Abstract
OBJECTIVE: The objective of the Children’s Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities.
PARTICIPANTS: COHI targets preschool children; 5–7-year-olds; pregnant women; and parents/caregivers in FN/I communities.
SETTING: The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program’s implementation and agree to support a community member to be trained as a COHI aide.
INTERVENTION: Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children’s teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries.
RESULTS: COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services.
CONCLUSION: The results demonstrate COHI’s success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.
Key words: Indigenous health services, pediatric dentistry, oral health, dental caries, community health worker
Résumé
OBJECTIF: L’Initiative en santé buccodentaire des enfants (ISBE) vise à élargir l’accès aux services de santé buccodentaire préventifs offerts aux enfants inuits et des Premières Nations (IPN) vivant dans les réserves fédérales et les communautés éloignées.
PARTICIPANTS: L’ISBE cible les enfants d’âge préscolaire, les enfants de 5 à 7 ans, les femmes enceintes, et les parents et aidants vivant dans les communautés IPN.
LIEU: Mis à l’essai par Santé Canada en 2004, le programme est potentiellement disponible dans toutes les communautés IPN. Toutefois, la communauté doit consentir à la mise en œuvre du programme et accepter de soutenir la formation d’un membre de la communauté comme représentant ou représentante en santé dentaire pour l’ISBE.
INTERVENTION: Des thérapeutes et des hygiénistes dentaires filtrent les enfants admissibles, appliquent un vernis fluoré et un scellant sur les dents des enfants et stabilisent les caries dentaires actives avec du verre ionomère. L’une des innovations du programme a été la création du poste de représentant ou représentante en santé dentaire pour l’ISBE. Cette personne plaide en faveur de la santé buccodentaire préventive dans la communauté et donne des instructions aux enfants, aux parents ou aidants et aux femmes enceintes sur la prévention de la carie dentaire.
RÉSULTATS: L’ISBE a été mise à l’essai dans 41 communautés en 2004. Dix ans plus tard, l’initiative était présente dans 320 communautés IPN, soit 55% des communautés IPN admissibles. En 2012, 23 085 enfants avaient reçu des services de santé buccodentaire préventifs de l’ISBE.
CONCLUSION: Ces résultats indiquent que l’ISBE est un modèle efficace de prestation de soins buccodentaires préventifs dans les communautés éloignées. La mise en œuvre et la prestation des services de santé buccodentaire préventifs sont rehaussées par la présence continue d’un représentant ou d’une représentante en santé dentaire pour l’ISBE.
Mots clés: services de santé autochtones, dentisterie pédiatrique, santé buccodentaire, caries dentaires, auxiliaires de santé communautaire
Footnotes
Conflict of Interest: None to declare.
References
- 1.Aboriginal Affairs and Northern Development Canada. Available at: http://pse5-esd5.ainc-inac.gc.ca/fnp/Main/Search/SearchFN.aspx?lang=eng (Accessed August 24, 2015).
- 2.Rohan S. Opportunities for Co-operative Health Provision in Rural, Remote and Northern Aboriginal Communities. Ottawa, ON: Canadian Co-operative Association; 2003. [Google Scholar]
- 3.Inuit Oral Health Survey Report, 2008–2009. Ottawa, ON: Health Canada, 2011.
- 4.Health Canada. First Nations Oral Health Survey, 2010. Ottawa, ON: Health Canada; 2010. [Google Scholar]
- 5.Lawrence HP. Oral health interventions among Indigenous populations in Canada. Int Dent J. 2010;60:229–34. [PubMed] [Google Scholar]
- 6.Health Canada. Generations of Smiles: COHI Aide Training Manual. Ottawa, ON: First Nations Inuit Health Branch, Health Canada; 2005. [Google Scholar]
- 7.First Nations and Inuit Health. Health Canada. Available at: http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/FN/Ih-spni-eng.php (Accessed August 24, 2015).
- 8.Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Cochrane Database Syst Rev. 2010. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Harrison RL, Wong T. An oral health promotion program for an urban minority population of preschool children. Community Dent Oral Epidemiol. 2003;31:392–99. doi: 10.1034/j.1600-0528.2003.00001.x. [DOI] [PubMed] [Google Scholar]
- 10.Harrison R. Oral health promotion for high-risk children: Case studies from British Columbia. J Canada Dent Assoc. 2003;69(5):292–96. [PubMed] [Google Scholar]
- 11.Lewin SA, Babigumira SM, Bosch-Capblanch X, Aja G, Van Wyk B, Glenton C, et al. Lay Health Workers in Primary and Community Health Care: A Systematic Review of Trials. Geneva: World Health Organization; 2006. [Google Scholar]
- 12.Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. National Household Survey, Statistics Canada, 2011. Ottawa, ON. Catalogue no. 99-011-X2011001. ISBN: 978-1-100-22203-5.
