Table 3.

General characteristics of studies selected

Study authors, year, country	Aims/purpose	Study population Sample size	Methodology/ Intervention	Key findings	Gaps in research noted
Van Midde et al. (2020)47 The Netherlands	Explored the accessibility of voluntary dental services for undocumented migrants	Refugees & migrants 21	Qualitative Semi-structured interviews	Voluntary dental care improved accessibility of oral health services for undocumented migrants. However, both migrants and dentists involved were unsatisfied with the treatment results as the level of care delivered varied widely owing to resource limitations and cultural differences.	N/A
Calvasina et al. (2015)19 Canada	Identified self-reported barriers to oral health care among settled immigrants in Canada over a 4-year period.	Immigrants 3976	Quantitative Longitudinal cohort study	Poor oral health and barriers to care are identified as being linked to sex, low employment and income, and self-perceived discrimination. The findings support the need for policy development to improve access to dental care. Strategies that also address poverty and psychosocial stressors experienced by immigrants are crucial.	Data on immigrants’ self-reported oral health are limited; more research from the perspective of immigrants is needed to better understand barriers to oral health and impacts of resettlement.
Karnaki et al. (2022)46 Europe	Investigated the determinants of health that influence migrants’ and refugees’ ability to access dental care.	Refugees & migrants 1407	Quantitative Cross-sectional survey design	Migrants with higher educational levels, lower age, lower sense of discrimination, and better general and mental health were found to have greater access to dental care services and improved oral health outcomes.	Future studies could aim to investigate the impact of acculturation on diet and the dental caries prevalence and oral health status of migrants living in different settings.
Charbonneau et al. (2014)41 Canada	Investigated the experiences of dental hygienists practising in multicultural societies	Dental hygienists 5	Qualitative interpretative analysis Focus group	There is a minimal collective understanding of the details associated with culturally competent care among practising dental hygienists. Findings support the need for structured educational sessions on culturally competent care.	Future research could focus on providing insights into the most effective manner to teach and impart information on culturally competent care for oral health providers.
Paisi et al. (2022)42 England	Investigated factors involved in dictating access to dental services and oral health behaviours of asylum seekers and refugees	Oral health care providers 12	Qualitative Semi-structured interviews	Described appropriate health promotion techniques that can be implemented to address identified barriers to dental care. Initiatives suggested include providing linguistically appropriate preventive oral health education and training for health professionals to improve their ability to develop meaningful patient connections and promote effective care.	N/A
Calvasina et al. (2014)9 Canada	Examined the predictors of unmet dental care needs for adult immigrants	Immigrants 2126	Quantitative Cross-sectional analysis	The most significant barriers to dental care were identified as a lack of dental insurance and a yearly income less than $40,000 CAD.	N/A
Nicol et al. (2014)49 Australia	Explored current understanding of the refugee experience related to childhood oral health	Refugees 44	Qualitative Community-based participatory analysis/focus groups	Three main themes were identified that impact refugees’ experience of early oral health care: the parent experience, resettlement issues, and enablers and barriers to accessing dental services.	N/A
Ruiz-Casares et al. (2016)43 Canada	Investigated health service providers’ knowledge of health care coverage for refugees	Health care providers 1772	Quantitative Cross sectional survey analysis	Health care providers were identified as having a minimal understanding of refugee health care coverage. Findings suggest the need for improving knowledge of policy changes to prevent confusion among health care professionals and ensure that appropriate care is given.	N/A
Doucette et al. (2018)40 Canada	Investigated the benefits of professionally trained versus untrained language interpreters in the delivery of dental hygiene care to immigrants	Dental hygiene students, faculty & volunteer language interpreters 22	Quantitative Cross-sectional survey design	The use of language interpreters was reported as improving dental hygiene students’ confidence in providing culturally competent care. A preference for professionally trained interpreters was identified as a facilitator to reducing miscommunication of health concepts.	Future research should investigate the impact of interpreters working alongside practising clinicians for improving cultural competency.
Suurmond et al. (2013)44 The Netherlands	Sought to identify challenges facing health care providers in their first contact with asylum-seeking/refugee populations	Public health nurse practitioners & physicians 46	Qualitative Surveys and focus group interviews	Care providers’ first contact experiences were dominated by 4 challenges: proper assessment of current health condition, assessment of health risks, providing information on the host country’s health system, and providing health education. Use of professional interpreters, sufficient time for health assessments, and improved referral pathways to other services/providers are needed to promote culturally competent care.	Future research should include the perspectives of both health care providers and asylum seekers to inform aspects of care requiring closer attention.
Subedi and Rosenberg (2014)20 Canada	Explored socioeconomic factors and health outcomes of recent versus settled immigrants in Canada	Immigrants 10,664	Quantitative Cross-sectional survey analysis	There are statistically significant variations in health outcomes between new and established immigrants in Canada. Health status was found to deteriorate with length of time in the country owing to challenges accessing health services, language barriers, low household income, and work-related stress.	Future research using longitudinal data may better inform mental health status of immigrants and impacts on health outcomes as well as health care challenges faced by immigrants.
Jensen et al. (2013)45 Denmark	Investigated the experience of general practitioners who provide care to refugees	General practitioners (MD) 9	Qualitative content analysis Semi-structured interviews	Care for refugees deviated from standards of care for the general populace. A lack of national policy to direct appropriate care management of refugee populations is identified as contributing to sentiments of disempowerment among providers leading to reluctance to initiate comprehensive care.	Future research should include the refugee patient perspective to better inform how care is received.
Burchill and Pevalin (2014)29 England	Explored the experiences of nurses working with refugee and asylum-seeking families using Quickfall’s model (2004; 2010) for cultural competency assessment	Public health nurses 14	Qualitative analysis In-depth interviews	Nurse providers were found to demonstrate aspects of cultural competence within their practice but were challenged by frequent health policy changes for refugees which elicited confusion about care they could provide and resentment towards patients with high needs in the face of limited resources.	N/A
Zghal et al. (2021)48 Canada	Explored new immigrant perceptions of the cultural competence of health care providers and its impact on their reported health-related quality of life.	Immigrants 117	Quantitative Descriptive cross-sectional survey analysis	Immigrants’ reported health-related quality of life was found to be linked to competency of care providers under the following variables: experiences of discrimination, interpreter use, and trust in the health care provider. Improvements for patient–provider communication include non-discriminatory health policy development and linguistically appropriate resources.	Current scales to measure cultural competence may over- or underestimate discrimination and its health effects. Development of reliable instruments and engagement of immigrants in research design are required.