Oral Health Beliefs, Perceptions and Utilisation of Oral Health Care Services among the Indigenous People (Orang Asli) in Pahang, Malaysia: A Qualitative Study

@#Introduction: Orang Asli refers to the indigenous people of Peninsular Malaysia, representing 0.6% of the Malaysian population. Vast inequality was observed regarding oral health beliefs, behaviour, and utilisation of oral health services between the Orang Asli and non-Orang Asli. The aim of the study was to explore the oral health beliefs, perceptions, and oral health service utilization behaviour among Orang Asli in the district of Bera, Pahang, Malaysia. Methods: Orang Asli’s oral health beliefs and perceptions of oral healthcare service were ascertained through four FGDs. Nineteen participants from Bera’s semi-urban and rural Orang Asli communities were convened. Emerging themes from the qualitative data were analyzed using thematic analysis. Results: Orang Asli believed that oral health is essential for an individual’s function and aesthetics. They are also aware that inadequate oral hygiene care will result in tooth decay and gum disease. Most of the Orang Asli that chewed betel nuts believed that limestone paste could cause oral cancer. The main barriers to Orang Asli accessing oral healthcare services were time constraints and distance to the nearby clinic. Conclusion: The Orang Asli believed oral health care is essential in ensuring a healthy oral condition. Despite their generational belief towards traditional healers and medication, Orang Asli in Bera had a perceived positive acceptance towards oral healthcare services.

Oral Health Literacy in Migrant and Ethnic Minority Populations: A Systematic Review.

Cultural background influences how migrants and ethnic minority populations view and assess health. Poor oral health literacy (OHL) may be a hindrance in achieving good oral health. This systematic review summarizes the current quantitative evidence regarding OHL of migrants and ethnic minority populations. The PubMed database was searched for original quantitative studies that explore OHL as a holistic multidimensional construct or at least one of its subdimensions in migrants and ethnic minority populations. 34 publications were selected. Only 2 studies specifically addressed OHL in migrant populations. Generally, participants without migration background had higher OHL than migrant and ethnic minority populations. The latter showed lower dental service utilization, negative oral health beliefs, negative oral health behavior, and low levels of oral health knowledge. Due to its potential influence on OHL, oral health promoting behavior, attitudes, capabilities, and beliefs as well as the cultural and ethnic background of persons should be considered in medical education and oral health prevention programs.

Creencias relacionadas al cuidado de la salud oral en cuidadores de adultos mayores institucionalizados de la ciudad de Antofagasta, Chile, 2019

Resumen Objetivo: analizar las creencias relacionadas al cuidado de la salud oral en cuidadores de adultos mayores institucionalizados de la ciudad de Antofagasta, Chile, 2019. Material y Métodos: Estudio cuantitativo, observacional, descriptivo, transversal. Se entrevistó a 49 cuidadores con el cuestionario DCBS-sp, para determinar sus creencias relacionadas al cuidado de la salud oral. Para análisis estadístico se utilizó STATA 14 ®. Resultados: El 36,73% tiene capacitación en salud oral y el 97,96%, percibe la necesidad de capacitarse. Cuidadores con capacitación tienen significativamente más puntajes promedio favorables a la salud bucal en las dimensiones locus control interno y autoeficacia. Conclusiones: Cuidadores tienen baja capacitación para el cuidado de la salud bucal, existiendo creencias desfavorables al cuidado de la salud bucal de las personas mayores institucionalizados. Es necesario diseñar intervenciones de educación para la salud bucal en este grupo que permitan mejorar las creencias relacionadas al cuidado de la salud oral.

