Oral health care in remote Kimberley Aboriginal communities: the characteristics and perceptions of dental volunteers

Oral health community engagement programs for rural communities: A scoping review

This scoping review aims to identify the available literature on oral health community engagement programs that have been developed to guide oral health care in rural communities and to summarize their outcomes. This review was conducted using the 5-stage scoping review framework outlined by Arksey and O'Malley. We conducted a literature search with defined eligibility criteria through electronic databases such as Science Direct, PubMed, ProQuest, Scopus, EBSCOhost, and Wiley Online; other well-established online scientific health and dental organizations such as the WHO, the Fédération Dentaire Internationale of the World Dental Federation, the American Dental Association, and the South African Dental Association; and grey literature spanning the time interval from January 2012 to August 2023. The charted data were classified, analysed, and reported using descriptive and thematic analyses. A total of 19 records were included in the final review. These records were classified into four categories of interventions: community-based, school-based, integrated dental-based, and non-dental volunteer oral health programs. The findings imply that there is a growing appreciation for the significance of qualitative data in enhancing oral healthcare interventions and outcomes. Furthermore, the study showed that oral health strategies were successful in shaping the understanding and perception of oral health among children and mothers/caregivers, and in improving the oral health and quality of life of edentulous older adults and children living in rural communities.

The 5C model: A proposed continuous quality improvement framework for volunteer dental services in remote Australian Aboriginal communities

OBJECTIVES

Aboriginal and Torres Strait Islander communities in remote parts of Australia are some of the most underserviced communities in regard to oral health care. These communities rely on volunteer dental programmes such as the Kimberley Dental Team to fill the gaps in care, however, there are no known continuous quality improvement (CQI) frameworks to guide such organizations to ensure that they are delivering high-quality, community-centred, culturally appropriate care. This study proposes a CQI framework model for voluntary dental programmes providing care to remote Aboriginal communities.

METHODS

Relevant CQI models wherein the (i) behaviour of interest was quality improvement, and (ii) the health context was volunteer services in Aboriginal communities were identified from the literature. The conceptual models were subsequently augmented using a 'best fit' framework and the existing evidence synthesized to develop a CQI framework that aims to guide volunteer dental services to develop local priorities and enhance current dental practice.

RESULTS

A cyclical five-phase model is proposed starting with consultation and moving through the phases of data collection, consideration, collaboration and celebration.

CONCLUSIONS

This is the first proposed CQI framework for volunteer dental services working with Aboriginal communities. The framework enables volunteers to ensure that the quality of care provided is commensurate with the community needs and informed by community consultation. It is anticipated that future mixed methods research will enable formal evaluation of the 5C model and CQI strategies focusing on oral health among Aboriginal communities.

The Kimberley Dental Team: A process evaluation of a volunteer dental programme serving remote Aboriginal communities in Australia

OBJECTIVES

This study aims to conduct a process evaluation of the Kimberley Dental Team (KDT), a not-for-profit, volunteer organization providing care to remote Aboriginal communities in Western Australia.

METHODS

A logic model was constructed to detail the operational context of the KDT model. Subsequently, the fidelity (the extent to which each of the programme's elements were implemented as planned), dose (types and quantity of services provided) and reach (demographic characteristics and communities serviced) of the KDT model were evaluated using service data, deidentified clinical records and volunteer rosters maintained by KDT from 2009 to 2019. Trends and patterns of service provision were analysed using total counts and proportions over time. A Poisson regression model was used to explore changed in the rates of surgical treatment over time. The associations between volunteer activity and service provision was also investigated using correlation coefficients and linear regression.

RESULTS

A total of 6365 patients (98% identifying as Aboriginal or Torres Strait Islander) were seen over the 10-year period with services being provided across 35 different communities in the Kimberley. Most services were provided to school-aged children, consistent with the programme's objectives. The peak preventive, restorative and surgical rates occurred among school-aged children, young adults and older adults respectively. A trend was observed indicating a reducing rate of surgical procedures from 2010 to 2019 (p < .001). The volunteer profile showed significant diversity beyond the conventional dentist-nurse structure and 40% being repeat volunteers.

