Teeth Tales: Applying the Learnings
Project description
The first phase of the project addressed the gaps in the evidence by exploring the social and cultural influences of child oral health in refugee and migrant communities. This helped us to understand the issues and to identify intervention components for the development of a culturally appropriate child oral health promotion and disease prevention program.
Teeth Tales – Applying the Learnings
The solutions identified by the community have now informed the community-based intervention which has been developed to form the second phase of Teeth Tales.
The Intervention program will include:
Despite clear evidence of consistent health inequities for refugee and migrant communities, there is little knowledge to assist in the understanding of the social and cultural determinants of child oral health in these communities. Community-based participatory research is an ideal approach for engaging and empowering communities to improve their health, in a sensitive and appropriate manner. However, strategies and methods informing participative research with refugee and migrant communities are limited. Past research has often excluded these communities due to perceived methodological difficulties.
Teeth Tales is a community-based child oral health research project. It is being led by The University of Melbourne and Merri Community Health Service.
Teeth Tales –Understanding the Issues
The first phase of Teeth Tales was developed in response to community concern for children’s oral health. The 3-year project, funded by the Telstra Community Fund and Dental Health Services Victoria, worked in partnership with the community and used qualitative research methodologies to explore the social, cultural and environmental determinants of the development of poor child oral health in refugee and migrant communities. Mothers and grandmothers from Iraqi (Assyrian Chaldean), Pakistani and Lebanese communities participated in focus groups and interviews. This involved community leaders, parents and grandparents, and cultural organisations and a series of semi structured focus groups (n=9) and interviews (n=12). We worked with Victorian Arabic Social Services (VASS), Arabic Welfare (formerly Australian Lebanese Welfare) and Pakistan Association Australia Melbourne (PAAM) to recruit participants and ensure each step of the research process was culturally competent. Dental and other health professionals were also interviewed as part of the study.
Teeth Tales is a community-based child oral health research project. It is being led by The University of Melbourne and Merri Community Health Service.
Teeth Tales –Understanding the Issues
The first phase of Teeth Tales was developed in response to community concern for children’s oral health. The 3-year project, funded by the Telstra Community Fund and Dental Health Services Victoria, worked in partnership with the community and used qualitative research methodologies to explore the social, cultural and environmental determinants of the development of poor child oral health in refugee and migrant communities. Mothers and grandmothers from Iraqi (Assyrian Chaldean), Pakistani and Lebanese communities participated in focus groups and interviews. This involved community leaders, parents and grandparents, and cultural organisations and a series of semi structured focus groups (n=9) and interviews (n=12). We worked with Victorian Arabic Social Services (VASS), Arabic Welfare (formerly Australian Lebanese Welfare) and Pakistan Association Australia Melbourne (PAAM) to recruit participants and ensure each step of the research process was culturally competent. Dental and other health professionals were also interviewed as part of the study.
The results highlighted that a number of traditional oral health practices continue to be used in these communities which are unfamiliar to health professionals. Significant barriers exist for people from refugee and migrant communities in accessing dental services and receiving appropriate care. Specifically, it was found:
- Whilst most people knew what caused Early Childhood Caries, there was limited knowledge in how best to prevent it
- Most people knew that junk and sweet foods could cause tooth decay however, parents were unsure how to stop providing these to their children
- Most people continued to use traditional oral health practices, some combined this with tooth brushing
- There is limited use of mainstream dental services in preference to use of services in their home country. This was often due to lack of awareness and confidence in navigating the service system, feelings of discrimination, which was exacerbated by social and physical isolation
- There was delayed introduction of oral health practices early in the child’s life, due to limited awareness of the importance of the primary dentition (first teeth) as well as not knowing how to brush children’s teeth and confidence in doing it correctly
- There was limited knowledge of the role and importance of fluoride and that it was added to tap water
- Positive oral health practices would be supported by social inclusion strategies and parenting support.
The first phase of the project addressed the gaps in the evidence by exploring the social and cultural influences of child oral health in refugee and migrant communities. This helped us to understand the issues and to identify intervention components for the development of a culturally appropriate child oral health promotion and disease prevention program.
Teeth Tales – Applying the Learnings
The solutions identified by the community have now informed the community-based intervention which has been developed to form the second phase of Teeth Tales.
