Table 2 Characteristics of included program evaluations on Integrated primary oral health care in Indigenous communities

Pacza T, et al. 2001, Australia [55]

Pilot study

• To develop IHW training program with the proper teaching methodologies assuring its effective delivery and to assess students’ experience

• Pilot training program developed as a prerequisite to a culturally appropriate preventive oral health program

• Conducted as series of modules at two Indigenous training schools

• Observation

• Questionnaires

• Program effectiveness

• Students’ feedback

• Program was effective and identified considering 10 students per trainer

• Students were satisfied and considered this training relevant to their needs.

Macnab AJ, et al., 2008, Canada [56]

Intervention

Cross-sectional study

• To improve oral health and oral health knowledge among school children

• Community visits by a team of 2 trained medical residents with one supervisor

• Integration of oral health program with well-baby and well-child clinic

• Incorporation of regular toothbrushing sessions, fluoride rinse and varnish application and dental health anticipatory guidance and classroom presentation by residents

• Pre-post intervention examination by dentist

• Community feedback

• dmfs/DMFS

• Caries free status

• Questionnaire on oral habits

• Subjective community experience

• dmfs/DMFS measures improved, and caries free children increased from 8 to 32% after 3 years of intervention

• Improved oral health behaviours

• Community responded positively for the program.

Jackson-Pulver L, et al., 2010, Australia [57]

Program evaluation/ Mixed method

• To develop a ‘Filling the Gap’ - volunteer dental program in partnership with the local community controlled primary health service

• Wuchopperen Health Service integrated dental services via a base clinic and mobile dental clinic

• Provision of visiting volunteer dentists

• Literature review

• Quantitative using patient health records and

• Qualitative using semi-structured interviews

• Episodes and type of care

• Effect on waitlist

• Stakeholders’ perception about the program

• Increased episodes of dental care and enrolment of new patient as well as increased volunteers’ visits.

• Meeting patient needs and reducing waiting list

• Improved workforce development and care continuity

Dyson K, et al. 2012, Australia [58]

Retrospective study

• To examine the cost-effectiveness of networked hub and spoke visiting model of Indigenous rural oral health services

• Integration of dental clinic with Indigenous health services at 5 rural sites

• Financial analysis (Measurement of service provision)

• Costs to value of care ratio (data retrieved records for the years 2006, 2008 and 2010)

• Cost to value ratio was 1.61.

• No significant different among 5 sites

• Cost to value ratio is similar to Government estimates (1.5–2).

Parker EJ et al., 2012,

(Aboriginal Children’s Dental Program in Port Augusta) Australia [59]

Intervention study/ Evaluation after 3.5 years

• To provide a cultural-friendly dental service

• Dental services by IHW and dentists, also in collaboration with dietician

• IHW were trained via dental students at Adelaide’s dental school through workshop

• Oral health related hospital records

• Informal interviews with health service staff

• Services statistics

• Key issues and challenges in the program

• Improved participation rates, increased number of preventive treatments compared to restorative treatments

• Key issues and challenges: issues related to consent, cancelled and failed appointments, difficulty in contacting and communicating parents and guardians

Harrison RL et al., 2012, Canada [60]

Cluster-randomized pragmatic trial

• To compare the dental health status of young Cree children whose mothers received maternal counselling with that of children whose mothers only received educational pamphlets

• Oral health related Motivational interview-style counselling by trained community health representatives or local women in test communities

• Distribution of educational pamphlets to mothers

• Dental examination

• Questionnaire

• Dental caries assessment (Pitts criteria) at 30 months of age

• Mothers’ dental health knowledge, behaviour and child caries related quality of life

• Low caries prevalence in test group compared to control, but not statistically significant.

• No significant difference for maternal oral health behaviours and child quality of life.

Portland District Health, Winda-Mara Aboriginal Corporation, 2012, Australia [73]

Deadly Teeth: promoting oral health in Gunditjmara country

• To provide a culturally appropriate oral health promotion services

• Oral health promotion services for families with children up to 5 years old

• Distribution of tip card including eat well, drink well and clean well tip cards

• Pre- and post- survey questionnaire over phone

• Culture appropriateness of the program

• 100% services believed that services were culturally appropriate.

Willder S et al., 2014, Australia [61]

‘Indigie-Grins’ program- A community-based oral health promotion program- Mixed method study

• To assess the oral health status of Indigenous children aged 5–12 years

• To develop and provide a culturally appropriate community intervention program

• IHWs helped in recruitment, retaining and education of the children and families during research

• They also participated as the principal researcher and designed the culturally specific aid and equipment for oral health promotion

• Oral health assessment by using dental caries and periodontal health indices

• Focus group discussion

• Oral health status

• Participants’ perception and attitude towards oral health (both pre- and post-)

• Improvement in unmet restorative needs, improved periodontal status of children

• Improved access, awareness and oral health behaviours of children and parents

Braun PA, et al., 2016, USA [62]

3-year Cluster-randomized community-based trial

• To measure the effectiveness of the program in reducing the caries increment in head start attending Navajo children

• Interventions (oral health promotion and Fluoride varnish application) were provided by trained Indigenous paraprofessionals, named as community oral health specialists.

• Oral examination, questionnaires

• Primary outcome indicator: change in dmfs with time

• Secondary outcomes indicators: DMFS, caries prevalence, caregiver oral health knowledge and behaviour

• No difference in caries reduction among intervention and control groups

• Improved knowledge among care giver at 1 year (but not at 2 and 3 year)

Murphy KL, et al., 2017, USA [63]

Non-experimental quality improvement project

• To integrate and evaluate a pediatric oral health project in an American Indian pediatric primary care setting

• This study involved pediatric and dental clinic at an Indian Health Service hospital

• Primary care providers had completed Smile for Life Curriculum

• They performed oral health screening, caries risk assessment, oral health education for parents and caregivers, and dental home referral

• Oral health screening and carried risk assessment using oral health risk assessment tool

• Oral health assessment

• Dental referrals

• Around 91% children assessed having high caries risk

• 72.4% referral and 74% of these were seen by the dentist

Mathu-Muju KR, 2017, Canada [53]

Qualitative research

• To explore the experiences of First Nations families whose children had enrolled in the COHI program

• COHI – Community-based preventive program for First Nations and Inuit children

• Semi-structured interviews

• Perception of community members whose children participated

• Improved oral health knowledge and behaviour of children and caregivers

• Improved access to preventive and restorative services

• Promoted continuity of care that facilitated referral and linkages for oral health care

Smith L, et al., 2018, Australia [64]

Community trial

• To evaluate the effectiveness of a dental health education program, Smiles not Tears, in preventing Early Childhood Caries in Indigenous children

• IHWs delivered age appropriate oral health education to families over five visits, screened children and distributed culturally appropriate resources

• At 6th visit, dental examination was done by dentist

• Dental caries indices (dmft, dmfs, Sic10 and SiC30)

• Comparison of caries prevalence of children at 30 months of age with children in control group

• More children in test group were caries-free compared to control group