Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. Three communities were selected for their high proportion of Aboriginal people and diverse regional and remote locations. Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted in the three communities (n = 5 coastal, n = 13 remote, and n = 13 border) and six themes identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

BackgroundLimited research has been undertaken in Australia to assess the dental status of pre-school Aboriginal children. This cross-sectional study records the number of decayed, missing and filled teeth (dmft) and surfaces (dmfs) of pre-school Aboriginal children living in different locations in New South Wales (NSW), Australia.MethodsA convenience sample of young children from seven Aboriginal communities in rural, remote and metropolitan areas of NSW, was recruited. One calibrated examiner recorded the dmft/s of children with written parental consent.Results196 children were invited to participate and 173 children aged two to five years were examined, a response rate of 88.3 %. Forty percent (n = 69) of the children were diagnosed with dental caries with a mean of 2.1 (SD = 3.6). The dmft scores were significantly higher in remote locations when compared to rural (p = <0.0001) and metropolitan areas (p = 0.0155). Children 4–5 years old living in remote NSW had a mean dmft of 3.5 and mean dmfs of 8.0 compared with children living in rural areas who had a dmft and dmfs of 1.5 and 4.2 respectively. Untreated dental caries was the primary contributor to the scores, and children who had previously received dental treatment still had active carious lesions.ConclusionThere was a high prevalence of untreated dental caries among the Aboriginal children, particularly for those in remote locations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2673-6) contains supplementary material, which is available to authorized users.

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This led to the co-design of a small-scale oral health therapy graduate year program for ACCHSs known as the Dalang Project, which enabled oral health therapists to engage with local Aboriginal communities and implement culturally competent, practical and evidence-based oral health promotion activities. This article provides an overview of the Dalang Project and its evaluation. Methods: All graduates of the Dalang Project were invited via email and social media to complete an online survey. The survey included questions about their year in the Dalang Project, why they applied, what they liked and disliked about the project, where they planned to work post-placement, and examples of the most significant changes they observed in the communities where they were placed. Host sites were also surveyed and data were collated on clinical services performed as well as oral health promotion activity. Results: Prior to commencing the Dalang Project only 4 of the 15 respondents came from rural or regional areas. Nine of the 15 respondents were considering working in a regional, rural or remote area prior to applying for the Dalang Project. Twelve respondents were working at the time of the survey and half were working in regional, rural or remote locations in NSW and one in the Northern Territory. All reported that they would be more likely to work in an ACCHS as a result of being a part of the Dalang Project. The majority of respondents said they would recommend the program to future graduates. A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project. A total of 3250 toothbrushes and fluoride toothpastes were distributed to children and families through the Dalang Project. A key part of the program was the installation of refrigerated and filtered water fountains in schools where there was no free filtered or refrigerated water supply. The inclusion of this component in the program was part of the co-design process and links the program to the wider population health strategies in NSW to help prevent childhood obesity. Conclusion: The Dalang Project is an example of a successful codesigned project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in ACCHSs. Overall, the Dalang Project was found to be a positive professional experience for the oral health therapists with many remaining in rural, remote and regional locations after completing the program.

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