The Intervention program will include:
- Peer Education and Support Program
The program involves training and educating members of cultural communities in child oral health and nutrition as well as how and where to access dental and health services. The peer educators then work with their respective communities. They will be trained to deliver community education sessions, via existing social networks, and increase the access and uptake of important health information in the community. Group dental visits will be organised to increase familiarity with the available dental and family support services. Recruitment and training of peer educators will be done in partnership with cultural organisations.
- A reorientation of dental and health services
Services and programs provided by community health services and local governments will take part in a cultural competence review in order to identify organisational strengths in cultural competency and areas for improvement. They will then be assisted to progress their organisation to become culturally competent at all organisational levels.
The intervention is currently being piloted in North Richmond, in the City of Yarra.
The main intervention will be undertaken by Merri Community Health Services in the City of Moreland. Discussions are currently underway with a comparison community.
The intervention is currently being piloted in North Richmond, in the City of Yarra.
The main intervention will be undertaken by Merri Community Health Services in the City of Moreland. Discussions are currently underway with a comparison community.
Current status
The findings from the first phase of Teeth Tales have been integrated with the prior evidence base of effective interventions, using socio-environmental models of health, a culturally competent framework and health promotion principles to develop a culturally competent community-based oral health research intervention and evaluation plan.
The Pilot study is underway to test the study design of the intervention and is being conducted in the North Richmond area which is situated in the City of Yarra. The cultural groups selected for this pilot study are the Vietnamese, Oromo and the Sudanese (Dinka and Arabic speaking) communities which were identified by the local community health service and settlement data.
The Pilot study is underway to test the study design of the intervention and is being conducted in the North Richmond area which is situated in the City of Yarra. The cultural groups selected for this pilot study are the Vietnamese, Oromo and the Sudanese (Dinka and Arabic speaking) communities which were identified by the local community health service and settlement data.
Project funding
Major research funding was received from the Australian Research Council Linkage funding and Merri Community Health Services. Funding contributions were also made by study partners Dental Health Services Victoria and Moreland City Council as part of the Linkage funding arrangements. Additional salary and operational support was received from the Jack Brockhoff Foundation and an NHMRC PhD scholarship for Elisha Riggs.
Study investigators
- Dr Lisa F Gibbs
- Professor Elizabeth B Waters
- Dr Andrea M de Silva-Sanigorski
- Associate Professor Mark G Gussy
- Ms Lisa C Gold
- Professor Laurence A Moore
- Professor Richard G Watt
- Dr Christine M Armit
- Adj/Professor Hanny Calache
-
Study partners
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre at The University of Melbourne
- The Health Promotion and Research Unit at Merri Community Health Services
- Dental Health Services Victoria (DHSV)
- Moreland City Council
- Victorian Arabic Social Services (VASS)
- Pakistan Australia Association Melbourne (PAAM)
- Arabic Welfare
- The Centre for Culture Ethnicity and Health (CEH)
- North Richmond Community Health
- Yarra City Council
- Representatives from the Community Health Service and the Council of the comparison community (to be confirmed)
Research outcomes
The aim of this study is to conduct a longitudinal matched comparison study to examine the effectiveness and cost-effectiveness of a community-based, culturally competent, child oral health promotion intervention. Specifically, we aim to determine whether the intervention can:
- achieve substantive and sustained improvements in the oral health behaviours of children and families from migrant and refugee backgrounds,
- reduce the strong social gradient evident in child oral health, and
- be a model for feasible, replicable, and cost effective child oral health promotion for culturally diverse Local Government Areas (LGAs) in Australia.
This project will enhance the cultural competence of services for refugee and migrant families including family and dental services provided by participating community health services and local government, including extension of preschool oral health education programs to cultural settings. It is intended to promote child oral health and wellbeing targeting increased child daily use of low- fluoride toothpaste, reduced child daily consumption of high sugar food and drinks, and increased parental knowledge, confidence and practice in primary dentition care
Research publications
Journal publications:- Riggs E, van Gemert C, Gussy M, Waters E, Kilpatrick N. Reflections on cultural diversity in oral health promotion. Global Health Promotion (accepted January 2011).
- Gibbs L, Gold LG, Kulkens K, Riggs EM, van Gemert C, Waters EB. Are the Potential Benefits of a Community-Based Participatory Approach to Public Health Research Worth the Potential Costs? Just Policy. 2008; 47:54-8.
