Oral health in Indigenous adults: Perceptions and beliefs about oral health and dental care

Current models of care are not reducing oral health disparities between Aboriginal and non-Aboriginal Australians. Poor oral health in Aboriginal Australians remains a significant concern. Evidence suggests that, despite dental caries being largely (theoretically) preventable, Australian Aboriginal people have worse periodontal disease, more decayed teeth and untreated dental caries than non-Aboriginal Australians. Current health care delivery systems need reviewing for their effectiveness in providing services that are culturally appropriate and understand the issues that many Aboriginal people face including marginalisation, racism and socio-economic disadvantage. Knowledge of Aboriginal perspectives of oral health and dental services is integral to developing responsive and appropriate oral health services that focus on upstream approaches such as preventing disease as well as providing tertiary dental care. The original concept of this project was suggested by a Noongar elder and developed over time through conversations with Community, Aboriginal health colleagues with leadership roles and with an Aboriginal co-investigator. Exploring perceptions is critical as they form the basis of health behaviour. There are a number of theories in relation to epidemiology, health promotion and behaviour change that investigate stages of change in terms of healthy behaviours and the impact of influences over a lifetime. Designed to respond to a pressing need to generate new knowledge and identify practical solutions to improve the provision of adequate primary oral health care to Aboriginal people, it was anticipated that project findings would provide evidence of how Aboriginal people perceive oral health and dental services, including barriers and enabling factors that can inform policy and practice development and future research projects. Aboriginal Australians living in rural and remote Australia face similar disparities in oral health which are multifactorial and multigenerational stemming from the legacy of colonisation and loss of culture and identity, but which are compounded by socioeconomic and geographical disadvantage. The maldistribution of the dental workforce and difficulties in retaining and attracting staff in remote areas makes providing dental services in this context an ongoing challenge. Using volunteers to extend dental care to the remote Kimberley region of Western Australia is a novel approach to address the issue. A secondary aim of this project was to understand the potential role volunteers may play in improving oral health outcomes for remote Australian Aboriginal communities. The study explored values and attitudes towards volunteering and the volunteers’ perceptions of oral health in remote Aboriginal communities. Aims Explore the issues, perceptions and attitudes regarding oral health among Aboriginal adults in the Perth metropolitan area. Explore the barriers and enablers to support oral health for Aboriginal adults in the Perth metropolitan area. Determine attitudes towards oral health among professionals who work with Aboriginal adults in the Perth metropolitan area. Understand the potential role volunteers play in improving oral health outcomes for remote Australian Aboriginal communities. Explore participants’ values and attitudes towards volunteering and their perceptions of barriers and enablers regarding oral health in rural and remote Aboriginal communities.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Successful ageing and oral health: incorporating dental professionals into aged care facilities

Population projections by the Australian Bureau of Statistics indicate a rapid increase in the proportion of the population aged 65 years and older from 14% in 2012 to 22% in 2061 and 25% in 2101. Older people in residential aged care facilities (RACFs) have limited access to appropriate oral health systems, preventative dental care and other dental services. Research indicates that many older people are in urgent need of oral health care when they enter aged care facilities. An increasing dependency on care, coupled with inadequate oral care after entering facilities, can also lead to further deterioration in this group’s oral health. There are also a number of barriers to the provision of adequate oral care in Australian residential aged care facilities including insufficient resources, ambivalent attitudes from health professionals and carers to providing oral care, lack of oral health knowledge and inadequate training of carers, including non-dental health professionals. Cultural issues and different lived experiences of carers can play an important role in knowledge of and comfort with dental services. There is a need for greater collaboration across dental health services, dental professionals, dental associations, pharmaceutical agencies and dental technician industries to enhance the promotion of better oral health in RACFs. Studies support a shift from a service delivery oriented model of oral care to a more collaborative, team-based, inter-professional approach. Also, there is an increasing trend to engage both dentists and other dental professionals in providing oral health services in residential aged care environments. Dental hygienists already provide dental care to aged care residents in Japan, Sweden and the United States. An Australian study investigating the dental examination and referral capability of dental hygienists found that there ‘was excellent agreement between the dentist and the dental hygienist regarding the decision to refer residents to a dentist for treatment. Currently dental care for older adults in various types of residential aged care in Australia is often conducted on an ad hoc basis with little structure to such services. Many aged care residents do not receive adequate oral hygiene or any dental services. In the current system, when delivering dental care to residents in aged care facilities, dentists work most often in isolation from other health care teams, often without adequate or any links to the primary health care team of the resident. Ageing Australians with high dental treatment needs have been recognised as a concern in terms of poor access to services that would improve quality of life. The limited number of geriatric-specialised dental services in Australia adds to poor oral health outcomes for older persons. The oral health status of older adults can decline with failing health, systemic diseases and medical treatment for comorbidities, with a profound effect on nutritional status and quality of life. Most previous studies into oral health in RACFs have approached the issue from the perspective of adapting current dental services and adding more care responsibilities for residential aged care staff. This project recognised that the incorporation of the dental professional into the primary health care team was a major factor required to achieve the adequate oral health care of residents in aged care facilities and investigated the perceptions of the stakeholders involved (dental professionals, non-dental health professionals and carers) of the barriers and enablers they faced and that dental professionals face in providing oral care to residents in aged care facilities.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people

