Abstract
BackgroundAustralian Aboriginal and Torres Strait Islander people continue to experience significant disparities in oral health and there remains an urgent need to improve services to rural and remote communities. Quantitative research has typically been used to highlight the disease burden and severity experienced by those living in remote communities, but this data does little to explore the lived reality and psychosocial nuances that impact on care. The Kimberley region of Western Australia is home to over 150 Aboriginal communities spread out across 400,000 square kilometres. The success and sustainability of oral health services to these remote communities relies on respect and reciprocity achieved through shared knowledge, decision making and involvement of Aboriginal people in discussions around oral health services and their delivery. This, study aimed to investigate the perceptions and attitudes toward dental services among Aboriginal Australian families living in remote Kimberley communities.MethodsSemi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia. Interviews were recorded, transcribed, and analysed guided by a constructivist grounded theory approach.ResultsIn total, 80 community members participated in the yarning process. Enablers to care included: promotion of existing services, integration with primary health services, using mobile dental services and volunteers to extend care. Barriers to care included transportation, cost of treatment, the complexity of appointment systems and shame associated with health-seeking behaviours.ConclusionsReassessing the prevailing operative model of dental care to remote Aboriginal communities is warranted to better address the overwhelming structural barriers that impact on oral health. Integration with existing primary health services and schools, the use of mobile units to extend care and increasing community engagement through clinical yarning are recommended in improving the current state of dental services to communities in the Kimberley.
Highlights
Oral health interventions have had limited success in Indigenous communities and all too often have failed to create sustainable improvements in oral health outcomes [1]
This paper focuses on the Kimberley region of Western Australia, noting that previous literature has suggested that Aboriginal Australians living in the Kimberley are the most disadvantaged group within the most disadvantaged population in Australia and continue to face significant disparities in oral health [7] (p2)
Enablers to care included: provision of culturally appropriate care, the use of mobile dental services, heightened awareness of existing services and supplemental services provided by visiting volunteer teams
Summary
Oral health interventions have had limited success in Indigenous communities and all too often have failed to create sustainable improvements in oral health outcomes [1]. Patel et al BMC Oral Health (2021) 21:662 knowledge and involving Aboriginal people in decisions about their health are critical factors towards success [2] This is in contrast to top-down approaches typically applied through a colonial lens which without adequate consultation, fail to create lasting change [3]. More recently Tynan and colleagues used a phenomenological approach to facilitate a deeper contextual understanding around oral health attitudes in Aboriginal communities [5] The use of such qualitative methods has highlighted the importance of this technique in identifying local barriers to care, community priorities and strategies to ameliorate services in the future [5, 6]. The success and sustainability of oral health services to these remote communities relies on respect and reciprocity achieved through shared knowledge, decision making and involvement of Aboriginal people in discus‐ sions around oral health services and their delivery. This, study aimed to investigate the perceptions and attitudes toward dental services among Aboriginal Australian families living in remote Kimberley communities
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