Dental Hygiene Students’ Perceptions of a Cultural Competence Component in a Tobacco Dependence Education Curriculum: A Pilot Study

Curriculum Indigenization in oral health professions' education worldwide: A scoping review

OBJECTIVE

To explore the literature on Indigenous content within the oral health professions' education curricula.

METHODS

This scoping review included all types of literature on oral health care educational programs on Indigenous content, following the JBI (Joanna Briggs Institute) methodology. An initial search using "Indigenous," "education," and "oral health" as keywords informed a full search strategy for MEDLINE, CINAHL, Embase, Scopus, ERIC, EPPI, MedEdPORTAL, Google Scholar, ProQuest Dissertations and Theses Global, Australian Government Department of Health, and Australian Indigenous HealthInfoNet. The search included literature available until November 1, 2023, irrespective of language. Two reviewers independently screened the studies, and data were extracted and presented in tabular and narrative summary formats.

RESULTS

A total of 948 records were identified, and 101 studies were chosen for full-text review. Twenty-three studies met the criteria for data extraction. Of all studies, 95.6% were published between 2007 and 2021, mostly from Australia and New Zealand. The most frequently covered content included Indigenous culture, followed by history, Indigenous oral health, and Indigenous Peoples' health. Rural and clinical placements were the most employed delivery methods, and evaluation surveys were the most employed assessment technique. Barriers to delivering an Indigenous curriculum included students' disinterest and limited interaction with Indigenous communities, while facilitators included cultural immersion and supportive mentorship.

CONCLUSION

Despite progress in integrating Indigenous content into oral health education, challenges persist. Prioritizing Indigenous perspectives, community partnerships, and standardized assessment tools is needed. Future research should focus on long-term impacts and best practices for Indigenous curriculum development and delivery.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions

Background

Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy.

Objective

We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations.

Methods

An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018).

Synthesis

Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery.

Conclusion

The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

Indigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review

Anti-Indigenous racism is a widespread social problem in health and education systems in English-speaking colonized countries. Cultural safety training (CST) is often promoted as a key strategy to address this problem, yet little evidence exists on how CST is operationalized and evaluated in health and education systems. This scoping review sought to broadly synthesize the academic literature on how CST programs are developed, implemented, and evaluated in the applied health, social work and education fields in Canada, United States, Australia, and New Zealand. MEDLINE, EMBASE, CINAHL, ERIC, and ASSIA were searched for articles published between 1996 and 2020. The Joanna Briggs Institute's three-step search strategy and PRISMA extension for scoping reviews were adopted, with 134 articles included. CST programs have grown significantly in the health, social work, and education fields in the last three decades, and they vary significantly in their objectives, modalities, timelines, and how they are evaluated. The involvement of Indigenous peoples in CST programs is common, but their roles are rarely specified. Indigenous groups must be intentionally and meaningfully engaged throughout the entire duration of research and practice. Cultural safety and various related concepts should be careful considered and applied for the relevant context.

Students Don't Know What They Don't Know: Dental and Oral Health Students' Perspectives on Developing Cultural Competence Regarding Indigenous Peoples

Indigenous Australians experience poorer oral health than non-Indigenous Australians despite closing-the-gap initiatives. Cultural competence is an important skill in the delivery of oral health care. The need for academic institutions to incorporate Indigenous culture more widely into their curricula to improve educational outcomes for Indigenous peoples and to increase cultural competence for all students has been recognized. The aims of this study were to identify students' perceptions of Indigenous content in current dental and oral health curricula; perceived barriers and supports for developing students' Indigenous cultural competence; and recommended strategies to inform future education in Indigenous culture. Students in the Doctor of Dental Medicine (DMD) and Bachelor of Oral Health (BOH) programs at the University of Sydney participated in semi-structured interviews to explore barriers and supports to students' becoming more competent in Indigenous culture. Thematic analysis was used to synthesize the students' responses. Fifteen students participated in interviews. In analysis of the data, five key themes emerged: defining Indigenous cultural competence; current Indigenous cultural content; barriers to incorporating Indigenous education; future Indigenous curricular content and strategies; and diversity within student cohorts. These findings suggest that increasing Indigenous cultural competence among dental and oral health students requires an informed history of Indigenous Australians, engagement with Indigenous communities, and reflection on these experiences. Additionally, recruitment of Indigenous staff and students in the school will facilitate culturally appropriate ways to redress Indigenous health disparities and increase the overall health of Indigenous peoples.

Indigenous Health Curriculum and Health Professional Learners: A Systematic Review

Background: Globally, an estimated 370 million Indigenous peoples reside in more than 70 countries with these people commonly experiencing health care access inequity. Purpose: This systematic review aimed to examine the impact of Indigenous health care curriculum on entry-level health professional learners in preparation to deliver equitable health care. Methods: Seventeen articles were identified and analyzed for: context; study design; study measures, teaching and learning delivery mode, content and duration; positive and negative learner reactions; learning gained and article quality was assessed using the Medical Education Research Study Quality Instrument. Results: Most included studies described face-to-face delivery along with blended learning combining a placement in an Indigenous setting, stand-alone placements and digital learning. Descriptions of learning gained covered five domains: remembering, understanding, self-knowledge, perspective and application relating mostly to cultural awareness. Factors contributing to positive learner reactions included attitude, environment, educator skill, pedagogy and opportunities. Factors contributing to negative learner reactions included attitude and environment. Conclusions: There is a need to further explore how health professional graduates are prepared to work in Indigenous health and the appropriate measures to do this. There is opportunity to learn more about Indigenous health teaching and learning across learning domains, in mainstream clinical placements and in digital learning.

Experiences and outcomes of health professional students undertaking education on Indigenous health: A systematic integrative literature review

OBJECTIVES

To explore the experiences and outcomes of health professional students when undertaking education on Indigenous health.