Introduction: The purpose of this paper is to draw on Aboriginal and Torres Strait Islander (Indigenous) perspectives, theoretical understandings, and available evidence to answer questions about what is required to effectively address Indigenous people’s mental health and social and emotional wellbeing. Social and emotional wellbeing is a multifaceted concept. Although the term is often used to describe issues of ‘mental health’ and ‘mental illness’, it has a broader scope in that Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community, how these connections have been shaped across generations, and the processes by which they affect individual wellbeing. It is a whole-of-life view, and it includes the interdependent relationships between families, communities, land, sea and spirit and the cyclical concept of life–death–life. Importantly, these concepts and understandings of maintaining and restoring health and social and emotional wellbeing differ markedly to those in many non-Indigenous-specific (or mainstream) programs that tend to emphasise an individual’s behavioural and emotional strengths and ability to adapt and cope with the challenges of life. This paper explores the central question of ‘what are culturally appropriate mental health and social and emotional wellbeing programs and services for Indigenous people, and how are these best delivered?’. It identifies Indigenous perspectives of what is required for service provision and program delivery that align with Indigenous beliefs, values, needs and priorities. It explores the evidence and consensus around the principles of best practice in Indigenous mental health programs and services. It discusses these principles of best practice with examples of programs and research that show how these values and perspectives can be achieved in program design and delivery. This paper seeks to provide an evidence-based, theoretically coherent discussion of the factors that influence the effective development, implementation and outcomes of initiatives to address Indigenous mental health and wellbeing issues. It seeks to assess whether the current investment in Indigenous people’s mental health is aligned with available evidence on what works. To this end, the paper reviews Australian literature and government health, mental health and social and emotional wellbeing policies and programs. The scope of programs and their criteria for inclusion in this paper are informed by the Key Result Area 4, Social and Emotional Wellbeing objectives, within the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–13: Australian Government Implementation Plan 2007–2013. This paper acknowledges the holistic nature of health, mental health and wellbeing, and the effects of Australia’s colonial history and legacy on the contemporary state of Indigenous social and emotional wellbeing. It recognises that there is a complex relationship between social and emotional wellbeing, harmful substance misuse, suicide, and a range of social and economic factors. Although this paper encompasses the broad priorities identified within the key Indigenous mental health policies and frameworks, it does not provide a detailed discussion of programs and resources that, although relevant here, are covered in a number of existing Closing the Gap Clearinghouse resource sheets and issues papers (see Appendix 1). These interweavings and overlaps are not surprising given the complexity and interconnectedness of the issues and determinants that are being addressed to strengthen Indigenous mental health and wellbeing

Facilitating empowerment and self-determination through participatory action research:Findings from the national empowerment project

