Oral Health Programmes in Indigenous Communities Worldwide—Lessons learned from the field: A qualitative systematic review

Abstract

Successful programmes considered cultural appropriateness in their design-including extensive community engagement before, during and after implementation to enhance ownership of, and thus participation in the programme. Collaborative approaches were seen as an advantage, not only with Indigenous communities, but also with local health providers and organizations, with particular emphasis on incorporation into existing services. Challenges included low community participation, unstable funding and staffing issues. In addition, future programmes should also incorporate advocacy and community development, focus on changes to public policy, utilize evidence-based interventions that include traditional models of health, attempt to secure a stable funding base, target strategies to ensure staff retention and develop interventions that target the multilevel causes of general and oral health. This review provides an evidence base that can aid in the successful design, implementation and sustainability of oral health programmes for Indigenous people in the future.

Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region

“…The few randomized controlled trials that have examined the effect of treating caries for children’s anthropometric outcomes did not find significant improvements as a result of caries treatment [41,44], pointing to the need for a more comprehensive model of intervention that recognizes determinants at multiple ecological levels [3,14,25] and risk factors that are shared across malnutrition and dental caries [13,15,24]. We note that indigenous populations’ disproportionate malnutrition experience has emerged not due to genetics, but to broader structural drivers of inequality including geographic location, healthcare access, parental education, and health behaviors [17].…”

“…Community-based health promotion and disease prevention approaches, such as the promotora model, hold the potential to address this need, with a growing body of literature documenting promising efficacy for promoting child nutrition and preventing common childhood illnesses, inclusive of dental caries [24,25,45,46]. In their role as both health promoters and community members, they possess unique contextual and cultural knowledge that can prove invaluable for ensuring prevention efforts penetrate into medically-underserved regions, particularly in the context of obesogenic and cariogenic environments (e.g., rapid access to stores selling junk food).…”

“…Considering these diseases as intrinsically entwined might benefit community-based prevention and health promotion efforts which often face resource limitations and cordon off interventions specific by disease, despite shared risk factors [24,25]. Thus, for the present study, our objective was to examine the relationships between early childhood caries, parent-reported mouth pain, and nutritional status among participating children in the Kichwa community.…”

Community based programs to improve the oral health of Australian Indigenous adolescents: A systematic review and recommendations to guide future strategies.

“…These reviews also report that: adopting an 'ecological' approach -namely a multi setting and multi strategy approach -to oral health prevention is promising; a consistent challenge faced at the intervention delivery level is sustained funding and; social and environmental contexts were significant barriers to good oral health (3,(15)(16)(17). We found no literature reviews that examined the quality and effectiveness of oral health interventions specifically for Indigenous adolescents.…”

“…These include in the Indian Himalayas (8), Brazil (9,10), Mexico (11), and Alaska (12) where high rates of dental pain (77%) tooth decay (71.3%) and pigmented lesions (47.6%) were reported. Maori children in New Zealand are more likely not to receive dental care than other children (13), and in Sri Lanka a high rate of oral cancer and oral potentially malignant disorders was found to exist among Indigenous Adolescents (14) Several literature reviews have examined oral health interventions for Indigenous peoples internationally (3,(15)(16)(17). These reviews found that successful interventions adopted community based participatory approaches that: are inherently collaborative and culturally appropriate; employed community workers in their delivery: and addressed the determinants of health (3,(15)(16)(17).…”