“Got to build that trust”: the perspectives and experiences of Aboriginal health staff on maternal oral health

Abstract

Background In Australia, models of care have been developed to train antenatal care providers to promote oral health among pregnant women. However, these models are underpinned by Western values of maternity care that do not consider the cultural needs of Aboriginal and Torres Strait Islander women. This study aimed to explore the perceptions and experiences of Aboriginal health staff towards oral health care during pregnancy. It is part of a larger program of research to develop a new, culturally safe model of oral health care for Aboriginal women during pregnancy. Methods A descriptive qualitative methodology informed the study. Focus groups were convened to yarn with Aboriginal Health Workers, Family Partnership Workers and Aboriginal management staff at two antenatal health services in Sydney, Australia. Results A total of 14 people participated in the focus groups. There were four themes that were constructed. These focused on Aboriginal Health Workers and Family Partnership Workers identifying their role in promoting maternal oral health, where adequate training is provided and where trust has been developed with clients. Yet, because the Aboriginal health staff work in a system fundamentally driven by the legacy of colonisation, it has significantly contributed to the systemic barriers Aboriginal pregnant women continue to face in accessing health services, including dental care. The participants recommended that a priority dental referral pathway, that supported continuity of care, could provide increased accessibility to dental care. Conclusions The Aboriginal health staff identified the potential role of Aboriginal Health Workers and Family Partnership Workers promoting oral health among Aboriginal pregnant women. To develop an effective oral health model of care among Aboriginal women during pregnancy, there is the need for training of Aboriginal Health Workers and Family Partnership Workers in oral health. Including Aboriginal staff at every stage of a dental referral pathway could reduce the fear of accessing mainstream health institutions and also promote continuity of care. Although broader oral health policies still need to be changed, this model could mitigate some of the barriers between Aboriginal women and both dental care providers and healthcare systems.

Aboriginal Health Workers promoting oral health among Aboriginal and Torres Strait Islander women during pregnancy: Development and pilot testing of the Grinnin’ Up Mums & Bubs program

“…Aboriginal and Torres Strait Islander pregnant women and better meet their needs [6,9,10,16]. The aim of this study was to develop and pilot test the intervention, a culturally appropriate model of care with Aboriginal Health Workers to promote oral health during pregnancy; the model of care was named Grinnin' Up Mums and Bubs.…”

“…Among Aboriginal and Torres Strait Islander pregnant women, poor oral health can contribute to ongoing economic and health inequalities [8]. Social, political, historical, and economic structural factors can restrict certain oral health behaviours, such as visiting the dentist, for some Australian Aboriginal and Torres Strait Islander pregnant women [6,9,10]. One example of these barriers includes obtaining a Con rmation of Aboriginality, a document issued by an Aboriginal community-controlled organisation that recognises an individual as being Aboriginal and Torres Strait Islander by a community in which the family is known or come from [11].…”

“…In some instances, individuals may also be able to obtain a Con rmation of Aboriginality where members of their family were born, through family records, or where people recognise the individual as Aboriginal and Torres Strait Islander [11,[13][14][15]. Depending on the context, these certi cates can support access to culturally safe and affordable services [11] such as dental care at Aboriginal community-controlled health services (ACCHSs) [10]. Other barriers to accessing dental services also include a lack of information and cultural safety among dental services [9,10].…”

“…Depending on the context, these certi cates can support access to culturally safe and affordable services [11] such as dental care at Aboriginal community-controlled health services (ACCHSs) [10]. Other barriers to accessing dental services also include a lack of information and cultural safety among dental services [9,10]. There is a need to capacity build the broader antenatal health workforce and develop health services that provide culturally safe and engaged oral health promotion and support certain oral health behaviours such as accessing the dentist.…”

“…There is a need to capacity build the broader antenatal health workforce and develop health services that provide culturally safe and engaged oral health promotion and support certain oral health behaviours such as accessing the dentist. Previous studies have identi ed the potential role and need for capacity building of Aboriginal health staff, such as Aboriginal Health Workers and Family Partnership Workers, to promote oral health care among Aboriginal and Torres Strait Islander pregnant women [10,16].…”