DESIGN

An integrative systematic literature review.

DATA SOURCES

The search was undertaken from September 2017-November 2017. Six databases were searched: CINAHL, Scopus, Informit Health Collection, Informit Indigenous Collection, Proquest - Nursing and Allied Health Collection; and Proquest - Health and Medical Collection. Reference lists of all articles were scanned for further relevant articles.

REVIEW METHODS

The search strategy was limited to English articles published in the previous decade. Articles were included if they focused on Indigenous health content provided to health professional university students, with a focus on Indigenous populations of Australia, New Zealand, Canada and the United States of America. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review. Studies were evaluated for methodological rigour using the CASP rating checklist. Both qualitative and quantitative data were coded using thematic qualitative analysis methods and presented as a meta-aggregation.

RESULTS

Twelve articles were included. Synthesis found significant variability in the ways Indigenous health issues were taught and integrated into health programs, particularly with regards to quality, methodological rigour of evaluation, pedagogical approaches and student experiences. Four themes were developed to describe student experiences and learning outcomes. These included: increasing knowledge of Indigenous health; emotional responses to content and teaching processes; perceived value of Indigenous health education; and cultural competence and critical thinking.

CONCLUSIONS

Methodologically sound longitudinal studies are required to test if early changes in student knowledge and attitudes may be sustained. How students' 'increase in knowledge' translates to cultural capability is unclear, and there is a need for validated tools to measure this construct. A more sophisticated critique of how students emotionally engage with Indigenous health content, including understanding the relationships between 'discomfort' and transformative experiences is required.

Improving Evaluation of Dental Hygiene Students' Cultural Competence with a Mixed-Methods Approach

Most dental hygiene educational programs include cultural competence education, but may not evaluate student outcomes. The aim of this study was to design and implement a mixed-methods evaluation to measure dental hygiene students' progression toward cultural competence. Two cohorts consisting of consecutive classes in one U.S. dental hygiene program participated in the study. A total of 47 dental hygiene students (100% response rate) completed self-assessments to measure their attitudes and knowledge at three time points between 2014 and 2016. Mean scores were calculated for three domains: Physical Environment, Communication, and Values. Qualitative analysis of the students' cultural diversity papers was also conducted to further evaluate students' knowledge and skills. Bennett's five-level conceptual framework was used to code phrases or sentences to place students in the general categories of ethnocentric or ethno-relative. The quantitative and qualitative results yielded different outcomes for Cohort 1, but not for Cohort 2. The Cohort 1 students assessed themselves statistically significantly lower over time in one of the three measured domains. However, the Cohort 2 students assessed themselves as statistically significantly more culturally competent in all three domains. Qualitative results placed 72% of Cohort 1 students and 83% of Cohort 2 students in the more desirable ethno-relative category. Since quantitative methods consisting of student self-assessments may not adequately measure students' cultural competence, adding qualitative methods to measure skills specific to patient care in this study added a robust dimension to evaluating this complex dental hygiene student competence.

Dialysis facility staff perceptions of racial, gender, and age disparities in access to renal transplantation

Background

Racial/ethnic, gender, and age disparities in access to renal transplantation among end-stage renal disease (ESRD) patients have been well documented, but few studies have explored health care staff attitudes towards these inequalities. Staff perceptions can influence patient care and outcomes, and identifying staff perceptions on disparities could aid in the development of potential interventions to address these health inequities. The objective of this study was to investigate dialysis staff (n = 509), primarily social workers and nurse managers, perceptions of renal transplant disparities in the Southeastern United States.

Methods

This is a mixed methods study that uses both deductive and inductive qualitative analysis of a dialysis staff survey conducted in 2012 using three open-ended questions that asked staff to discuss their perceptions of factors that may contribute to transplant disparities among African American, female, and elderly patients.

Results

Study results suggested that the majority of staff (n = 255, 28%) perceived patients’ low socioeconomic status as the primary theme related to why renal transplant disparities exist between African Americans and non-Hispanic whites. Staff cited patient perception of old age as a primary contributor (n = 188, 23%) to the disparity between young and elderly patients. The dialysis staff responses on gender transplant disparities suggested that staff were unaware of differences due to limited experience and observation (n = 76, 14.7%) of gender disparities.

Conclusions

These findings suggest that dialysis facilities should educate staff on existing renal transplantation disparities, particularly gender disparities, and collaboratively work with transplant facilities to develop strategies to actively address modifiable patient barriers for transplant.

Teaching Cultural Competence in Dental Education: A Systematic Review and Exploration of Implications for Indigenous Populations in Australia

Indigenous and other minority populations worldwide experience higher rates of disease including poor oral health than other populations. Cultural competence of practitioners is increasingly being recognized as fundamental to health care and quality of life in addressing these disparities. The aims of this study were to conduct a systematic review of the literature about teaching cultural competence in dental education and to explore the particular relevance of that teaching for the oral health care of Indigenous populations in Australia. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted of published studies that explored cultural competency interventions in dental curricula. A total of 258 studies from 2004 to 2015 were identified; after removing duplications and applying criteria for exclusion, 12 were selected for analysis, involving 1,360 participants. The principal themes identified in the qualitative analysis of these studies were curriculum content, curriculum delivery, community service-learning, reflective writing, and evaluation. Students need knowledge of health disparities and community health to better understand the perspectives of culturally diverse populations and to communicate effectively with people from various cultures. The principal strategies that improved cultural competence in the articles examined in this study were educational seminars, community service-learning, and reflective writing. These findings suggest that integration of cultural competency curricula using a combination of didactic or online training, community engagement, and reflective writing may increase the cultural knowledge and skills of dental students.