Abstract
BackgroundImproving oral health for Aboriginal Australians has been slow. Despite dental disease being largely preventable, Aboriginal Australians have worse periodontal disease, more decayed teeth and untreated dental caries than other Australians. Reasons for this are complex and risk factors include broader social and historic determinants such as marginalisation and discrimination that impact on Aboriginal people making optimum choices about oral health. This paper presents findings from a qualitative study conducted in the Perth metropolitan area investigating Aboriginal Health Workers’ (AHWs) perceptions of barriers and enablers to oral health for Aboriginal people.MethodsFollowing extensive consultation with Aboriginal stakeholders, researchers conducted semi-structured interviews and focus groups across 13 sites to investigate AHWs’ perceptions of barriers and enablers to oral health based on professional and personal experience. Responses from 35 AHWs were analysed independently by two researchers to identify themes that they compared, discussed, revised and organised under key themes. These were summarised and interrogated for similarities and differences with evidence in the literature.ResultsKey findings indicated that broader structural and social factors informed oral health choices. Perceptions of barriers included cost of services and healthy diets on limited budgets, attending services for pain not prevention, insufficient education about oral health and preventing disease, public dental services not meeting demand, and blame and discrimination from some health providers. Suggested improvements included oral health education, delivering flexible services respectful of Aboriginal people, oral health services for 0–4 year olds and role modelling of oral health across generations.ConclusionReviewing current models of oral health education and service delivery is needed to reduce oral health disparities between Aboriginal and non-Aboriginal Australians. Shifting the discourse from blaming Aboriginal people for their poor oral health to addressing structural factors impacting on optimum oral health choices is important. This includes Aboriginal and non-Aboriginal stakeholders working together to develop and implement policies and practices that are respectful, well-resourced and improve oral health outcomes.
Highlights
Improving oral health for Aboriginal Australians has been slow
Durey et al International Journal for Equity in Health (2016) 15:4 decisions about oral health is important [9]. It avoids the trap of tacitly blaming Aboriginal people for their poor oral health because of ‘non-compliance’ with public health messages and instead recognises complex factors underpinning choice [10]
Barriers to good oral health and dental care identified by Aboriginal people include services disrespectful of cultural differences and/or with no Aboriginal Health Workers (AHWs) on staff [13]; cost, long waiting times, distance to services, especially for those living in remote areas [14], and limited access to healthy food [15]
Summary
Despite dental disease being largely preventable, Aboriginal Australians have worse periodontal disease, more decayed teeth and untreated dental caries than other Australians. Reasons for this are complex and risk factors include broader social and historic determinants such as marginalisation and discrimination that impact on Aboriginal people making optimum choices about oral health. Barriers to good oral health and dental care identified by Aboriginal people include services disrespectful of cultural differences and/or with no Aboriginal Health Workers (AHWs) on staff [13]; cost, long waiting times, distance to services, especially for those living in remote areas [14], and limited access to healthy food [15]. An Aboriginal Health Worker is defined as a person of Aboriginal or Torres Strait Islander descent or who identifies as such and is accepted by the Aboriginal and Torres Strait Islander community; has a minimum qualification in Aboriginal and Torres Strait Islander primary health care and delivers care that is holistic and culturally safe [16]
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