Parent perceptions of minimally invasive dental treatment of Australian Aboriginal pre-school children in rural and remote communities

Introduction: Aboriginal children in rural and remote communities in Australia suffer from a higher burden of dental decay and have poorer access to dental services than their non-Aboriginal counterparts. In the Kimberley region of Western Australia (WA), Aboriginal children experience 6 times the rate of untreated dental decay than non-Aboriginal children. Access to dental care is challenged by the availability and appropriate delivery of services in remote locations. This study elicited the experiences and perceptions of parents and carers (P/Cs) who participated in a project which tested the minimally invasive Atraumatic Restorative Treatment and the Hall Technique approaches (ART/HT) to manage early childhood dental caries among Australian Aboriginal pre-school children.
Methods: The core study design was a stepped wedge cluster community-randomised controlled trial. Consenting communities in the Kimberley region of WA were randomised into early and delayed intervention groups. Children were clinically examined at study commencement and the early intervention group was offered dental treatment using the ART/HT approach, and the delayed group was advised to seek dental care from their usual service provider. At the 12-month follow-up children in both groups were re-examined and offered care using the minimally invasive model of care and P/Cs were invited to take part in focus group interviews. Semi-structured interviews, guided by the yarning approach were conducted with consenting P/Cs in community locations of convenience to participants. The same open-ended questions were asked of all participants, and the interviews were audio recorded with permission, and transcribed by an independent agency. Thematic analysis was undertaken and coding of the transcripts using NVivo software performed, and emergent themes were identified and developed.
Results: One-to-one interviews were conducted with 29 P/Cs. (ten P/C’s from five test communities; 19 P/C’s from eight control communities). Interviewees consisted of 3 males and 26 females. Following thematic analysis three main themes (and sub themes) were identified: 1. Access to care (barriers, service availability, family impact due to lack of access); 2. Care received (cultural safety, child-centred care, comprehensiveness of care); 3. Community engagement (service information, engagement, oral health education).Structural and system factors as well as geography were identified as barriers by P/Cs in accessing timely and affordable dental care in culturally safe environments as well as the impacts from lack of access to care. Comprehensive care delivered within community, underpinned by child-and family-centred care, was valued by P/Cs. Of equal importance was the holistic approach adopted through the building of community engagement and trusting relationships.
Conclusions: A high level of satisfaction was reported by P/Cs with their experience of dental care for their children with the minimally invasive approach. Satisfaction was expressed around ease of accessing services delivered in a child- and family-centred manner, and which were well supported by appropriate engagement between service providers, communities and families. The findings from this study suggest a minimally invasive dental care model can be considered effective and culturally acceptable, and should be considered in delivering oral health services for young children in rural and remote locations.