The Teeth Tales Showcase: The Finale to an 8 year community-based oral health research study

Written by Research Fellow Dana Young

My role for the most part of the last 4 years has been implementing a child oral health promotion intervention for children from a migrant and refugee background, also known as Teeth Tales. Although the inception of the project began many years before my involvement, I was involved with rolling out the exploratory trial phase of study.

The idea for the Teeth Tales research study arose in 2006 due to community concerns for the oral health of children from a refugee or migrant background residing in the Moreland and Hume local government areas (LGAs) of Melbourne. From this a PhD study(1) exploring the sociocultural influences on oral health was developed and conducted in partnership with Arabic Welfare, Victoria Arabic Social Services and Pakistani Australia Association of Melbourne to discuss these issues with mothers from a Lebanese, Iraqi and Pakistani background. Based on the findings from this initial work the next phase of Teeth Tales was designed and piloted to explore the implementation of a community based child oral health promotion intervention for children from a migrant and refugee background (2). For more background information about the Teeth Tales study visit out website here.

The Teeth Tales study has been an 8 year project led in partnership between Merri Community Health (MCHS) and The University of Melbourne and was culminated through a showcase on the 23rd of October 2014. This half day event involved members of the key partner agencies involved in the project, which alongside MCHS and the University of Melbourne include Dental Health Services Victoria, Moreland City Council, Arabic Welfare, Victorian Arabic Social Services, Pakistani Australia Association of Melbourne, The Centre for Culture, Ethnicity and Health and North Richmond Community Health Service. Key findings from the research were presented and representatives from the partner organisations presented their experiences and learnings associated with being involved in the Teeth Tales study.

Mandy Truong presenting at the Teeth Tales Showcase October 2014

Mandy Truong presenting at the Teeth Tales Showcase October 2014

This research project provided 667 children with a community based dental screening. For many children this was the first time they had seen a dental professional. Twelve percent of these children were referred on for further treatment at a dental clinic. Parents allocated to the intervention group received education from trained peer educators around the Dental Health Services Victoria key oral health messages of ‘Eat Well, Drink Well, Clean Well and Stay Well’. Based on earlier findings the discussion of traditional oral health practices was incorporated into the peer education oral health course. Results indicate the Teeth Tales intervention increased the oral hygiene practices of the participants, which is very important for the prevention of oral health problems.

Outcomes from the Teeth Tales study were applicable for not only the families involved as study participants but also for the multiple partner organisations involved. Working in partnership with established cultural organisations is critical to health promotion initiatives for families with migrant and refugee backgrounds. The Teeth Tales showcase was an exhibit of the wonderfully strong organisational partnerships that have been created and maintained over the life of the project and how involvement in the project has forged links between the local organisations and potential clients in the community. There was unanimous feedback from the partner organisations that this project had provided them with an opportunity to promote additional health and social service support to participants. Data collection sessions, where children received a free dental screening, were seen as an ideal opportunity to provide this information. One organisation arranged for families to attend appointments at the time data collection sessions were being run to alleviate travel demands on the families to their organisation. Findings from the study will also contribute to the updated Dental Health Services Victoria clinical guidelines for dental clinicians and maternal child health nurses.

It has been extremely rewarding working as a researcher involved with this study. I have developed my skills working with culturally diverse communities in a culturally appropriate manner, undertaken community and stakeholder engagement and liaised between participants and local services; whilst also witnessing the capacity of the cultural partner organisations grow to promote preventative health messages and to be able to aid migrant families to navigate the community health sector. Links have been created between culturally specific social services organisations, community health and the child and family services at local council – which will be of ongoing benefit for newly arrived families trying to access a multitude of services for their family.

For access to resources developed for the Teeth Tales study please visit the relevant organisations websites.

  • The Teeth Tales Peer Education Manual includes class materials for child oral health peer education trainers. You can access it from the Merri Community Health Services Website http://mchs.org.au/research-partnerships/latest-research. For more information, email Maryanne Tadic at maryannet@mchs.org.au
  • The Cultural Competency Organisational Review (CORe) Tool documents will be available via the The Centre for Culture, Ethnicity and Health website soon at ceh.org.au

References:

  1. Riggs E. Addressing child oral health inequalities in refugee and migrant communities. 2010.
  2. Gibbs L, Waters E, de Silva A, Riggs E, Moore L, Armit C, et al. An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales. BMJ open. 2014; 4 (3): e004260.

