Abstract
Introduction: Resettled refugees suffer from unmet dental treatment needs at a high rate and face many challenges in accessing dental healthcare services. Relevant knowledge and favourable self-care practices are key to preventing oral conditions and enhancing engagement with available services.
Aims: To develop and evaluate a culturally appropriate oral health promotion intervention to reduce smoking, support and improve oral self-care behaviours, and facilitate access to dental health care services for a population of former Syrian refugees. This thesis aimed to answer the following questions: (1) What are the main barriers and facilitators former Syrian refugees face when seeking dental care in New Zealand? (2) Does this intervention improve oral health-related knowledge and behaviours of former Syrian refugees?
Materials and methods: This research took a mixed methods approach, including focus group sessions, one-on-one interviewing, questionnaires, and clinical data collection. Consenting former Syrian refugees (n=63, >18 years of age) who arrived in Dunedin, New Zealand, from 2016 to 2019 were invited to complete a dual English/Arabic language electronic questionnaire using the Qualtrics survey platform. This questionnaire collected data on participants’ personal characteristics and oral healthcare habits. Those who completed the questionnaire were then invited to participate in a health promotion intervention in either an online group setting (n=39) or a 1-on-1 clinical dental setting (n=21); in total, 60 people participated, with the remainder not participating any further. , First, to identify challenges faced by Syrian former refugees in seeking oral health care, focus groups were conducted based on existing family/social networks and the interviews were conducted online via Zoom™. Secondly, to ensure cultural appropriateness, participants were invited to co-design a set of dual language (Arabic/English) oral health education resources at the time of focus group meetings. Finally, to test the intervention, those who participated in a 1-on-1 clinical dental setting were dentally examined for caries, missing teeth, periodontal health, and oral hygiene; the findings of these examinations were discussed with each participant in their native Arabic language, and they were motivationally interviewed, encouraged to make a change to their oral self-care relevant to their individual risk factors. The co-designed resources were then sent to all participants monthly for five months, with a new theme for each month (oral home care, how to access dental care in New Zealand, how to quit smoking, sugars and dental health, and a summary in the final month). Finally, after six months, to evaluate the intervention, all participants were invited to complete a follow-up questionnaire (Appendix 11) and those who were in the clinical arm were dentally re-examined. All interviews were recorded, transcribed verbatim then translated to English. Thematic analysis involved familiarisation; coding of data; identifying themes, and collating data into themes; and reporting on the results. Quantitative findings were analysed statistically using the software Stata SE 15.1.
Results: Multiple factors hindered or facilitated the participants’ ability to address their oral health needs, including finances, communication and language, providers’ (poor) cultural competency and inherent process issues (structural); and participants’ expectations of the oral health care system and differences to that in Syria, their oral health care attitudes and beliefs, and specific issues associated with resettlement (sociocultural).. In the co-design of the health education resources, participants engaged well and provided considerable feedback. The resources were judged by participants as useful, easy to read, worthwhile and that even information which they already knew was useful and motivational. Participants’ oral health self-care behaviours significantly improved following receiving these educational resources over a 5-month period. Over half of participants reported improvements to their toothbrushing behaviours, while among those who consumed sugary drinks at least weekly, over 90% reported having taken steps to reduce their sugar intake. None of the smoking participants quit smoking but 52.4% reported cutting back on their smoking. Among those who participated in the clinical arm of the study, oral hygiene was markedly improved (with a reduction in plaque scores of greater than 50%).
Conclusion: Former refugees experience barriers to accessing dental care. Their unique needs should be considered by policymakers and dental clinicians. The participatory intervention designed in this research was found to be effective in helping former refugees adopt better oral health behaviours. Future research should investigate whether this intervention should be implemented more widely among former refugees.