Improving Access To Oral Health Of Underserved Immigrants By

Stakeholder Collaboration

Quality Improvement Survey & Literature Review Report

Ahthesham (Practicum Student)

Canada- Land of Immigrants

• Cultural diversity• Skilled employment• Contribution to arts, literature,

research• Improved trade and commerce • Innovation – risk takers

• “Saskatoon- Youngest, fastest growing city” (National Post, Epoch Times, Stats Can)

Source: http://www.statcan.gc.ca/pub/91-214-x/91-214-x2009000-eng.pdf

Why Do So Many Immigrate To Canada?

Healthy Immigrant Symbiosis Cycle

Aspirant

Screened for Good Health

ImmigratesLow Disease Burden

Optimal Contribution to Canadian

Economy

Successful Symbiotic

Relationship

What Actually Could Be Happening

Aspirant

Screened for Good Health

Immigrates

Barriers to Oral Health

Access

Deteriorating Oral Health

Oral Effects General Health

Poor Quality of

Life

Symbiosis Fails

Objectives Of The Project

1. To establish the disparities in oral health conditions of new immigrants

2. To identify barriers that lead to disparities

3. To identify collaborative approaches by partners to mitigate barriers

4. To assess stakeholder receptiveness to participate in opening access to care

5. To formulate recommendations based on findings

Source CountriesSource country 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

1 Philippines 11,011 11,987 13,303 17,525 17,718 19,067 23,727 27,277 36,580 34,991

2China, People's Republic of 33,304 36,251 36,429 42,292 33,078 27,013 29,337 29,051 30,195 28,696

3 India 28,838 24,594 25,573 33,141 30,746 26,047 24,548 26,117 30,252 24,965

4 United States 5,294 6,013 7,507 9,263 10,943 10,449 11,216 9,723 9,245 8,829

5 Iran 7,889 5,651 6,063 5,502 7,073 6,663 6,010 6,064 6,815 6,840

6 United Kingdom 4,724 5,199 6,062 5,864 6,541 8,128 9,243 9,565 9,499 6,550

7 Haiti 2,217 1,945 1,657 1,719 1,650 1,614 2,509 2,085 4,552 6,208

8 Pakistan 14,173 12,351 12,793 13,575 12,329 9,545 8,051 6,213 4,986 6,073

9 France 3,962 4,127 5,028 5,430 4,915 5,526 6,383 7,299 6,934 5,867

10 United Arab Emirates 4,444 3,321 4,358 4,053 4,100 3,368 4,695 4,640 6,796 5,223

Source: Citizenship and Immigration Canadahttp://www.cic.gc.ca/english/resources/statistics/facts2011/permanent/10.asp

Disparities Among New Immigrants • Have a higher rate of unmet dental needs

• Lower rates of visiting a dental office

• Are less likely to have oral health insurance

• Children of immigrants bare a disproportionate burden of oral diseases

Barriers To Oral Health Access

• Age of Immigrants– Negatively correlated

• Financial Barriers– Dental Care rated 4th most expensive disease to treat- WHO

• Language– China, India, Philippines do not speak English or French as their

primary language

• Gender– Barrier in male dominated societies

• Educational Background– Less educated have lesser access to oral health care

Stakeholders in Collaboration

Government Agencies– Norway and Japan ~ 75% public borne

– 5 to 6% of Canadians covered under public insurance

– Saskatchewan has limited public sponsored oral health programs

Stakeholders in Collaboration Cont..Dental Professionals

– Disproportionate distribution of dentists– Long waiting period– Expensive

• Dental Therapists• Dental Assistants• Dental Hygienists • Oral Health Educators …under Dentist’s supervision/ partnership

Researchers– Research on dentistry needs a boost

Quality Improvement Survey

Immigration and Settlement Agencies – Key Partners

MethodologyI. Pilot Interviews

2 prominent agencies approached for focus discussions

al. 10 Question Survey Target Audience: The users of services- New immigrants and

the University Students

bl. 7 Question SurveyTarget Audience: The providers of integration services

Paper Based

Social Media

E-mail

Results• 77% of respondents were in Canada for < 2yrs• 93% Good oral health is important• 22% do not know where to seek information• 63% of the respondents have Dental insurance

Top 3 Barriers

COSTACCESS TIME CONSUMING

The 7 Question Survey

• Methodology– 13 Settlement agencies contacted- phone– A fillable macros word document (tool) was developed– Disseminated as an email attachment

• Results– 2 Responses!– Agreed on the importance of opening access

Limitation and Discussion• Sampling

– Convenience Sampling

• 10 Question SurveyDiscontinuation of key partner pinned down the number of participants for the 10 Question Survey– Change in implementation plan– Probability of bias

• 7 Question SurveyLow response rate from target agencies– No conclusive results

• Participation was completely voluntary– No incentives offered

• Results were self reported– Chances of over reporting (bias)

Recommendations1. Continue to advocate for continuation of fluoridation of water in Saskatoon

by involving and educating the residents.

2. Establish new immigrant families as an underserved group with 'unique barriers' and advocate for a dedicated, sustainable, need centric public sponsored oral health care program.

3. Involve the researchers in identifying the 'unique barriers' using this evidence based approach, collaborate with appropriate partners in reducing barriers.

4. Establish integration and settlement agencies as 'key partners' in acting as important facilitation centers: to disseminate oral health education, identify and mitigate barriers and open access to any information to dental care.

5. Train the trainer- Identify one champion from integration and settlement services to be trained and certified by SHR in disseminating oral health education/information to its clients.

6. Explore the opportunity to pilot train registered nurses to identify dental needs in immigrant domains they serve.

7. Encourage collaborations between dental students and student therapists/hygienists to conduct periodic screening camps in immigrant communities

Median Age by Census Metropolitan Area-2010 (Immigrants Included)