An update from the Cochrane Public Health Group

Our work within Public Health Insight aims to generate evidence-informed solutions for decision makers. Public Health Insight incorporates the Cochrane Public Health Group (CPHG) and we thought it was time to provide an update on the work of CPHG and highlight the scope of our Cochrane reviews.

By way of background, in 2005 the World Health Organisation (WHO) convened the Commission on Social Determinants of Health to determine the available evidence globally on health inequities. The ultimate goal of the commission was to identify strategies to curb the increase in inequities.

The results suggested that inequities were not naturally occurring and could be avoidable by improving policy choices, i.e. acting on the social and structural determinants of population health.

In 2008, the Cochrane Public Health Group (CPHG) was registered as an editorial group with the international Cochrane Collaboration to address these challenges. Our mandate is to produce systematic reviews of interventions that seek to support decision-making involving the upstream determinants of health. Our group filled a crucial gap in the existing coverage of Cochrane review topics relevant to global population-level health evidence.

CPHG authors, guided by our editorial team, have utilised contemporary systematic review methods to identify not only whether interventions work, but the ability of these interventions to reduce inequities. Our reviews also seek to identify pointers to potential ineffectiveness or harm (including inequities) due to implementation or resource issues. We understand the need for decision-makers to have access to information about how to implement effective interventions in their own contexts. Review authors are also asked to highlight issues for low and middle income countries, often in the absence of good quality evidence in these countries.

The CPHG works with the Campbell and Cochrane Equity Methods Group to encourage authors to utilise the PROGRESS (Places of residence, race/ethnicity, occupation, gender, religion, socioeconomic status and social capital) tool for extracting data and reporting outcomes.

We currently have a wide range of reviews published or underway (see below). If you are interested in learning more visit our website and please join us on Twitter (@CochranePH), where you will be notified of exciting new reviews published and other news items of relevance to evidence-informed public health. If you are interested in being involved in any of the topics (for example, by commenting as a content expert) contact our Managing Editor (Jodie Doyle: jodied@unimelb.edu.au).

Education

  • Later school start times for supporting the education, health and well-being of high school students
  • Interventions for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity
  • prevention in child care settings
  • Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition

Employment & the Work Environment

  • Flexible working conditions and their effects on employee health and wellbeing
  • Workplace-based organisational interventions to prevent and control obesity by improving dietary intake and/or increasing physical activity

Food Supply/Access and Public Health Nutrition

  • Staple crops biofortified with increased micronutrient content for improving vitamin and mineral status in populations
  • Interventions for preventing undernutrition in children (0-5 years) living in slum environments Portion, package or tableware size for changing consumption of food, alcohol and tobacco
  • Policy level and environmental interventions for reducing the consumption of non-alcoholic sweet drinks among children
  • Interventions for preventing obesity in children
  • Interventions for preventing obesity in children: an overview of systematic reviews
  • Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders
  • Nutritional labelling to promote healthier food purchasing and consumption
  • Fortification of condiments and seasonings with iron for preventing anaemia and improving health
  • Community-level interventions to improve food security in developed countries
  • Community-level interventions for improving access to food in low- and middle-income countries
  • Fortification of rice with vitamins and minerals for addressing micronutrient malnutritition
  • Fortification of staple foods with vitamin A for preventing vitamin A deficiency
  • Wheat flour fortification with iron for reducing anaemia and improving iron status in whole and at-risk populations
  • Fortification of maize flour with iron for preventing anaemia and iron deficiency in populations
  • Fortification of wheat and maize flour with folic acid for population health outcomes
  • Population-level interventions in government jurisdictions for dietary sodium reduction
  • Food fortification with calcium and vitamin D: impact on health outcomes
  • Fortification of staple foods with zinc for improving health outcomes in the general population
  • Food fortification with multiple micronutrients: impact on health outcomes

