Addressing child oral health inequalities in refugee and migrant communities

Abstract

© 2010 Dr. Elisha RiggsGood health is vital for successful settlement for people from refugee and migrant backgrounds newly arrived in developed countries. Such good health enables them to deal effectively with the challenges of settling in a new country and to participate fully in economic, social, cultural and community life. Although in the developed world there have been dramatic improvements in child oral health over the past thirty years, there is a widening gap of oral health inequalities experienced by some communities. In developed countries, it is suggested that disadvantaged children, including those of refugee and migrant backgrounds, experience up to 70 per cent more dental caries than the rest of the population. Moreover, there is strong evidence that severe dental decay that is experienced early in a child’s life is an extremely debilitating disease with lifelong consequences. Despite clear evidence of consistent health inequities for refugee and migrant communities, there is little knowledge to assist in the understanding of the social and cultural determinants of child oral health in these communities. Community-based participatory research is an ideal approach for engaging and empowering communities to improve their health, in a sensitive and appropriate manner. However, strategies and methods informing participative research with refugee and migrant communities are limited. Past research has often excluded these communities due to perceived methodological difficulties. This research proposes to address these gaps in the evidence by exploring the social and cultural influences of child oral health in refugee and migrant communities. This will inform the development of culturally competent intervention strategies to address these significant inequalities. This research will demonstrate a commitment to working in partnership with the communities at all stages of the research process. Accordingly, this PhD has the following objectives: - To systematically review the evidence-base of the oral health status, practices and environments for children from migrant and refugee backgrounds in Australia, and internationally - To work within a culturally competent framework to explore the social, cultural and environmental determinants of oral health of children and families in refugee and migrant communities - To identify the strategies for a feasible, acceptable and culturally appropriate oral health promotion intervention for children and families of refugee and migrant communities A systematic review of all national and international child oral health research undertaken with refugees and migrants was conducted. A total of 48 studies were included. In all studies that had a comparison group, child oral health for refugees and migrants was worse than that of the host or comparison population. The review identified that there are few community-based intervention research studies addressing child oral health inequalities and that the research is of limited cultural competence. In response, Teeth Tales was developed. This is a community-based participatory research study working in partnership with a community health services and cultural organisations. The study involved working with Iraqi, Lebanese and Pakistani communities in Melbourne. Eleven focus groups and seven interviews were conducted with people from these cultural backgrounds. Five interviews were also conducted with a range of health care professionals. Four broad categories of results were identified: ‘Child Oral Health’, ‘Service Use’, ‘Migration and Settlement’, and ‘Community Solutions’. This thesis has been successful in generating new knowledge about sociocultural differences in child oral health using culturally competent strategies. This in turn has informed the development of culturally competent intervention strategies. These strategies include a peer education program, and a reorientation of universal primary health and social health systems to become culturally competent. A further outcome of this thesis is the successful funding for the implementation and evaluation of the community-based intervention, from the Australian Research Council, 2010-2013. Furthermore, this study has demonstrated that oral health research with refugee and migrant communities can be conducted in a culturally competent manner. The consideration and application of a social model of health and social theory further informs the study. Critically, in terms of both ethics and rigour within an overall cultural competence framework, the contributions of this study are all firmly based on strong collaborative partnerships with cultural and community organisations throughout the research process. This adds further weight to the validity of the findings and to the contributions of the study