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1 Elisha Riggs, 1 Lisa Gibbs, 2 Christine Armit, 3 Mark Gussy, 4 Amal El-Khoury, 5 Leila Alloush, 6 Saiqa, 7 Saher Ali, 1 Elizabeth Waters 1 The McCaughey.

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Presentation on theme: "1 Elisha Riggs, 1 Lisa Gibbs, 2 Christine Armit, 3 Mark Gussy, 4 Amal El-Khoury, 5 Leila Alloush, 6 Saiqa, 7 Saher Ali, 1 Elizabeth Waters 1 The McCaughey."— Presentation transcript:

1 1 Elisha Riggs, 1 Lisa Gibbs, 2 Christine Armit, 3 Mark Gussy, 4 Amal El-Khoury, 5 Leila Alloush, 6 Saiqa, 7 Saher Ali, 1 Elizabeth Waters 1 The McCaughey Centre, The University of Melbourne; 2 Merri Community Health Services; 3 School of Dentistry and Oral Health, Latrobe University, 4 Arabic Welfare; 5 Victorian Arabic Social Services; 6 Pakistani Community Representative, 7 Pakistan Association Australia Melbourne TEETH TALES: ADDRESSING CHILD ORAL HEALTH INEQUALITIES IN REFUGEE AND MIGRANT COMMUNITIES 20th IUHPE World Conference on Health Promotion Monday July 12 th 2010

2 Community Identified Issue Merri Community Health Services –Health Promotion Unit –Identified issues of concern Issues identified: –High sugar foods and drinks seen as luxury items –Avoidance of tap water – no fluoride intake –Use of the miswak chewing stick –Avoidance of toothpaste due to cultural or religious dietary restrictions –Minimal current uptake of dental services and access barriers

3 City of Moreland Highly diverse community 32% residents born overseas 45% speak a language other than English 7 th most socioeconomically disadvantaged in Victoria High incidence of low-incomes, low skilled occupations, low educational attainment, high rate of unemployment

4 Significance of the Problem Early Childhood Caries (ECC) is one of the most common and costly childhood diseases Over the past 30 years dental caries rates have decreased for the general population However a clear social gradient exists and there are significant inequalities Dental problems are prevalent among migrant and refugee populations in Australia and internationally Limited oral health data on refugee and migrant children

5 Research Framework Socio-ecological framework (Brofenbrenner 1986, McLeroy 1988, Fischer-Owens 2007)

6 Research Framework Cultural competence (NHMRC 2005) –A set of congruent behaviours, attitudes, and policies that come together in a system, agency or among professionals –More than awareness of cultural differences; integrates culture into the delivery of health services –Cultural Competence Continuum (Cross et al 1989)

7 Teeth Tales - Community Partnerships Victorian Arabic Social Services (VASS) Arabic Welfare (formally Australian Lebanese Welfare ALW) Pakistani community researcher Pakistan Association Australia Melbourne (PAAM)


9 Teeth Tales - Findings Four themes: –Child oral health – knowledge, practices and beliefs –Dental service experience –Migration and settlement –Community solutions Although there were differences and similarities across and within cultural groups, there were mostly differences between the refugee and migrant groups Contrasting views between community and health care professionals Contrasting views between health care professionals

10 Child Oral Health Child oral health particularly tooth decay was an issue of concern to everyone Varied levels of knowledge across all groups Differing practices – current and traditional, home county and new country Many risk and protective factors identified by both community and health professionals: –Diet, oral health practices, breastfeeding, bottle use, dummy use, smoking, genetics, fluoride, water consumption, dental fear, pregnancy, access to oral health messages, information and dental services

11 Child Oral Health Importance of child oral health: Teeth are very important, if there is any problem with your teeth…it can affect the body and the stomach (Iraqi mother Interview) We have a culture that when the milk teeth come out we make a celebration. (Palestinian participant) I dont know if it is just as a cultural thing that teeth are not as important… I think there might be this perception that they are only baby teeth, so it doesnt matter because they are going to be lost anyway. (Dental Professional)

12 Child Oral Health Oral health is a health issue of increasing concern: My grandchild is seven years old, they extracted, removed all of his teeth from the age of two and a half. (Iraqi grandmother Int) His face was swollen and painful and I was worried. (Lebanese mother FG) My son, he is almost three and a half years old, when I went to the dentist. Eleven of his teeth are damaged. (Pakistan mother FG) Children with bleeding gums, children with loose teeth, black teeth. One family I saw few weeks ago the little girl she was only five and all of her teeth were black. (Arabic Liaison Officer) I mean thats what they do all day, every day [at the Dental Hospital] they do full clearances on three year olds, take every tooth out, they just do it all the time, the teeth are very bad at the moment, very bad. (Dental Professional)


14 Child Oral Health Oral hygiene practices: She thinks they are too young for anything to be done; she thinks it is an invasion. She starts when they are about four years, shows them how to brush. Before then, nothing (Interpreter Iraqi FG) The nurse told her that children or toddlers should start cleaning their teeth when they are two years old, she doesnt believe in that and she hasnt applied it to her children (Group facilitator Lebanese FG) Dental Professional: Theyve never brought it up [using traditional practices] and Ive never even thought to…I just explain to them, you know, what ideally needs to happen Facilitator: And theyre all using toothbrushes and toothpastes? Dental Professional: I would imagine so, I dont ask.

15 Dental Service Experience Extensive variation between home country and new country Preference for home country - refugees usually can not return home Cost, waiting list, quality of treatment, health information and advice, appointment experience When I take him to the doctor, the doctor tell me some teeth need check up and some teeth [need] filling, I say ok. He say sign here, so I sign here. When he go in, he asleep, then when he come out he has only two teeth. All gone. And I cry and I cry. I say, where are all the teeth and he tell me the teeth no good (Pakistani mother)

16 Dental Service Experience Access – navigating the system Appointment experience – communication: not just interpreters Please give correct information only. A lot of things we dont know. Lebanese FG) Its a bit embarrassing for us to say youve got to pay and you got to wait three years – no, we cant get you in. Oh yes I know, I can understand youre in pain but you have to wait, [this is whilst you are] on the phone for three hours talking to someone who doesnt speak your language. (Refugee Health Nurse) We find it hard to get the message across, you do everything you can, you try to get the message across but two years later you find the next child [in the family] is going to the dental hospital to have a general anesthetic to have teeth out then you realise that the message didnt come across. (Dental Professional)

17 Community Solutions Community involvement essential Communication: patient, health professional, health service Settings for oral health promotion –Community gatherings –Primary schools –Early childhood settings –Adult education sites –Dental practice Organisational and systems change The school, the dental [services], the family, they work together, they must work together about this (Assyrian Chaldean FG) We have to think creatively now what we can do (Refugee Health Nurse)

18 Intervention Considerations and Further Research Other broader factors that need to be considered in the intervention and these communities more broadly: –Racism & discrimination – services & community –Social Inclusion/exclusion –Maternal isolation and depression –Parenting: lack of extended family support, role of father/husband –Religion and spirituality

19 Community Intervention Peer education-support model: Increase parental knowledge, awareness and skills in a culturally appropriate manner Build upon social networks and supports by facilitating links to community programs and services Facilitate access to dental services Reorient services to become culturally competent All organisational levels Review community health and social services for cultural competence Strengths based approach Identify areas for improvement

20 For further information: Elisha Riggs

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