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.
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Beyond Bushfires: Community Resilience and Recovery

Beyond Bushfires: Community Resilience and Recovery is a five year study in partnership with community, government, emergency services and other service providers. This study, led by our Program, aims to profile the range of mental health, wellbeing and social responses to the Victorian 2009 bushfires over time. Multiple methodologies are being used to explore the medium to longer term impacts from the February 2009 bushfires and the interplay between individual and community factors.

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Community Centre in Steels Creek

We are very proud to announce that last week our Beyond Bushfires team had their protocol paper for the study published, detailing the study design and methodology. The multidisciplinary team and the contributions from government, agency and community partners ensures that we have a very strong, rigorous and respectful process for conducting the study and interpreting the findings from the mixed methods, including social network analysis, epidemiological and qualitative approaches. The team has rich and fruitful discussions at every meeting and the findings emerging are useful to policy, services and community alike. We are now in the process of sharing and discussing the emerging findings with community partners and plan to publish the initial findings shortly in academic journals.

 

Professor Elizabeth Waters

 

To read the paper click here: http://www.biomedcentral.com/1471-2458/13/1036/

To learn more about the Beyond Bushfires study, click here: http://beyondbushfires.org.au/

Connect with Beyond Bushfires on facebook: https://www.facebook.com/BeyondBushfires

Twitter: https://twitter.com/BeyondBushfires

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.

Disasters impacting communities all over the world.

At the international conference on The Demography of Disasters, I was overwhelmed with the amount of deaths resulting from overseas disasters that killed hundreds of thousands of people. It struck me that the 2009 Victorian bushfires seem on such a small scale compared to this. As I have been working on a project for three years now (looking at the medium to long term impacts from the 2009 Victorian bushfires), I feel that I have some understanding of the huge impact it has, and continues to have, on many people and communities. Therefore I can only imagine the impact on these other countries when such loss has occurred. Especially as these countries are at high risk of future disasters and are usually under resourced to prepare, respond and recover from these. This is a massive challenge for recovery and resilience work within these areas. But imagine if we had that many people die within Victoria? How come there is such a large difference in the death toll between these countries and our own? Is it that these countries are highly populated, even in their rural areas? Or is it because we have greater resources and preparedness mechanisms in place to prevent such large scale impacts?

Over the two days, it was emphasised that disaster recovery efforts need to be tailored to the particular area in which they occur. This is due to variability of culture and traditions, which can both assist and hinder the resilience process. Change in anyone’s life is difficult, especially after a disaster, therefore attempting to restore traditions is important but the difficulty within these countries is that at times it’s more dangerous to restore these traditions than change. The cultural relevance within Victorian communities differs greatly from these countries, which further complicates the applicability of these learnings in different contexts.

Throughout the conference there were many different presentations, exploring the impact on communities after a disaster. However, many of the areas being presented were at constant high risk of disasters. Recovery planning needs to occur after a disaster along with planning for the possibility of another disaster, as they are at high threat of one occurring within their lifetime. This threat needs to be accounted for in regards to resilience and future preparedness.

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Trees recovering from the Victorian 2009 bushfires.

Some of the presenters completed studies in Asian countries – however, some of the limitations of their studies included not knowing or understanding the local context and how their research findings fit into this. To overcome this many of these researchers collaborate with others within the country or the particular rural area in which the research is being completed. For our study: Beyond Bushfires: Community, Resilience and Recovery (www.beyondbushfires.org.au) we have also taken on this approach. We have many stakeholders from local areas within the participating communities which include residents, local government, NGO’s. As part of the research process we are taking back our initial findings to our community partners and asking them for assistance in interpreting these in terms of what they mean locally. This knowledge adds another level of understanding and allows for non-fire related impacts to be accounted for.

There is a shift in the social environment being just as important as the physical environment in the countries that were presented. However, as this is a major focus of our study – hopefully we can add some interesting evidence to this literature. So stay tuned to not only to this blog but the emerging findings that the Beyond Bushfires team has to report later this year.

If you would like to keep updated with the project to join the Beyond Bushfires email list please send an email to: info-beyondbushfires@unimelb.edu.au