title: Informing a culturally appropriate approach to oral health and dental care for pre-school refugee children: a community participatory study.
abstract: BACKGROUND
  Pre-school children in families of recently settled refugees often have very high rates of early childhood caries (ECC). ECC is associated with a high level of morbidity and is largely preventable, however effective culturally appropriate models of care are lacking. This study aimed to provide a deeper understanding of the refugee experience related to early oral health by exploring pre-school refugee families (i) understanding of ECC and child oral health, (ii) experiences of accessing dental services and (iii) barriers and enablers for achieving improved oral health. The knowledge gained will be critical to the development of effective early oral health programs in refugee children.
  
  
  METHODS
  Community based participatory qualitative methodology using focus groups of resettled refugee families and community refugee nurse interviews. A community reference group was established and a bi-lingual community research associate was employed. Transcripts were analysed for thematic content using NVivo software.
  
  
  RESULTS
  There were 44 participants: eight focus groups (nine countries of origin) and five interviews. Emergent themes were (i) the major influence of parents' previous experience, including their beliefs about deciduous (baby) teeth, traditional feeding practices and poverty; and a consequent lack of understanding of the importance of early oral health and early dental caries, (ii) the burden of resettlement including prioritising, parenting, learning about new foods and how to assimilate into the community, and (iii) refugees' difficulties in accessing both information and dental services, and the role of schools in addressing these issues. An Opportunities for Change Model was proposed.
  
  
  CONCLUSIONS
  The main implication of the study is the demonstration of how enhanced understanding of the refugee experience can inform improvement in early oral prevention and treatment. The community participatory methodology of the study provided a basis for cross-cultural understanding and has already assisted in translating the findings and raising awareness in the provision of targeted refugee oral health services.
authors.affiliation: School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Science, M561 University of Western Australia, Perth 6009, Western Australia. pam.nicol@uwa.edu.au.
authors.forename: Pam
authors.initials: P
authors.lastname: Nicol
authors.forename: Arwa
authors.initials: A
authors.lastname: Al-Hanbali
authors.forename: Nigel
authors.initials: N
authors.lastname: King
authors.forename: Linda
authors.initials: L
authors.lastname: Slack-Smith
authors.forename: Sarah
authors.initials: S
authors.lastname: Cherian
mesh_terms: D022126:Access to Information; D000069:Acculturation; D000328:Adult; D001294:Attitude to Health; D002675:Child, Preschool; D055812:Community-Based Participatory Research; D054626:Consumer Health Information; D054521:Cultural Competency; D003729:Dental Care; D003731:Dental Caries / Q000517:prevention & control*; D005248:Feeding Methods; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009909:Oral Health; D016487:Parenting; D010290:Parents / Q000523:psychology; D011203:Poverty; D036301:Qualitative Research; D012036:Refugees; D012574:Schools; D014094:Tooth, Deciduous / Q000033:anatomy & histology; D014904:Western Australia