Book chapters:- Gibbs L, Abebe M, Riggs E. Working with minority groups in developed countries. In: Waters E, Seidell J, Swinburn B, Uauy R, eds. Community-based childhood obesity prevention: Evidence, policy and practice. Oxford, United Kingdom, Wiley Blackwell Publishing, 2009.
- Waters E, Gibbs L, Renzaho A, Riggs E, Kulkens M, Priest N., Cultural competence in Public Health. Encyclopaedia of Public Health. Ed. Heggenhougen K. Elsevier Inc., Oxford United Kingdom,UK. 2008.
Government policy:- Learnings from Teeth Tales informed the Victorian Refugee Health Network’s Oral Health Working Group facilitated by Foundation House. A policy paper submitted to DHS resulted in ’riority access to public dental services for people with refugee backgrounds across Victoria.
- Teeth Tales was included in an update of the ‘Evidence-based review of oral health promotion resource’ as an example of best practice for community based participatory research with refugee and migrant communities
- Rogers JG, Evidence-based oral health promotion resource. Prevention and Population Health branch, Government of Victoria, Department of Health, 2011
Project funding:- Gibbs L, Waters E, de Silva-Sanigorski A, Gussy M, Gold L, Moore L, Watt R, Armit C, Calache H, Riggs E, Merri Community Health Services. Teeth Tales: A culturally competent community intervention for child oral health in low SES area of urban Melbourne, March 2010, $405,000
- Gibbs L, Waters E, Sanigorski A, Gussy M, Gold L, Moore L, Watt R, Armit C, Calache H, Hahn B, Alloush L, El-Khoury A, Gondal I. Teeth Tales: A culturally competent community intervention for child oral health in low SES area of urban Melbourne. $491,000 (Yr1 $151,000, Yr2 $123,000, Yr3 $150,000, Yr4 $67,000). ARC Linkage Grant, 2009
- Riggs E, McCaughey Centre PhD Student Development and Opportunities Fund, 2009 $1,500
- Riggs E. Teeth Tales: Socio-cultural determinants of child oral health. Deakin University, PHRPE Cluster Funding, 2007 $5,180
- Waters E, Kulkens M, Riggs E, Van Gemert C, Kilpatrick N, Gibbs L, Cook K, Watt R, Gussy M. Development and trialling of an intervention to tackle social determinants of childhood oral health for new and emerging communities. Dental Health Services Victoria.2006 $50,000
- Waters E., Riggs E., Van Gemert C., Gibbs L., Kulkens M., Kilpatrick N., Gussy M., Cook K., Watt R. Social, cultural and environmental determinants of oral health in families with young children from new and emerging communities. Telstra Foundation Community Development Fund. 2006-2009 $150,000
Conference presentations:
- Riggs E, Addressing Child Oral Health Inequalities in Refugee and Migrant Communities, Victorian Dental and Oral Health Therapists Association (VDOHTA) Healesville, August 2011
- Armit, C, Development of a culturally competent oral health peer education program, Dental Health Services Victoria Research Showcase Seminar,Melbourne May 2011
- Riggs E, Pradel V, Gibbs L, Armit C, Chowdhry R, Alloush L, El-Khoury A, Reorienting health services for refugee and migrant communities: development of a cultural competence review tool, Oral Health Symposium. Innovative models of oral health care for high risk populations. Melbourne October 2010
- Riggs E, Gibbs, L, Armit C, Pradel V, Waters E, Gussy M, Alloush L, El-Khoury A, Gondal I. Teeth Tales: Addressing child oral health inequalities in refugee and migrant communities. International Union of Health Promotion and Education, Geneva, July 2010
- Riggs E, Addressing Child Oral Health Inequalities in Refugee and Migrant Communities Corporate Seminar Series, Dental Health Services Victoria, June 2010
- Pradel V, Armit C, Riggs E, Gibbs L, Chowdhry R, El-Khoury A, Alloush L, Waters E. Towards best practice in organisational cultural competency. Diversity in Health Conference, Melbourne, June 2010.
