, clinical practice, professional bodies and community-related sectors participated in a multi-stage process involving context-setting, small-group brainstorming and a co-creation workshop. Identified barriers and proposed strategies were then rated by all 12 participants for perceived feasibility and expected impact using a 5-point Likert scale. Consensus was defined a priori as at least 80% agreement. RESULTS: Stakeholders identified barriers across four domains: policy and regulatory environment; patient, caregiver, and public engagement factors; workforce capability and professional readiness; and service-delivery and resource constraints. DOMS implementation was perceived to be limited by regulatory ambiguity, insufficient workforce preparedness, coordination challenges and underdeveloped service models. Strongly supported strategies included regulatory clarification, continuing professional training, integrated care pathways involving other healthcare providers, temporary clinic arrangements and partnership-based service support. Undergraduate curriculum reform and broader inter-professional development were viewed as important but less immediately feasible. CONCLUSIONS: Strengthening DOMS for older adults in Malaysia will require a phased, system-oriented approach. Near-term priorities include clearer regulatory guidance, targeted workforce development, improved cross-sector coordination and practical partnership-supported delivery models. These findings provide stakeholder-informed directions for policy and service planning.