The National Empowerment Project (NEP) is an innovative Aboriginal-led community-based project. Since 2012, it has been working with communities in 11 sites across Australia to develop a culturally appropriate health promotion and primary prevention intervention strategy to reduce the high rates of psychological distress and suicide among Aboriginal and Torres Strait Islander peoples. The NEP is built around the use of localized participatory action research (PAR) processes to support communities to identify key factors negatively impacting on their lives as well as strategies for promoting well-being and building resilience. This article details the application of the PAR approach by the NEP Aboriginal community-based researchers. It provides some unique insights into how PAR facilitated communities to have a voice and the ways in which it supported important change processes at both an individual and a community level

Social determinants of Aboriginal and Torres Strait islander social and emotional wellbeing

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Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis

BACKGROUND Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a stepped-wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. METHODS AND RESULTS An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of "action items," which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing "self-management support" and "community linkage" streams of the chronic care model. Increased momentum was evident in later stages of the study. CONCLUSIONS The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.This study was funded by the Australian National Health and Medical Research Council (NHMRC) project grant 1027040 and Center of Research Excellence 1080401 and by the Wesfarmers Center for Vaccines and Infectious Diseases at Telethon Kids Institute. Ralph and Maguire are supported by NHMRC fellowships (1142011 and 1046563, respectively)

Conceptions of nymphomania in British medicine 1790-1900

Thesis (PhD)--Macquarie University, Division of Humanities, Dept. of Modern History, 2003.Bibliography: p. 305-333.Introduction -- Female excess: early medical conceptions of women's erotic desire -- Defining excess in the age of restraint: the modern conception of nymphomania -- Women and nineteenth century medical discourse: conceiving the disordered sex -- Dangerous desires: controlling women's sexual excess -- The urge to cut: treating nymphomania -- Challenging the science of women: rethinking nymphomania -- Sex in mind, sex in body: nymphomania at the end of the Nineteenth century -- Conclusion.In nineteenth-century British medical discourse, nymphomania was understood as a disorder of excessive or insatiable erotic desire. It did not refer, as many assume, to a woman's frequent sexual intercourse. This thesis traces how excessive erotic desire in women constituted a somatic disorder in the eyes of physicians. It explores the central role accorded both the clitoris and beliefs about the female body in physicians' understanding of this disorder. Generations of physicians subscribed to the view that the clitoris was inherently dysfunctional, and that woman was innately prone to disorder. This examination seeks to understand why this was so. For physicians in the nineteenth century, nymphomania raised a number of contradictions. The incongruity they confronted arose from a clash between the legacy of medical thinking about woman they inherited, and social preoccupations of their age. Women were considered weak, irrational, lacking control and prone to immoderate erotic desire. Yet at the same time, they were expected to repress their natural urges, and strictly control their behaviour. Examining the way nymphomania was conceived offers insight into the complexities surrounding women's sexuality that so pervaded the nineteenth century. At the same time, it also shows how nineteenth century medical discourse not only supported dominant expectations about woman, but fundamentally challenged such ideals.Mode of access: World Wide Web.vii, 333

Aboriginal children and penicillin injections for rheumatic fever: how much of a problem is injection pain?

Abstract Objective: To explore young Aboriginal people's and clinicians’ experiences of injection pain for the 10 years of penicillin injections children are prescribed to prevent rheumatic fever recurrences. Methods: Aboriginal children on the penicillin regimen and clinicians were purposively recruited from four remote sites in Australia. Semi‐structured interviews and participant observations were conducted. Views were synthesised and thematically analysed. Results: A total of 29 Aboriginal children and 59 clinicians were interviewed. Sixteen participants appeared to become accustomed to the injection pain, eight did not find pain an issue, and five found injection pain difficult. A further five believed the injections made them unwell. Patients expressed varying abilities to negotiate with clinicians about the use of pain reduction measures. Clinicians revealed good knowledge of pain reduction measures, but offered them inconsistently. All clinicians found administering the injections distressing. Conclusion: Repeated painful procedures in children necessitate well‐planned and child‐focused care. Current practices are not in line with guidance from the Royal Australasian College of Physicians about effects of repeated painful procedures on children. Initiating the long‐term injection regimen for rheumatic fever is a special event requiring expert input. A newly reported finding of a subset of young people feeling unwell after receiving the injection requires further investigation. Implications for public health: Improvement of local and jurisdictional guidelines on use of pain reduction measures for children who have been prescribed repeated painful injections for rheumatic fever is needed