Resumo Objetivo: analisar as crenças relacionadas à atenção à saúde bucal em cuidadores de idosos institucionalizados na cidade de Antofagasta, Chile, 2019. Materiais e Métodos: Estudo quantitativo, observacional, descritivo, transversal. 49 cuidadores foram entrevistados com o questionário DCBS-sp para determinar suas crenças relacionadas aos cuidados com a saúde bucal. Para análise estatística, foi utilizado o STATA 14 ®. Resultados: 36,73% possuem treinamento em saúde bucal e 97,96% percebem a necessidade de treinamento. Cuidadores treinados apresentam escores médios significativamente mais elevados favoráveis ​​à saúde bucal nas dimensões de controle do locus interno e autoeficácia. Conclusões: Os cuidadores apresentam baixa formação para os cuidados com a saúde bucal, há crenças desfavoráveis ​​em relação aos cuidados com a saúde bucal de idosos institucionalizados. É necessário desenhar intervenções de educação em saúde bucal nesse grupo para melhorar as crenças relacionadas aos cuidados com a saúde bucal.

Abstract Objective: to analyze oral health care related beliefs among caregivers of the institutionalized elderly in Antofagasta, Chile, 2019. Material and methods: A quantitative, observational, descriptive, cross-sectional study was conducted. Forty-nine caregivers were interviewed with the DCBS-sp questionnaire to determine their oral health care beliefs. STATA 14® was used to conduct the statistical analysis. Results: Of the caregivers interviewed, 36.73% have oral health training, and 97.96% feel they need training. Trained caregivers have significantly better average oral health scores on internal locus of control and self -efficacy. Conclusions Caregivers have insufficient oral health training, and there are unfavorable beliefs about the oral health care of the institutionalized elderly. It is necessary to design oral health educational interventions to allow this group of professionals to improve their oral health care related beliefs.

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT.

BACKGROUND: Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. OBJECTIVES: To test effectiveness and assess the cost-benefit of different dental recall intervals over a 4-year period. DESIGN: Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost-benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. SETTING: UK primary care dental practices. PARTICIPANTS: Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. INTERVENTIONS: Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. MAIN OUTCOMES: Clinical - gingival bleeding on probing; patient - oral health-related quality of life; economic - three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. RESULTS: A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of -0.91 (95% confidence interval -5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of -0.98 (95% confidence interval -5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval -3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval -1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. LIMITATIONS: Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. CONCLUSIONS: Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. FUTURE WORK: Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN95933794. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Traditionally, dentists have encouraged both patients at low risk and patients at high risk of developing dental disease to attend their dental practices for regular 6-month 'check-ups'. There is, however, little evidence available for either patients or dentists to use when deciding on the best dental recall interval (i.e. time between dental check-ups) for maintaining oral health. In this study, we wanted to find out, for adult patients who regularly attend the dentist, what interval of time between dental check-ups maintains optimum oral health and represents value for money. A total of 2372 adults who regularly attended 51 different dental practices across Scotland, Northern Ireland, England and Wales were involved. Patients aged 18 years or over who received all or part of their care as NHS patients were randomly allocated to groups to receive a check-up either every 6 months, at an individualised recall interval based on their own risk of oral disease (risk-based recall), or every 24 months (if considered at low risk by their dentist). The recruited adults completed questionnaires at their first trial appointment and then every year of the 4-year study. Their attendance at recall appointments was recorded and they received a clinical assessment taken by study staff at the end of their involvement at year 4. After 4 years, there was no evidence of a difference in the oral health of patients allocated to a 6-month or variable risk-based recall interval. For patients considered by their dentists to be suitable for a 24-month recall interval, there was no difference between those in the 24-month, 6-month or risk-based recall intervals. However, people greatly value and are willing to pay for frequent dental check-ups. The recall strategy that offers the best value for money to patients and the NHS, therefore, depends on what people and decision-makers wish to value within a health-care system.

Hispanic Seasonal Farmworker Caregivers' Beliefs and Perceptions of Early Childhood Caries.

