Migrant mums and oral health

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migrant mums and oral health

Migrant mums have been set up to fail when it comes to accessing oral health support, with confusion over billing and difficulty navigating the public and private health systems adding to their hesitancy, a new study has found. By Tracey Porter

Flexibility in appointments and greater collaboration between primary healthcare providers will go a long way to ensuring migrant families are better able to access good dental care in Australia.

However, research shows the options represent just a small fraction of the multitude of solutions required to address the oral health inequities faced by the culturally and linguistically diverse (CALD) community.

The findings were contained in a new study by University of Sydney and Flinders University researchers aimed at investigating the experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers.

The paper, ‘Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers’, sought the lived experiences of 33 CALD mothers including 20 from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. 

University of Sydney dental PhD scholar Kanchan Marcus, one of four authors of the study, says the delay or avoidance of dental care in CALD communities means that mothers are not seeking preventive-oriented oral healthcare, and are at times living with pain. 

Marcus, who is also the mixed methods researcher at the University’s Menzies Centre for Health Policy and Economics, says by delaying obtaining oral healthcare support, these mothers are at an increased risk of their general wellbeing being impacted.

They may require more invasive procedures at a later date, he says.

“Inadequate oral healthcare support to access and utilisation in the community has also resulted in dental tourism for some mothers, which was predominantly for family visitation and child-care support, reduced costs and known providers.” 

Five areas of concern

The study unearthed five main barriers that prevented migrant mothers from accessing timely dental care in Australia, with cost being identified as the foremost issue.

With more pressure on Government, increasing inequalities within and between communities, oral health should be brought forward on the policy agenda.

Kanchan Marcus, dental PhD scholar, University of Sydney

This was of particular concern in the instances where dental practices had the discretion to decide the fee amount, which invariably differs between each surgery. 

Because some practices charged consultation fees or provided unnecessary work, CALD mothers who encountered such experiences then sought to avoid that specific dental provider for future dental visits for their own family, the study found. 

An example was given of a CALD mother who says she was forced for an X-ray at a new clinic when she had already retained a recent X-ray from a previous clinic and didn’t wish to expose herself to radiation superfluously. 

“The lack of standardisation in billing or policies at provider centres was further questioned by CALD mothers in terms of patient interests or business profits,” the report noted.

The findings mirror a similar National Study of Adult Oral Health investigation that found 42 per cent of immigrants avoid oral health check-ups due to financial difficulty and dental treatment costs.

Other concerns cited by CALD mothers as to why they avoided or delayed seeking help with their oral health issues included a lack of confidence or trust in providers. 

Confusion in navigating a public and private healthcare system was highlighted as a concern, as was the fact that competing priorities often took precedence. 

The researchers found that often child-family responsibilities took precedence for CALD mothers while time challenges added to the complexity when working full-time or negotiating care for children. 

A regular dental clean or check-up was also not a priority due to competing health concerns that were considered more significant than oral healthcare.

Complacency was also found to be a problem, with respondents perceiving the risk of getting ill from a lack of regular oral healthcare as low—a factor that resulted in CALD mothers generally neglecting their own oral health until there is severe pain or urgency.

As found in my study, the general practitioner and community nurses are key gatekeepers to the health system and information. They are the first point of contact in CALD communities and can help migrants navigate the oral healthcare system.

Kanchan Marcus, dental PhD scholar, University of Sydney

Marcus says while none of the respondents had accessed or utilised dental services in rural or regional areas in the past year, there was ample evidence to suggest that oral healthcare inequalities in regional areas were just as bad as in urban areas. 

“Public dental waiting lists are long, and very few eligible adults can access these services,” he says. “Barriers in regional areas for CALD communities underline further challenges in English language proficiency, social isolation, and literacy, among other factors. These are more pronounced in refugee and humanitarian migrants.”  

Universal health coverage required

Marcus says for members of the CALD community to be in a position to receive more equitable access to oral healthcare, a multi-pronged approach is required. 

In 2021, the World Health Organization, of which Australia is a member signatory, approved the resolution in oral health.

Marcus says this means the Federal Government should include dental care in Medicare as universal health coverage would encourage regular check-ups, and promote preventive care and early intervention.

“With more pressure on Government, and increasing inequalities within and between communities, oral health should be brought forward on the policy agenda. Universal health coverage in oral health would reduce emergency presentations at public hospitals, lessen long-term economic costs and promote prevention-oriented health.”

Marcus says mothers influence their children’s and family’s oral health behaviours. 

Family appointments with a child and mother is one possible solution to supporting CALD mothers, while flexibility in appointments (after hours/weekends) would also be advantageous.

The integration and collaboration within and between the primary healthcare sector should also be strengthened, he says. 

“As found in my study, the general practitioner and community nurses are key gatekeepers to the health system and information. They are the first point of contact in CALD communities and can help migrants navigate the oral healthcare system.” 

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