Housing and the Built Environment

  • Housing improvements for health and associated socio-economic outcomes
  • Built environment interventions for physical activity in adults and children
  • Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children
  • Slum upgrading strategies and their effects on health and social outcomes
  • Interventions to reduce ambient particulate matter air pollution and their effect on health

Income Distribution and Financial Interventions

  • Welfare to work interventions and their effects on the health and wellbeing of lone parents and their children
  • In-work tax credits for families and their impact on health status in adults
  • Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low and middle income countries
  • Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low and middle income countries
  • Livestock development programs: effects on indicators of livelihood and health status for families in low and middle income countries

Natural Environment

  • Interventions for reducing adverse health effects of high temperature and heatwaves
  • Participation in environmental enhancement and conservation activities for health and well-being in adults
  • Participation in outdoor education programs in natural environments and children’s health

Public Safety

  • Interventions for preventing abuse in the elderly

Social Networks/Support

  • Social cohesion and community building interventions in local communities for improving health and quality of life
  • Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people
  • Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations
  • Individual-, family-, and school-level interventions for preventing multiple risk behaviours in individuals aged 8 to 25 years
  • Population-level intervention for preventing multiple risk behaviours in 8 to 25 year olds

Systems for Health

  • Interventions implemented through sporting organisations for increasing participation in sport
  • Policy interventions implemented through sporting organisations for promoting healthy behaviour change
  • Interventions for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity prevention in childcare services
  • Portion, package or tableware size for changing consumption of food, alcohol and tobacco
  • Collaboration between local health and local government agencies for health improvement
  • Service brokerage for improving health outcomes in ex-prisoners (previously entitled, Population level interventions for improving health outcomes in ex-prisoners)
  • Community-based, population level interventions for promoting child oral health
  • Knowledge translation strategies for facilitating evidence-informed public health decision making among managers and policymakers
  • Interventions for improving the use of the oral healthcare services by adults

Transport, Active Transport and Physical Activity

  • Legislative and engineering interventions for preventing road traffic injuries and fatalities among vulnerable road users (nonmotorised road users and motorised two-wheel road users) in low and middle income countries
  • Community wide interventions for increasing physical activity
  • Environmental and behavioural interventions for reducing sedentary behaviour in community dwelling older adults
  • Public health interventions for increasing physical activity in adults, adolescents and children: an overview of systematic reviews
  • Workplace based organisational interventions to prevent and control obesity by improving dietary intake and/or increasing physical activity
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity prevention in child care settings
  • Built environment interventions for physical activity in adults and children
  • Incentive-based interventions to increase physical activity
  • Interventions for preventing obesity in children
  • Interventions for preventing obesity in children: an overview of systematic reviews

Highlights from a rookie researcher’s first conference.

A few weeks ago I attended the conference Progress 2013 (http://progress2013.org.au/). The first of its kind in Australia, it brought together progressive left thinkers with not-for profit organizations, unions, private industry and experts in the health and environment sector. Its aim was to talk about the issues that will define Australia’s not-for profits and social movements for the years to come. As a recent graduate, this was my first ever conference and a chance to understand how people from all over the workforce come together to share skills, nut out ideas and most importantly – network. This blog post will cover some of the major highlights from the conference and touch on some of the lessons I learnt, from the perspective of a budding young researcher.

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Highlight no 1.
To begin, one of the major highlights for me was listening to rock star academic and expert on the social determinants of health, Richard Wilkinson (http://www.ted.com/talks/richard_wilkinson.html), speak about the importance of understanding how income inequality affects health and wellbeing. Wilkinson, author of ‘The Spirit level’ and co-founder of The Equality Trust (http://www.equalitytrust.org.uk), researches the problems of inequality in society and produces evidence-based arguments to support social movements for change. In particular, Wilkinson drew attention to the problem that health and wellbeing in high and middle income countries is worse for all when the gap between the rich and poor is greater. Data was collated to demonstrate that even in high income countries as measured by Gross Domestic Product (GDP), population levels of health and wellbeing are influenced by income inequality. Therefore, the average wellbeing of societies is not dependent on gross national income and the rhetoric of economic growth but rather the relation between each other within society itself. This trend also occurs in child health and wellbeing, mental health, drug abuse and obesity – proving the tangible effect that inequality has in society. Some factors Wilkinson attributed as the drivers of negative health in unequal societies include status anxiety, stress, mistrust and dominance caused by a competitive consumer based economy. Wilkinson therefore advocated for a more inclusive society where value is placed on the way we relate to one another and where possible to harness positive social relations, such as friendship. Although these insights seem somewhat intuitive, I was taken aback by how relevant it is to continue to produce evidence that highlights this problem. When considering health and wellbeing, Wilkinson makes us think about the less visible effects of how we relate to one another and re-establishes the importance of family, friendship and positive social interaction to maintaining a sustainable quality of life.