CONCLUSIONS

The KDT programme maintained a strong focus on service provision to school-aged children over the last decade with the educational and preventive components being central to the care being provided. This process evaluation found that the dose and reach of the KDT model grew with an increase in resources and was adaptive to perceived community need. The model was shown to evolve through gradual structural adaptations contributing to its overall fidelity.

Community-centred oral healthcare for adults experiencing homelessness in Australia: Perceptions and experiences of key stakeholders

The objective of the study was to identify whether creating a responsive, respectful and trustworthy environment that provides free dental care for clients who are homeless using volunteer dental professionals was effective in meeting their oral health needs in Fremantle, Western Australia. Qualitative research conducted between October 2018 and August 2019 was guided by a social constructivist paradigm to gather and analyse data. Semi-structured interviews were conducted with adults experiencing homelessness accessing a community dental clinic and health providers and other stakeholders involved in its establishment, management and service delivery. An inductive approach to analysis was used to organise themes under the categories of 'establishing the oral health clinic' (OHC) and 'responses to the implementation of the clinic' Thirty-nine semi-structured interviews were conducted across eight participant groups: clients, executive management, the oral health clinical reference group, volunteer dentists, employed staff, nursing students, volunteer staff and other stakeholders. Key findings across all groups included positive responses to the establishment and implementation of the OHC, the quality of care and the safe and respectful environment in which services were delivered. Challenges related to sustainability include uncertainty around ongoing funding and recruitment of dental professionals. Whilst volunteer dental services fill a gap in meeting the complex needs of this population group, mainstream services must consider and address issues of equity in this context. Findings can be used to guide this process that includes creating environments of respect and trust where adults who are homeless or at risk of homelessness feel safe, welcomed and more likely to return to the service.

'We had to take a hammer to get some roots out' - experiences, motivations and challenges among volunteer dentists: a qualitative study

Objectives To address a gap in the literature by examining the experiences, motivations and challenges among volunteer dentists engaged in short-term missions to low- and middle-income countries.Methods In-depth interviews among volunteer dentists (n = 20) who had provided voluntary dental care in low- or middle-income countries within the preceding five years. Interviews lasted on average 55 minutes and were recorded, transcribed and analysed using NVivo. Routine debriefings complemented analysis. COREQ principles guided this research.Results Motivations to volunteer included: exposure to new dental challenges (enhancing competence); discovering a new setting (tourism); and enhancing the lives of clients (humanitarianism). Volunteers enjoyed undertaking new tasks and developing new skills, but were burdened by a high patient load, challenging clinical conditions, peri- and post-operative complications, and a concern that their work was not addressing root causes of inadequate access to basic dental care. Respondents recommended that more information regarding the vision, equipment status, armamentarium and dental supplies be made available pre-departure, and that more dental schools include training on global oral health. Such measures could facilitate volunteers' abilities to provide care while also enhancing their personal and professional development. Creating an appropriate, sizable and competent capacity-building programme for local dentists was described as essential.

Oral health interventions in Australian Aboriginal communities: a review of the literature

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.

APPRAISAL OF ACCESS TO DENTAL SERVICES IN SOUTH EAST OF IRAN USING FIVE AS MODEL

BACKGROUND

Access to dental services not only refers to utilization but also to the extent by which the utilization is judged according to professional norms. This study aimed to study the access to dental services using the Five As model.

METHODS

This cross sectional study was conducted in southeast of Iran. A sample of 400 subjects participated in the study according to a multistage sampling method. A questionnaire was used for data collection. Data were analyzed using independent T test, ANOVA and multivariate linear regression models by means of SPSS V.20 software.

FINDINGS

Affordability, availability, accessibility, accommodation and acceptability mean scores were 58.2±12.2, 53.9±12.9, 59.4±15.7, 60.2±8.6, 70±11.5 and 60.3±7.4 respectively. According to multivariate linear regression models, there was significant associations between affordability and age, education level, having basic insurance and family income. Moreover, total accessibility was significantly correlated with education and monthly family income.

CONCLUSION

This study showed that access to dental services was at the moderate level among the studied population. It also revealed that age, basic insurance coverage, family income and level of education, are determinants of this accessibility.