Using Aboriginal knowledge to improve oral health

Transcription

1 Using Aboriginal knowledge to improve oral health Oral Health Inequities Research Group School of Dentistry University of Western Australia Angela Durey Marlia Fatnowna Dan McAullay Linda Slack- Smith

2 Perth, Western Australia

3 Background well documented oral health disparities between Aboriginal and non-aboriginal Australians (Jamieson et al 2010a; Jamieson et al 2010b, Slack-Smith et al 2011) progress is slow in improving oral health for Aboriginal Australians (AIHW 2014) dental caries seen as preventable but

4 Context Aboriginal Australians make up 3% of the Australian population (3.8% in WA) (ABS 2011) 34.8% live in major cities, 43.8% in regional centres and 21.4% in remote Australia (ABS 2011) Dental services in WA Private Public ACCHS Volunteer WA free school dental services from aged 5 Limited services for 0-4year olds

5 Objectives To investigate Aboriginal perspectives on barriers and enablers to oral health Health workers (Durey et al 2016a) Parents/carers (Durey et al, 2016b) Teenagers

6 Methods Research team Community engagement Ethics approval Recruitment of participants

7 Methods Data collection 110 participants 36 health workers (27 female, 9 male), 4 group discussions, 11 interviews, 13 sites 52 parents/carers(mainly mothers), I interview, 9 groups discussions, 10 sites 22 Aboriginal teenagers,(10 females,12 males), 4 focus groups and one semi-structured interview, 4 sites

8 Methods Data analysis line by line analysis of transcripts to identify categories and key themes related to the topic that were then reviewed and discussed, noting comparisons within and between groups, and interrogated with existing literature

9 Findings oral health matters People are concerned about their teeth if they are painful, or they are ugly or they don t want to smile because they have teeth missing (AHW). Self-esteem- 'Then I would smile everyday maybe' (Teenager) Barriers and enablers to oral health

10 Findings Barriers Access to care Cost of services Long waiting lists for public dentists Other priorities Lack of education and promotion of oral health (eg in ante-natal care) Limited oral health training for AHWs

11 Findings Barriers Discrimination from service providers: I want to be treated like everyone else that walks in the door. Some people when they see an Aboriginal person coming, we are all put in that category we are all put in that box if they have had a bad experience with another Aboriginal person. They wouldn t do that to an Italian woman if they had a bad experience with another Italian woman. But they will do it with an Aboriginal person (parent) Shame It feels degrading I was like I m not coming back. People don t like it if you re getting bad service at that dentist, why would you go back? (parent)

12 Findings Enablers education about preventing disease and promoting oral health from pregnancy onwards oral health training for AHWs free dental services for 0-4 year olds respectful and welcoming dental services there wasn't an awkward silence, they had a lot of things in there to keep you focused. They had a TV up and they asked me if I was comfortable or if I wanted the channel changed and every now and again they would ask me if I was ok. And they said if it hurts do this (Teenager)

13 Findings Enablers parents as role models I grew up having rotten teeth And now me having a baby, I just want him to have good teeth. I don t give him cordial Mainly I give him water (Parent). upstream determinants of oral health Like what you were saying about the impact of alcohol and cigarettes, the way they use that shock tactic, should be applied to sugar if you want to get the message through, show the shocking facts about what sugar does to poor little kids and adults (Parent)

14 Discussion oral health matters where does the problem lie? role of structural factors Aboriginal people often blamed for poor oral health accountability of the system in contributing to poor oral health outcomes? the averted gaze (Wisniewski 2000:51) critical review of oral health policies and practices

15 Conclusion current services not meeting Aboriginal people s needs oral health disparities between Aboriginal and non-aboriginal Australians persist how can Aboriginal knowledge about oral health link to improving oral health outcomes? opportunity for Aboriginal and non-aboriginal stakeholders to work together to review policies and practices to ensure they improve oral health for Aboriginal Australians changing the discourse that views Aboriginal people as the problem for not improving their oral health rather than acknowledging broader structural issues that can negatively impact on making optimum oral health choices

16 Conclusion

17 Conclusion

18 Conclusion

19 Conclusion

20 Crowd funding website

21 Acknowledgements Funded by Australian Primary Health Care Research Institute and Healthway Diabetes WA for assistance in the Gary Goanna posters Conflict of Interest None noted Contact

22 References Australian Bureau of Statistics : Estimates of Aboriginal and Torres Strait Islander Australians June Canberra Australian Bureau of Statistics. AIHW. Aboriginal and Torres Strait Islander Health Performance Framework 2012: Detailed analyses. Cat. no. IHW 94. Canberra: Australian Institute of Health and Welfare AIHW. Mortality and life expectancy of Indigenous Australians: 2008 to Cat. no. IHW 140. Canberra: Australian Institute of Health and Welfare; Durey, A., McAullay, D., Gibson, B., & Slack-Smith, L. (2016). Aboriginal health worker perceptions of oral health: A qualitative study in Perth, Western Australia. International Journal of Equity in Health, 15, DOI /s Durey, A, McAullay D, Gibson, B and Slack-Smith L (2016b). Oral health in young Australian Aboriginal children: Qualitative research on parents perspectives. Journal Dental Research: Clinical and Translational Research (Accepted 6/8/2016)

23 References : a)jamieson, L., Sayers, S., & Roberts-Thomson, K. (2010). Clinical oral health outcomes in young Australian Aboriginal adults compared with national-level counterparts. Medical Journal of Australia, 192, b)jamieson, L., Roberts-Thomson, K., & Sayers, S. (2010). Dental caries risk indicators among Australian Aboriginal young adults. Community Dentistry Oral Epidemiology, 38, Slack-Smith, L., Read, A., Colvin, L., Leonard, H., Kilpatrick, N., McAullay, D., et al. (2011). Total population investigation of dental hospitalizations in Indigenous children under five years in Western Australia using linked data. Australian Dental Journal, 56, White K. An introduction to the sociology of health and illness. London: Sage; 2002.