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Highlight no 2.

Another highlight was the talk given by Anat Shenker-Osorio, a communications expert and researcher who authored the book ‘Don’t Buy It: The Trouble with Talking Nonsense about the Economy’. Her work looks at how people understand issues, such as the economy or climate change, through the words used to narrate them. Without getting too bogged down in detail, the gist of her research suggests that you can reliably persuade or change a person’s thinking about an issue depending on the words used to describe it. For example, immigration. A study was conducted to measure how people responded to immigrants depending on whether they were framed as either a burden or a resource. The findings showed that when immigrants were talked about in a positive framing, by expressing what they bring to society and not what they lack, people’s acceptance of immigrants were overall more favourable. Shenker-Osorio argues that by literally changing the words we use to speak about an issue, we can also influence how people think about it, having repercussions for politics and policy. Something to think about when writing the next report or talking at a conference about a sticky issue. Frame it positively and you will have people receive it much more favorably.

Highlight no 3.

Arguably one of the best parts of Progress 2013 however, was the chance to mingle with those I consider some of my professional role models. As I mentioned above, this was my first ever conference, so the task of introducing yourself to those you admire is quite daunting. However, after a few awkward first conversations I learnt the following things;

  1. Go with a plan. Since time is scarce at these events and the professionals you meet talk to so many different individuals every day, working out a plan of who you want to speak to and what you want to speak to them about prior to the meeting is essential. This way, you won’t get caught in a conversation about the weather and how good the muffins are, but instead get to use your limited time to your best advantage.
  2. Don’t be scared to introduce yourself. As daunted as you might be about shaking hands with someone you find just a huge bit intimidating because of their greatness, it never hurts to just introduce yourself and say you are a huge admirer of their work. A few times I saw rock star academics on their lonesome at the coffee table, probably because everyone was too in awe to say hi.
  3. When in doubt ask questions. When you have reached your small talk capacity and feel like the conversation is drying out, ask questions of them. People love to talk about themselves and asking them questions about themselves shows that a) you have a strong interest and b) that you are engaged in what they do.

Written by Hannah Morrice
Research Assistant, Jack Brockhoff Child Health & Wellbeing Program
The University of Melbourne
e: hannah.morrice@unimelb.edu.au

Research with culturally and linguistically diverse communities

Encouraging people to participate in research can be a tough gig. We are usually asking people to volunteer their time just for a small piece of information, which is sometimes only relevant and generalisable if large numbers provide this same, small piece of information. As researchers we know the enormous value that gathering this information can have to inform change at the policy, practice and the community level. But the general population sometimes does not place the same value on research or understand how important the research and outcomes can be. So, how do we encourage people to participate in research? And in particular, how do we encourage those from culturally and linguistically diverse backgrounds, where research may not be a common concept or practice.

I am currently working on a large scale child oral health research project entitled ‘Teeth Tales’, being conducted in partnership with government and community agencies  and Australian families from refugee and migrant backgrounds. Oral health is included in the Victorian Health and Wellbeing Plan 2011 – 2015 as a priority area for preventative health, as it is one of the most preventable diseases, particularly for children. Tooth decay is Victoria’s most prevalent health problem, with more than half of all children and almost all adults affected (1). Initial qualitative research was conducted with mothers from Lebanese, Iraqi and Pakistani backgrounds exploring oral health practices, beliefs and service needs. We learnt about many cultural differences and the real interest these communities have to learn more about keeping their children’s teeth healthy. From this earlier research, a community-based trial was developed to include an oral health education program for parents delivered by a trained educator from the same cultural background. This peer educator is able to talk about traditional beliefs and practices and introduce parents to the key Dental Health Services Victoria oral health messages of ‘Eat Well, Drink Well, Clean Well and Stay Well’. The program also included a site visit to local dental and family services. In addition to this education program, local services underwent a review of their practices to improve their competence in dealing with culturally diverse communities.

