Introduction by Croakey: The latest instalment of the #TalkingTeeth series of articles focusing on oral health follows the theme on advancing outcomes in oral health for Australians left out of the mainstream.
Below, authors Cathryn Forsyth, Marc Tennant, John Gilroy, Stephanie Short and Michelle Irving discuss reforms in the wider higher education sector to focus efforts on understanding Aboriginal and Torres Strait Islander culture in the context of healthcare.
This includes the development of a new Model for Indigenous Cultural Competence in Dentistry Education which aims to facilitate an improvement in the delivery of oral health services to Australia’s Aboriginal and Torres Strait Islander peoples and have a positive impact on the general health of Aboriginal and Torres Strait Islander Australians.
This was undertaken by Cathryn Forsyth as part of a PhD project. Cathryn’s awareness of the struggles faced by Aboriginal and Torres Strait Islander Australians was sparked by a childhood friend who was Aboriginal and adopted by a non-Indigenous family.
She stresses the important role that her Aboriginal and Torres Strait Islander colleagues and community members have played in developing her knowledge and attitudes toward Australia’s past and her understanding of the ongoing process of reconciliation.
She is committed to closing the huge gap that still exists between the oral health of Aboriginal and Torres Strait Islanders and non-Indigenous Australians and believes that one essential strategy to achieve this goal is to teach dental and oral health students to spend time learning in Indigenous communities and have an informed understanding of the history of Australia.
Cathryn Forsyth, Marc Tennant, John Gilroy, Stephanie Short and Michelle Irving write:
Aboriginal and Torres Strait Islander Australians experience more tooth decay and gum disease than non-Aboriginal and Torres Strait Islander Australians and untreated oral disease significantly impacts on their quality of life.
Twenty-seven percent of Aboriginal and Torres Strait Islander people suffer toothache compared to 15 percent of non-Indigenous Australians and most of their oral health problems go untreated, leading to tooth loss.
Aboriginal and Torres Strait Islander Australians also have more than double the rate of untreated dental decay – 57 percent compared to 25 percent in the non-Indigenous population – and 3.5 times the rate of gum disease.
Aboriginal and Torres Strait Islander children also experience consistently higher levels of dental decay than their non-Indigenous counterparts, with children who are socially disadvantaged and those living in rural or remote areas most affected.
Multiple factors hinder the availability of dental and oral health care for Aboriginal and Torres Strait Islander communities, including costs of treatment and access to services. Cultural appropriateness is often overlooked as a factor influencing access to dental and oral health services.
Dental educators in Australian universities struggle to equip future dental clinicians with sufficient psychosocial skills for cultural competence as traditional dental education has a narrow focus on restorative and surgical care.
Cultural competence in dental education
Cultural competence has been recognised as a leading strategy to improve dental and oral health outcomes for at-risk populations within the United States since the early 2000s.
In 2007 an Indigenous cultural competence curriculum framework for dental students was developed in 2007 by a team at the Centre for Rural and Remote Oral Health, now the IRCOHE at the University of Western Australia.
This foundation work led to the development of accreditation standards by the Australian Dental Council which require all dentistry and oral health professionals within Australia to provide culturally safe and culturally competent practices.
This includes recognition of the distinct needs of Aboriginal and Torres Strait Islander Australians in relation to oral health care provision.
L to R: Cathryn Forsyth, Michelle Irving, John Gilroy, Marc Tennant & Stephanie Short
A new model
Building on this work, a team of dental clinicians and social scientists from the Universities of Sydney and Western Australia has developed a new Model for Indigenous Cultural Competence in Dentistry Education.
This aims to support the integration of Aboriginal and Torres Strait Islander curricula for dental and oral health schools in Australia.
The model is based on five years of research, including several studies on how Aboriginal and Torres Strait Islander cultural competence can best be integrated into dental curricula.
In this model three main themes emerged being critical to students’ achieving Aboriginal and Torres Strait Islander cultural competence.
Firstly; governance is central to Aboriginal and Torres Strait Islander cultural competence educational reform, requiring commitment from accreditation and regulatory authorities in addition to all universities.
Secondly; an informed history of Aboriginal and Torres Strait Islander Australia is essential in consultation with Aboriginal and Torres Strait Islander peoples, to present content from an Aboriginal and Torres Strait Islander perspective.
Finally; students need to engage with Aboriginal and Torres Strait Islander communities and reflecting upon these experiences to improve their level of Aboriginal and Torres Strait Islander cultural competence upon graduation. (Figure 1)
Implementing the new model
Implementing this model requires qualified Aboriginal and Torres Strait Islander facilitators and sufficient teaching resources to equip academics to develop and deliver relevant and engaging cultural competence curricula.
This will enable students to actively participate in curricula through; didactic or online content, cultural immersion experiences within communities, and reflective writing practices; in order to increase their cultural competence knowledge, understanding and skills over the course of their degree.
This supports a positive and progressive movement along the cultural competence continuum, resulting in significant transformation for some students, with a minimal standard of cultural competence being achieved by all students. (see figure 1 below)
Figure 1: Aboriginal and Torres Strait Islander Cultural Competence Model for Dentistry Education; Br Dent J,2020
The aim of this new model is that all dental and oral health students recognise the social determinants of health, understand the needs of culturally diverse populations and can communicate with people across a variety of cultural settings.
This will facilitate an improvement in the delivery of oral health services to Australia’s Aboriginal and Torres Strait Islander peoples and have a positive impact on the general health of Aboriginal and Torres Strait Islander Australians.
Funding for this research project was provided by the Deputy Vice Chancellor Aboriginal and Torres Strait Islander Strategy and Services at the University of Sydney, key drivers of the Wingara Mura Bunga Barrabugu Aboriginal and Torres Strait Islander Strategy.