ObjectivesTo determine oral health literacy (REALD-30) and oral health literacy-related outcome associations, and to calculate if oral health literacy-related outcomes are risk indicators for poor self-reported oral health among rural-dwelling Indigenous Australians.Methods468 participants (aged 17-72 years, 63% female) completed a self-report questionnaire. REALD-30 and oral health literacy-related outcome associations were determined through bivariate analysis. Multivariate modelling was used to calculate risk indicators for poor self-reported oral health.ResultsREALD-30 scores were lower among those who believed teeth should be infrequently brushed, believed cordial was good for teeth, did not own a toothbrush or owned a toothbrush but brushed irregularly. Tooth removal risk indicators included being older, problem-based dental attendance and believing cordial was good for teeth. Poor self-rated oral health risk indicators included being older, healthcare card ownership, difficulty paying dental bills, problem-based dental attendance, believing teeth should be brushed infrequently and irregular brushing. Perceived need for dental care risk indicators included being female and problem-based dental attendance. Perceived gum disease risk indicators included being older and irregular brushing. Feeling uncomfortable about oro-facial appearance risk indicators included problem-based dental attendance and irregular brushing. Food avoidance risk indicators were being female, difficulty paying dental bills, problem-based dental attendance and irregular brushing. Poor oral health-related quality of life risk indicators included difficulty paying dental bills and problem-based dental attendance.ConclusionsREALD-30 was significantly associated with oral health literacy-related outcomes. Oral health literacy-related outcomes were risk indicators for each of the poor self-reported oral health domains among this marginalised population.

The reliability, validity and precision of the short-form version (HeLD-14) were acceptable when tested in a sample of rural dwelling indigenous Australians. However, it will be important to replicate these findings in other populations before it can be used in health services research to determine the effects of interventions or programs aimed at improving oral health outcomes. This short form will be easy and efficient for use in research and clinical settings.

A context-specific oral health literacy intervention was partially successful in improving oral health literacy and oral health literacy-related outcomes in this vulnerable population, but only after MI.

Background Dental disease has far-reaching impacts on child health and wellbeing. We worked with Aboriginal Australian communities to develop a multifaceted oral health promotion initiative to reduce children's experience of dental disease at age 2 years. Methods This was a single-blind, parallel-arm, randomised controlled trial. Participants were recruited from health service providers across South Australia. Women pregnant with an Aboriginal child were eligible. The intervention comprised: (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12 and 18 months; (3) motivational interviewing delivered in conjunction with; (4) anticipatory guidance. The primary outcome was untreated dental decay as assessed by the number of teeth with cavitated and non-cavitated carious lesions (mean dt) at child age 24 months. Analyses followed intention-to-treat principles. The RCT was registered with the Australian and New Zealand Clinical Trial Registry, ACTRN12611000111976. Findings Women (n = 448) were recruited from February 2011 to May 2012, resulting in 223 children in the treatment group and 225 in the control. Mean dt at age two years was 0.62 (95% CI 0.59 to 0.65) for the intervention group and 0.89 (95% CI 0.85 to 0.92) for the control group (mean difference − 0.27 (95% CI − 0.31, − 0.22)). Interpretation A culturally-appropriate intervention at four time-points from pregnancy through to 18-months resulted in improvements in the oral health of Aboriginal children. Further consultation with Aboriginal communities is essential for understanding how to best sustain these oral health improvements for young Aboriginal children.

Indigenous Australians experience poor oral health. Oral health perceptions among a group of rural-dwelling Indigenous Australians were explored so that a culturally appropriate, community-owned oral health promotion initiative might be developed. Focus group methodology was used, with prompt questions including oral health knowledge, oral health's role in general health, how community oral health had changed in recent times, the causes of poor oral health and ways to prevent poor oral health at a community level. Some 34 participants took part; age range 21-72 years. A core category emerged from the data and was labelled 'cultural adaptation'. Five sub-categories were also identified; 'lifestyle changes', 'oral health behaviours', 'barriers to dental care', 'impact of poor oral health' and 'oral health literacy'. Participants felt that historical legacy impacted on the oral health of community members, through continued practices of being told what to do, where to live and what oral health services were available to them. Participants perceived they had little power over their oral health or oral health care decisions. Findings from the focus group discussions were used in the development of a context-specific, oral health promotion initiative, which involved construction of an audiovisual tool in Phase I and a series of interactive, context-specific seminars focused on key issues raised in the focus groups in Phase II. Oral health promotion initiatives among rural-dwelling Indigenous Australians may be more successful if perceptions of the anticipated audience are considered in the design stage of such strategies.