Barriers and facilitators to oral healthcare utilisation in culturally and linguistically diverse (CALD) communities

Abstract

This dissertation examines the barriers and facilitators to oral healthcare utilisation in CALD communities. Middle range theory is applied and a convergent mixed methods approach is undertaken. The systematic review synthesised the oral healthcare evidence of the phenomenon. Twenty included papers highlighted a multitude of factors at system, provider and family levels, which is depicted in my CALD specific rainbow model.

Quantitative analysis was conducted (n=25,000) using the NSW Adult Population Health Survey (2013, 2015). CALD adults/mothers were classified using country of birth and language variables, with dental utilisation as the outcome. Regression analysis revealed underutilisation of dental services in CALD adults, while CALD mothers (n=578) sought treatment-oriented services. CALD mothers experiencing psychological distress and those residing in outer remote areas also underutilised dental services. Thus, language and culture compounded inequalities.

Qualitative interviews with CALD mothers (n=33) and thematic analysis resulted in 1) dental hesitancy and 2) experiences with health workforce personnel. Firstly, five “C” factors were identified; Cost, Confidence in quality care, Confusion in the public-private health system, Competing priorities and Complacency. This was theorised as the dental hesitancy phenomenon to describe the delay or avoidance in accessing timely dental care. Secondly CALD providers, which I coin as the ‘dental diaspora’, were enablers for oral healthcare, as evidenced by waived fees, appointment flexibility, cultural and linguistic considerations.

Findings underscored the significant need for Universal Health Coverage in oral healthcare in

Australia and the need to reduce dental hesitancy barriers. The dental diaspora are facilitators to oral healthcare in CALD mothers. Aligned to WHO policy, this thesis contributes empirically, methodologically and theoretically to the dental social sciences field in oral health equity.