- Riggs E, Gibbs L, Armit C, Gussy M, El-Khoury A, Alloush L, Peterson S, Ali S, Waters E. Hard-to-reach communities or hard-to-access services? Diversity in Health Conference, Melbourne, June 2010
- Riggs E, Addressing Child Oral Health Inequalities in Refugee and Migrant Communities, PhD Completion Seminar, University of Melbourne, May 2010
- Riggs E, Ali S, Gibbs L, Waters E, Gussy M, Armit C, Younan N, Zoghaib S. Community participation and cultural competence in child oral health research. International Association of Dental Research, Thailand, September 2009.
- Riggs E, Ali S, Gibbs L, Waters E, Gussy M, Armit C, Younan N, Zoghaib S.. Cultural competency in qualitative data analysis: the importance of community perspectives Public Health Association of Australia, Canberra, September 2009
- Gibbs L, Waters E, Riggs E, Abebe M. Cultural competence in community-based research. 5th Australasian Occupational Science Symposium Contextual Perspectives – Participation for wellbeing. Melbourne 2008
- Riggs E, van Gemert C, Gibbs L, Waters E, Gussy M, Alloush L, El-Khoury A. A culturally competent study exploring the socio-cultural determinants of child oral health from refugee/migrant communities. Population Health Congress, July Brisbane 2008
- Riggs E, Waters E, Kilpatrick N, Gibbs L, Kulkens M, van Gemert C, Watt R. Socio-cultural determinants of children’s oral health in CALD communities – a systematic review. The 19th International Union of Health Promotion and Education, July 2007
- Gibbs L, Waters E, Renzaho A, et al. Incorporating cultural competency into a public health framework. In: 38th Public Health Association of Australia Annual Conference; Alice Springs; 2007.
- Gibbs L, Waters E, Renzaho A & Kulkens M (2007) Incorporating cultural competency into a public health/health promotion framework. The 19th IUHPE World Conference on Health Promotion and Education.
- Riggs E, Waters E, Kilpatrick N, Gibbs L, Kulkens M, van Gemert C & Watt R (2007) Socio-cultural determinants of child oral health in new and emerging communities. The 19th IUHPE World Conference on Health Promotion and Education.
Project staff
Research Team
McCaughey Centre, University of Melbourne- Dr Lisa Gibbs, Research Project Manager
- Dr Elisha Riggs, Research Fellow
- Ms Mandy Truong, PhD Student
Merri Community Health Services- Dr Christine Armit, Manager, Health Promotion and Research Unit
- Mrs Coralie Mathews, Peer Education Coordinator
- Ms Dana Young, Research Assistant
- Mr Mulugeta Abebe, Cultural Advisor
Project Partners
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre at The University of Melbourne
- The Health Promotion and Research Unit at Merri Community Health Services
- Dental Health Services Victoria (DHSV)
- Moreland City Council
- Victorian Arabic Social Services (VASS)
- Pakistan Australia Association Melbourne (PAAM)
- Arabic Welfare
- The Centre for Culture Ethnicity and Health (CEH)
- North Richmond Community Health
- Yarra City Council
- Representatives from the Community Health Service and the Council of the comparison community (to be confirmed)
- Dr Lisa Gibbs, McCaughey Centre, University of Melbourne
- Professor Elizabeth Waters, McCaughey Centre, University of Melbourne
- Dr Andrea de Silva-Sanigorski, McCaughey Centre, University of Melbourne/ Dental Health Services Victoria
- Assoc Prof Mark Gussy, Latrobe University
- Ms Lisa Gold, Public Health Research Evaluation and Policy Cluster Deakin University
- Prof Laurence Moore, Cardiff University
- Dr Richard Watt, University College London
- Dr Christine Armit, Merri Community Health Service
- Dr Hanny Calache, Dental Health Services Victoria
- Dr Elisha Riggs, McCaughey Centre, University of Melbourne
Contact names:
- Dr Lisa Gibbs
Project Manager
The University of Melbourne
Ph: 8344 0920
Email: lgibbs@unimelb.edu.au
- Mandy Truong
PhD Student
The University of Melbourne
Email: mtr@unimelb.edu.au
- Dr Christine Armit
Manager, Health Promotion and Research Unit,
Merri Community Health Services
Ph: 9389 2265
Email: ChristineA@mchs.org.au
- Coralie Mathews
Peer Education coordinator
Merri Community Health Services
Ph: 93892274
Email: CoralieM@mchs.org.au
- Dana Young
Research Fellow
Merri Community Health Services
Email: DanaY@mchs.org.au