Purpose: Children of Hispanic seasonal or migrant farmworkers in the United States (US) experience high rates of Early Childhood Caries (ECC) and have high rates of untreated dental caries. The purpose of this study was to explore Hispanic seasonal farmworker caregivers' beliefs and/or perceptions regarding ECC their children's oral health.Methods: A qualitative explanatory model interview approach was used with a purposive sample of Hispanic parents/caregivers, working and residing in Orange and Ulster Counties, New York. The Explanatory Model Interview Catalogue (EMIC) was used as a guide to the semi-structured, recorded interviews conducted in locations selected by the participants. The texts were independently read and thematically analyzed by two researchers.Results: A total of 20 parents/caregivers consented to participate. Six themes were identified for the components of the EMIC and included: etiology: eating candy/sweets (65%); sign/symptoms of decay: tooth color change (50%); pathophysiology: not brushing daily (75%); course of disease/impact on daily life: appearance (40%); impact of caries on child's future health: affects child until adult teeth erupt (25%); treatment for pain: tooth brushing (55%). Over half of the respondents (55%) indicated that getting dental care for their children was a priority.Conclusion: Results from this study showed that Hispanic seasonal farmworkers have a desire to maintain their children's oral health. However, they lacked knowledge in some key concepts related to the disease process and prevention of ECC. Caregivers need additional oral health education with consideration for oral health literacy.

A storytelling intervention reduces childhood caries risk behaviors among American Indian and Alaska Native mothers in Northern California.

OBJECTIVES: To evaluate a storytelling intervention targeting the oral health beliefs, knowledge, and behaviors of AIAN pregnant women and mothers. METHODS: Fifty-three adult AIAN women from three tribal communities in Northern California participated. The intervention story delivered oral health messaging using a traditional storytelling format. The effect of the intervention on self-reported oral health behaviors, dental knowledge, and beliefs was assessed using a pretest-posttest design, with an additional six-month follow-up. Tests of repeated measures using Generalized Linear Models were conducted to assess changes in oral health knowledge, beliefs, and behaviors. RESULTS: Knowledge and beliefs significantly increased as a result of the intervention and persisted after six months. A consistent, significant increase in positive oral health behaviors from baseline to six-months was also observed. CONCLUSIONS: The results of this intervention study suggest promise for traditional storytelling to increase oral health-related knowledge, beliefs, and behaviors among self-identified AIAN pregnant women and mothers.

Vietnamese Oral Health Beliefs and Practices: Impact on the Utilization of Western Preventive Oral Health Care.

Purpose: Infrequent use of the Western health care by the Vietnamese may be explained by deeply-rooted traditional oral health beliefs and practices unique to the Asian culture. This study investigated Vietnamese oral health beliefs and practices and their relationship to the utilization of Western preventive oral health care services among Vietnamese-Americans.Methods: An exploratory, cross-sectional survey design with a convenience sample of 140 par-ticipants (n = 140) was used for this study. Participants were recruited on site of a Vietnamese-owned business, with questionnaires consisting of 28 questions that were distributed in hard copy by the principal investigator (PI) on multiple occasions and at various times of the day.Results: Spearman Rank Correlations tests showed participants who agreed with the statement, "Regular dental visits will help prevent dental problems," were more likely to utilize medical health services (p< 0.05) and visit a dentist if their "gums were bleeding" (p< 0.05). However, only 22.86% of the participants would visit a dentist if experiencing a toothache. Despite results showing a strong association between the use of medical health care services and the belief that dental visits can prevent future dental health problems, participants did not believe in seeking Western oral health care for all dental health issues. No statistical significance was found between age, gender, pri-mary language, years spent in the United States, education level, religion and the Vietnamese survey participants' individual oral beliefs and practices.Conclusion: The results suggest that Vietnamese Americans holding the belief that dental visits help prevent oral health problems, were more likely to utilize Western health care services. The study also supports existing literature that Vietnamese oral health beliefs and practices impact the use of Western health care services.

Oral health beliefs, knowledge, and behaviors in Northern California American Indian and Alaska Native mothers regarding early childhood caries.

