Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed‐methods systematic review

Abstract

Objectives Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. Methods Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed‐method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. Results A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual‐family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial‐system, provider and individual‐family levels and illustrated in the rainbow model of CALD oral health. Conclusion The review strengthens evidence for multilayered, system‐related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia

“…The evidence illustrates oral health inequalities and inequities in the mouth for women and culturally and linguistically diverse (CALD) mothers [7]. Nettleton analysed intersections between Western governments, dental providers and dental agents -the mother, which affirmed power-knowledge relations [8].…”

“…Despite evidence that mothers are influential in children's oral health care behaviours [9], the level of agency a mother has, is compounded by multiple inter-related barriers in provider experiences, social factors, time, cost and pregnancy among others [10,11]. This is further compounded for CALD mothers, who encounter language, literacy, racial and further barriers [7]. For instance, an integrated mixed method systematic review on the oral healthcare barriers and facilitators was undertaken in CALD carers.…”

“…For instance, an integrated mixed method systematic review on the oral healthcare barriers and facilitators was undertaken in CALD carers. This review identified complex upstream, mid-level and populations level factors, with numerous studies conducted in the USA and only one in Australia [7]. Thus, context specific solutions are required to reduce population inequalities.…”

“…A small body of literature recognises health care inequalities/inequities in CALD mothers and populations [7,18,19]. For example, a scoping review identified CALD migrant mothers were less likely to access healthcare, with barriers identified in 'appropriateness' of services [20].…”

Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers

“…Yet, fundamentally, CALD mothers experience various, multiple influences in the country in which they live. System and policy barriers, including long public dental waiting lists as well as negative provider experiences and an illness approach to dental care are some known barriers for CALD mothers [16]. Moreover, it is unclear whether intra-variability exists in oral healthcare access across CALD communities, given the limited number of qualitative studies conducted within an Australian context.…”