‘There’s a Wall There—And That Wall Is Higher from Our Side’: Drawing on Qualitative Interviews to Improve Indigenous Australians’ Experiences of Dental Health Services

Abstract

Indigenous Australians experience high levels of untreated dental disease compared to non-Indigenous Australians. We sought to gain insight into barriers that prevent Indigenous Australians from seeking timely and preventive dental care. A qualitative study design was implemented, using face-to-face interviews conducted December 2019 to February 2020. Participants were 20 Indigenous Australians (10 women and 10 men) representing six South Australian Indigenous groups; Ngarrindjeri, Narungga, Kaurna, Ngadjuri, Wiramu, and Adnyamathanha. Age range was middle-aged to elderly. The setting was participants’ homes or workplaces. The main outcome measures were barriers and enablers to accessing timely and appropriate dental care. The findings were broadly grouped into eight domains: (1) fear of dentists; (2) confusion regarding availability of dental services; (3) difficulties making dental appointments; (4) waiting times; (5) attitudes and empathy of dental health service staff; (6) cultural friendliness of dental health service space; (7) availability of public transport and parking costs; and (8) ease of access to dental clinic. The findings indicate that many of the barriers to Indigenous people accessing timely and appropriate dental care may be easily remedied. Cultural competency training enables barriers to timely access and provision of dental care to Indigenous Australians to be addressed. The findings provide important context to better enable health providers and policy makers to put in place appropriate measures to improve Indigenous people’s oral health, and the Indigenous oral health workforce in Australia.

“Does this dental mob do eyes too?”: perceptions and attitudes toward dental services among Aboriginal Australian adults living in remote Kimberley communities

“…Participants in this study indicated that oral health and access to timely dental care is important to Aboriginal people living in remote communities, however current service delivery systems are struggling to address the levels of acute need. Transport to and from the nearest dental service, accommodation and the costs associated with dental treatment have all been underlined as barriers to care in the literature and further reinforced by the findings of this study [ 5 , 6 , 20 , 23 ]. Although participants expressed the need for a predictable, on-site dental service, the low population densities combined with the high running costs of a dental practice means that establishing a permanent dental workforce and full-time services is generally not viable nor sustainable in many remote communities [ 24 , 25 ].…”

“…More recently Tynan and colleagues used a phenomenological approach to facilitate a deeper contextual understanding around oral health attitudes in Aboriginal communities [ 5 ]. The use of such qualitative methods has highlighted the importance of this technique in identifying local barriers to care, community priorities and strategies to ameliorate services in the future [ 5 , 6 ]. This paper focuses on the Kimberley region of Western Australia, noting that previous literature has suggested that Aboriginal Australians living in the Kimberley are the most disadvantaged group within the most disadvantaged population in Australia and continue to face significant disparities in oral health [ 7 ] (p2) .…”

Oral health changes among Indigenous and non‐Indigenous Australians: findings from two national oral health surveys

“…Across both surveys, the prevalence of Indigenous Australians who attended for annual dental visits was far lower than the estimates for non‐Indigenous Australians, and the general Australian population 12,15 . Much of this disparity can be attributed to the lack of cultural safety many Indigenous Australians feel when attending for dental care, largely based on past experiences and general fears in the Indigenous community around dental care provision 16 . The high costs for those not eligible for care through the dental public health sector likely also contribute.…”

How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries

“…The exploitation of these labels, and the labelling of difference, can be effectively used to create stigma through discrimination and exclusion, rejection and systemic disapproval. A newly emerging, but increasingly recognized determinant of health, stigma has profound impacts on social inequality and life chances, with manifest consequences on Indigenous oral health inequalities such as not applying for jobs because of embarrassment about missing teeth or not seeking dental care because of fear of dentists' moral judgement [121].…”