A comparison of two models of dental care for Aboriginal communities in New South Wales

Using a Collective Impact framework to evaluate an Australian health alliance for improving health outcomes

Complex social issues such as population health mean that no one person, organization or sector can resolve these problems alone and instead require a collaborative approach. This study applied the Collective Impact framework to evaluate the alliance responsible for delivering a large-scale health promotion initiative. Committee meeting minutes for a 4-year period and qualitative interviews with key stakeholders (N = 14) involved in the design and implementation of the initiative explored the factors that contributed to collaborative efforts and initiative outcomes. Major strengths of the Healthier Queensland Alliance (the Alliance) stemmed from identifying a common agenda and using frequent communication to develop trust among Alliance partners. These processes were important, particularly in improving key relationships to ensure inclusivity and equity. Reinforcing activities helped to support individual organizational efforts, while shared measurement systems promoted data-driven decision-making and learning, which contributed to continuous improvement and innovation. Current findings support the use of the Collective Impact framework as a scaffold to assist collaborative alliances in working effectively and efficiently when implementing large-scale initiatives aiming to create positive social impact. This study has identified the foundations of practice to establish a successful Collective Impact alliance.

A scoping review to inform the use of continuous quality improvement in Australian Aboriginal oral health care

ObjectiveThe need to improve existing services to Aboriginal communities is prioritised by Australia's National Oral Health Plan. Although only an emerging area in dentistry, continuous quality improvement (CQI) approaches have positively impacted the delivery of primary health services to Aboriginal communities. This scoping review maps the applicability of CQI strategies to Aboriginal Australian oral healthcare services.MethodsA scoping review was conducted and studies that reported using CQI approaches to improve existing oral health services or quality of care deemed relevant to Aboriginal Australian communities were included.ResultsA total of 73 articles were retrieved and eight articles were included in the final synthesis. Several CQI tools were identified, including: plan-do-study-act cycles, dental quality alliance measures, prioritisation matrices, causal mapping and the use of collective impact methodology.ConclusionData exploring CQI in the context of Aboriginal oral health is scarce. The plan-do-study-act cycle and its variations show potential applicability to Aboriginal oral health care. However, for CQI approaches to be adequately implemented, the prevailing model of dental care requires a paradigm shift from quality assurance to quality improvement, acknowledging the impact of structural and process elements on care.

The Progress of the New South Wales Aboriginal Oral Health Plan 2014–2020: A Scoping Review

There are major disparities in oral health between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander people. The New South Wales (NSW) Aboriginal Oral Health Plan 2014–2020 was developed to improve the oral health of Aboriginal people. This scoping review describes programs that have been undertaken to implement the NSW Aboriginal Oral Health Plan 2014–2020. The methodology by Arksey and O’Malley was used to guide this review. Academic and grey literature were searched using a structured Medline, Lowitja and advanced Google searches. Articles were included if they aligned with the strategic directions of the Plan. Key information, including the aims of the study, methodology and results were recorded in a template on Microsoft Excel software. A total of 31 articles were included in this review. This included 25 articles from the academic literature and six initiatives from the grey literature. Included articles were categorised according to the six strategic directions in the NSW Aboriginal Oral Health Plan. Four studies were related to the first strategic direction, six related to strategic direction two, four related to strategic direction three, six initiatives related to strategic direction four, five related to strategic direction five, and eight related to strategic direction six. While there has been significant progress in achieving the strategic directions of the NSW Aboriginal Oral Health Plan, there is scope for continued collaboration between oral health service providers, universities and Aboriginal communities to improve oral health outcomes for Aboriginal people in NSW.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial

INTRODUCTION

The management of early childhood caries (ECC) is challenging.

OBJECTIVES

A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia.

METHODS

Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities.

RESULTS

A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group.

CONCLUSION

A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health.

KNOWLEDGE TRANSFER STATEMENT

This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

Evaluation of the ECOHIS and the CARIES-QC among an Australian "Aboriginal" population

PURPOSE

An evaluation of the reliability and validity of two child oral health-related quality of life (COHRQoL) measures among Australian Aboriginal children who participated in a randomised trial was undertaken.

METHODS

Study participants completed the Early Childhood Oral Health Impact Scale (ECOHIS) and the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The questionnaires were completed a second time to test the scales' test-retest reliability. Internal consistency, convergent and discriminant validity were evaluated through Cronbach's alpha, correlation of the scale scores with the global oral health evaluation, and comparison of scale scores among children with varying levels of caries experience, respectively.

RESULTS

Worse COHRQoL was reported by parents who rated their child's oral health as poor and by children who rated their teeth as being a lot of problem. Cronbach's alpha for the child impact section (CIS), family impact section (FIS), total ECOHIS score and the total CARIES-QC scale were 0.88, 0.81, 0.91 and 0.84, respectively. Spearman's correlations between scale scores and global oral health ratings of the CIS, FIS, total ECOHIS and the CARIES-QC were 0.42, 0.34, 0.45 and 0.70, respectively, p < 0.001. The Kruskal-Wallis test of scale scores with grouped caries experience was statistically significant, p < 0.005. Test-retest reliabilities for the ECOHIS were CIS ICC = 0.91, FIS ICC = 0.89, total ECOHIS ICC = 0.93 and for the CARIES-QC, ICC = 0.61.

CONCLUSIONS

Both the ECOHIS and the CARIES-QC were reliable and valid scales for use among an Australian Aboriginal population for assessing COHRQoL of preschool children.

TRIAL REGISTRATION

ACTRN12616001537448, date of registration-08 November 2016.