Disparities in spatial accessibility to public dental services relative to estimated need for oral health care among refugee populations in Victoria

Abstract

Objectives: To examine the spatial accessibility to public dental services (PDS) relative to the estimated oral health needs of refugee populations within the state of Victoria, Australia. Methods:The study employed enhanced two-step floating catchment area method to measure spatial accessibility to PDS by driving and public transit modes at statistical area level 2 (SA2). Principal component analysis of select census-derived socioeconomic variables specific to the refugee population was conducted to derive an areabased indicator of refugee oral health needs, also at SA2 level. Individual indices were then developed for each of these components using standardized z-scores. Finally, an integrated need-accessibility index was developed to identify low-accessibility areas associated with high needs. Results:The results show clear contrast in spatial accessibility to PDS for the refugee populations between metropolitan and rural areas as well as between driving and public transit modes. There are critical limitations in accessibility for refugees living in the rural areas and those dependent on public transit mode for travel. Also, there is evident disparity between the estimated oral health needs of refugees in metropolitan and rural areas. Overall, approximately 29% of all SA2s with refugee population are in the 'High' needs category, which comprise 19.8% of the total Victorian refugee population. Integrating accessibility and oral health needs measures revealed that about 30% and 18% of refugee population are identified as under-serviced, when considering driving and public transit modes respectively. Conclusion:The findings provide implications for researchers and policy makers to address the inequalities in access to PDS among the refugee population in Victoria.The methodology outlined in this study provides a complementary approach in planning oral health service provision in the absence of population level data at a smallarea scale on access to dental services or need for oral health care. K E Y W O R D Sdental health services, health services accessibility, health services needs and demand, population oral health, refugeesThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country

“…The perceptions of at least 3,561 different refugees and 259 rural health service providers and/or administrators were captured. Most studies looked at health access generally, although one study specifically examined the spatial accessibility of public dental services relative to the refugee population [ 21 ], while another reported on the major outcomes faced by mental health professionals working in the Rohingya humanitarian response [ 22 ]. Access to health services studied included all services, including local and governmental ones [ 20 , 23 – 31 ], primary, secondary, and hospital [ 13 , 22 , 30 , 32 ], mental [ 33 , 34 ], mobile [ 35 , 36 ], maternal and child health services [ 37 ], dental [ 21 ], online [ 25 , 38 , 39 ] and Médecins Sans Frontières [ 40 ].…”

“…This is not surprising; as noted in the Background healthcare can be difficult to access in rural areas for all members of rural communities. Factors that were recognised as impacting on access included the size of the rural or regional town or city, a lack of transportation, the judgemental attitudes of some doctors, and the availability of interpreters and health specialist services [ 13 , 21 , 22 , 30 , 31 , 33 , 35 , 37 , 40 ]. In Germany, Hahn et al [ 35 ] reported that the social security system can limit access to healthcare and specialists.…”

Patterns and predictors of public dental service utilisation among refugees in Victoria, Australia: a latent profile and multilevel analysis

“…List of RHP sites were gathered from the Victorian Department of Health and were assigned to their respective SA2s based on their suburb and postcode in the postal address [ 19 ]. Spatial accessibility to PDS was calculated using the enhanced two-step floating catchment area method individually via road network (for driving mode including car or other motor vehicle) and public transit network (for various public transit modes including bus, tram, metro, or train), as detailed elsewhere [ 20 ]. The spatial accessibility index scores obtained from these calculations represent the ratio of full-time equivalent dental professionals to the population eligible for PDS within each SA2, weighted by the travel time between their respective locations via driving or public transit mode; these scores were used as continuous variables.…”

A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country

“…The perceptions of at least 3,561 different refugees and 259 rural health service providers and/or administrators were captured. Most studies looked at health access generally, although one study speci cally examined the spatial accessibility of public dental services relative to the refugee population [20], while another reported on the major outcomes faced by mental health professionals working in the Rohingya humanitarian response [21]. Access to health services studied included all services, including local and governmental ones [19,[22][23][24][25][26][27][28][29][30], primary, secondary, and hospital [13,21,29,31], mental [32,33], mobile [34,35], maternal and child health services [36], dental [20], online [24,37,38] and Médecins Sans Frontières [39].…”