OBJECTIVES: To assess the oral health beliefs, knowledge, and behaviors related to early childhood caries (ECC) risk in a convenience sample of American Indian and Alaska Native (AIAN) mothers residing in rural Northern California communities. METHODS: Fifty-three mothers of young children were recruited from three tribal communities in Northern California with the assistance of the California Rural Indian Health Board, Inc. and its California Tribal Epidemiology Center and Dental Support Center. Trained study staff administered questionnaires to obtain basic socio-demographic information, to survey participants on their oral health beliefs, knowledge, and behaviors as related to ECC risk, and to identify possible barriers to their accessing professional oral health care. Analyses of covariance were used to explore associations between socio-demographic indicators and oral health behaviors, after controlling for knowledge, beliefs and barriers to care. RESULTS: Overall, 53 percent of participants reported their oral health as "fair" or "poor." Mothers' education (high) and being employed were positively associated with better oral health behavior scores. Additionally, 72 percent of mothers reported having one or more barriers to oral health care including access. There was a significant relation (P = 0.03) between high number of reported barriers to oral health care and low oral health behavior scores. CONCLUSIONS: Despite generally high-level oral health knowledge, perceptions of self and child oral health remains low in this sample of AIAN mothers. Factors identified as being associated with oral health behaviors in this sample were similar to those found in other health disparities populations.

Creencias en salud oral de cuidadores de pacientes discapacitados y adultos mayores institucionalizados de la comuna de Quilaco, Región del Biobío / Oral health beliefs in caregivers of institutionalized disabled and elderly patients of the Quilaco commune, Biobío Region

El envejecimiento demográfico acelerado de la población de Chile supone un aumento en la prevalencia no solo de enfermedades crónicas, sino también de personas con discapacidad, y necesidad de ser cuidadas en forma permanente. En este sentido, tomando como grupo de estudio a los cuidadores de los adultos mayores institucionalizados de la comuna de Quilaco, Región del Biobío, analizamos las creencias en salud oral que los cuidadores poseen al momento de llevar a cabo la atención de los adultos mayores que se encuentran a su cargo.

The rapid aging of the population of Chile will produce an increase not only in the prevalence of chronic diseases, but also of people with disabilities, and their need to be cared for permanently. In this sense, taking the caregivers of the institutionalized elderly population of the Quilaco commune, Biobío Region, as a study group, we analyzed the oral health beliefs that caregivers have at the time of undertaking the care of older adults.

Qualitative description of dental hygiene practices within oral health and dental care perspectives of Mexican-American adults and teenagers.

OBJECTIVES: The objectives of this study were to identify dental hygiene themes voiced by adults and teenagers of Mexican origin [or Mexican Americans (MAs)] and place these themes within the larger landscape of oral health and dental care perceptions. METHODS: Interviews with urban-based MAs were analyzed to identify barriers, beliefs, and behaviors influencing engagement in dental hygiene practices. RESULTS: Adult (n = 16, ages 33-52) and teenage (n = 17, ages 14-19) MAs reported themes pertaining to structural factors (financial and economic-related barriers, the dual challenges of reduced access to care vis-à-vis successfully navigating the dental care system, and the effects of reduced social support derived from migration) and to individual factors (different agendas between MAs and health systems for dental care utilization and indications for oral self-care, including limited dental hygiene instruction from professionals and larger impacts from school-based and mass media). Also, prior experiences with dental hygiene, prevention, and associated themes were characterized by a range of attitudes from fatalistic to highly determined agency. Good family upbringing was instrumental for appropriate dental hygiene, anteceding good oral health; and outlining a loose structure of factors affecting oral health such as diet, having "weak" teeth, or personal habits. CONCLUSIONS: Themes from adults and teenagers in the Midwest United States were generally similar to other groups of MA parents and younger children. Dental hygiene was not salient relative to other oral health and dental care matters. Several opportunities for improvement of knowledge and enhancing motivation for dental hygiene practices were identified, both within and outside professional resources.