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Photo from:  http://www.dshs.state.tx.us/dental/promo_oh.shtm

For this trial we recruited Lebanese, Iraqi and Pakistani families in metropolitan Melbourne with children aged 1 – 4 years. We wanted to make sure that the research was as useful and relevant to families as possible so we sought the advice and expertise of relevant cultural organisations. They provided guidance on the cultural practices and beliefs of the target cultural groups, and the cultural appropriateness of our research methodology. They also helped us to recruit families, conduct the trial, interpret the findings and they provided language assistance. If it wasn’t for these partnerships we may have been lucky to recruit 10 families rather than the over 500 families who ended up participating! The advice and support of these cultural partners is invaluable when trying to recruit families with a refugee or migrant background, some of whom may be unfamiliar with research conduct, health promotion and the Australian health system.

In order to evaluate the success of the program we needed to check children’s teeth before and after the trial, as well as ask parents to complete a questionnaire. The free dental screenings for the children proved to be a key incentive for parents to register for the study. Oral health is one of the most contentious current health issues in Australia as access to fast, affordable dental care is often not available. The private dental system is run as a business and many walk out of the service with an expensive bill. The public dental system has huge waiting lists and strict eligibility for access. We found that many parents were not aware that children and refugee and asylum seekers in Victoria are considered a priority group for public dental services access. So when our study offered a free dental screening for children many families jumped at the opportunity!

The strategies outlined above helped us to successfully recruit over 500 families into our study. Engaging culturally and linguistically diverse groups in research can be difficult, but is very important, particularly for health services that need to respond to the evolving health needs of refugee and migrant and groups.

To read more about the ‘Teeth Tales’ study please visit:  http://mccaugheycentre.unimelb.edu.au/research/current/intergenerational_health/teeth_tales

Blog by Dana Young

Research Fellow, Child Public Health

The University of Melbourne

e: dana.young@unimelb.edu.au

References

  1. NACOH. 2004, Healthy mouths healthy lives: Australia’s National Oral Health Plan 2004-2013. Adelaide, National Advisory Committee on Oral Health, Australian Health Ministers’ Advisory Council.

Welcome to Research Connect

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‘Before, I have a lot of problem you know. I have a lot of thinking about my family you know. But I came to Ucan2 and got a lot of friends came, talk and speak like that… Before I come I can’t laugh – because I can’t. After I come to Ucan2, yeah I can laugh with my friends’

(Afghan male 26)

Hearing inspirational quotes like the one above changes our lives. It reenergizes our passion for research and health promotion and we remember why we do this job and why we love it. Those countless hours of planning, ethics submissions, draft upon drafts of papers, and the acceptance or rejection from journals are all part of the life of an academic, and all worth it when you hear a quote like this.

Here at the Child Health & Wellbeing Program, we work towards a vision of every child having the opportunity for a fulfilling and healthy life. Our research, through partnerships and an evidence-informed approach, aims to significantly shift population health and reduce gaps in child health inequalities.

Through this blog, you will hear stories from our team about why we carry out research in this field. What motivates and inspires our team and why they take these approaches to their research. We encourage others to engage in friendly debate about our topics and ask questions, whether you are a fellow researcher, a colleague or are just interested in child health research and promotion.

We will be covering topics such as mental health, disability, wellbeing, quality of life, oral health, obesity, health eating, physical activity, learning, development, disadvantage, vulnerability, equity, human rights and children and families in the contexts of disasters.

Please do share your thoughts and comments by commenting on these pages. We hope you enjoy our blog.

Liz Waters

Professor Elizabeth Waters is the Jack Brockhoff Chair of Child Public Health at The University of Melbourne.