Abstract
BackgroundIndigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population. The integration of oral health care with primary health care has been highlighted to be effective in addressing these oral health disparities. Scoping studies are an increasingly popular approach to reviewing health research evidence. Two-eyed seeing is an approach for both Western and Indigenous knowledge to come together to aid understanding and solve problems. Thus, the two-eyed seeing theoretical framework advocates viewing the world with one eye focused on Indigenous knowledge and the other eye on Western knowledge. This scoping review was conducted to systematically map the available integrated primary oral health care programs and their outcomes in these communities using the two-eyed seeing concept.MethodsThis scoping review followed Arksey and O’Malley’s five-stage framework and its methodological advancement by Levac et al. A literature search with defined eligibility criteria was performed via several electronic databases, non-indexed Indigenous journals, Indigenous health organizational websites, and grey literature. The charted data was classified, analyzed, and reported using numeral summary and qualitative content analysis. The two-eyed seeing concept guided the interpretation and synthesis of the evidence on approaches and outcomes.ResultsA total of 29 publications describing 30 programs conducted in Australia and North America from 1972 to 2019 were included in the final analysis. The following four program categories emerged from the analysis: oral health promotion and prevention programs (n = 13), comprehensive dental services (n = 13), fly in, fly out dental services (n = 3), and teledentistry (n = 1). Biomedical approaches for integrated primary oral health care were leadership and governance, administration and funding, capacity building, infrastructure and technology, team work, and evidence-based practice. Indigenous approaches included the vision for holistic health, culturally appropriate services, community engagement, shared responsibility, and cultural safety. The program outcomes were identified for biological, mental, and emotional dimensions of oral health; however, measurement of the spiritual dimension was missing.ConclusionOur results suggest that a multiple integrated primary oral health care approach with a particular focus on Indigenous culture seems to be efficient and relevant in improving Indigenous oral health.
Highlights
Indigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population
The selected publications consisted of 15 articles describing primary research (12 quantitative studies, one qualitative study, and two mixed-methods studies), eight original field reports and case studies, five publications describing the application of the framework to the integration of oral health in primary health care in the form of an annual report or manual, and one literature review [25, 46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73]
The quantitative studies included a Characteristics of programs The following four categories of programs emerged from the analysis and represented the synthesis of the data: oral health promotion and prevention programs (n = 13), comprehensive dental services (n = 13), fly in, fly out dental services (n = 3), and teledentistry (n = 1)
Summary
Indigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population. The two-eyed seeing theoretical framework advocates viewing the world with one eye focused on Indigenous knowledge and the other eye on Western knowledge This scoping review was conducted to systematically map the available integrated primary oral health care programs and their outcomes in these communities using the two-eyed seeing concept. Indigenous people face barriers related to the impact of colonization and government assimilation policies, discrimination and subsequent marginalization, lifestyle and dietary modifications, lack of understanding of their cultural values, and provision of culturally inappropriate services [7,8,9,10,11] Those living in rural and remote areas further encounter barriers to oral health care such as access to and availability of dental services, shortage and accessibility of dental professionals, geographical remoteness, poor socioeconomic status, travel difficulties, infrastructure deficit, and diminished dental insurance coverage [12,13,14]. As per the Aboriginal Mental Health best practices working group, integration is a concept that completes the circle of care [24, 25]
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