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.

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.