- 13.Jamieson LM, Armfield JM, Roberts-Thomson KF. Oral health inequalities among indigenous and nonindigenous children in the Northern Territory of Australia. Community Dent Oral Epidemiol. 2006;34(4):267–76. doi: 10.1111/j.1600-0528.2006.00277.x. [DOI] [PubMed] [Google Scholar]
- 14.Mikkonen J, Raphael D. Social Determinants of Health: The Canadian Facts. Toronto, ON: York University, School of Health Policy and Management; 2010. [Google Scholar]
- 15.Jamieson LM, Parker EJ, Richards L. Using qualitative methodology to inform an Indigenous-owned oral health promotion initiative in Australia. Health Promot Int. 2008;23(1):52–59. doi: 10.1093/heapro/dam042. [DOI] [PubMed] [Google Scholar]
- 16.Adelson N. The embodiment of inequity: Health disparities in aboriginal Canada. Can J Public Health. 2005;96(Suppl2):S45–61. doi: 10.1007/BF03403702. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Hackett P. From past to present: Understanding First Nations health patterns in a historical context. Can J Public Health. 2005;96(Suppl1):S17–21. doi: 10.1007/BF03405311. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Traverso-Yepez M, Maddalena V, Bavington W, Donovan C. Community capacity building for health: A critical look at the practical implications of this approach. SAGE Open. 2012;2(2):1–12. doi: 10.1177/2158244012446996. [DOI] [Google Scholar]
- 19.Laverack G, Labonte R. A planning framework for community empowerment goals within health promotion. Health Policy and Plan. 2000;15(3):255–62. doi: 10.1093/heapol/15.3.255. [DOI] [PubMed] [Google Scholar]
- 20.Dumont J. First Nations Regional Longitudinal Health Survey (RHS) Cultural Framework. Ottawa, ON: First Nations Information Governance Centre; 2005. [Google Scholar]
- 21.Starkes JM, Baydala LT. Health research involving First Nations, Inuit and Métis children and their communities [Article in English, French] Paediatr Child Health. 2014;19(2):99–102. doi: 10.1093/pch/19.2.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Kemmis S, McTaggart R. Participatory research in action. In: Denzin NK, Lincoln YS, editors. Handbook of Qualitative Research. London: Sage Publications Ltd.; 2000. pp. 271–330. [Google Scholar]
- 23.Jamieson LM, Paradies YC, Eades S, Chong A, Maple-Brown L, Morris P, et al. Ten principles relevant to health research among Indigenous Australian populations. Med J Aust. 2012;197(1):16–18. doi: 10.5694/mja11.11642. [DOI] [PubMed] [Google Scholar]
- 24.Nash DA, Friedman JW, Mathu-Muju KR, Robinson PG, Satur J, Moffat S, et al. A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Therapists to the Oral Health Workforce in the United States. 2012. [Google Scholar]
- 25.Jamieson LM, Parker EJ, Richards L. Using qualitative methodology to inform an Indigenous-owned oral health promotion initiative in Australia. Health Promot Int. 2008;23(1):52–59. doi: 10.1093/heapro/dam042. [DOI] [PubMed] [Google Scholar]
- 26.Macintosh AC, Schroth RJ, Edwards J, Harms L, Mellon B, Moffatt M. The impact of community workshops on improving early childhood oral health knowledge. Pediatr Dent. 2010;32(2):110–17. [PubMed] [Google Scholar]
- 27.Watt R, Sheiham A. Inequalities in oral health: A review of the evidence and recommendations for action. Br Dent J. 1999;187(1):6–12. doi: 10.1038/sj.bdj.4800191. [DOI] [PubMed] [Google Scholar]
- 28.Harrison RL, Veronneau J, Leroux B. Effectiveness of maternal counseling in reducing caries in Cree children. J Dent Res. 2012;91(11):1032–37. doi: 10.1177/0022034512459758. [DOI] [PubMed] [Google Scholar]
- 29.Treatment of Preventable Dental Cavities in Preschoolers: A Focus on Day Surgery under General Anesthesia. Ottawa: Canadian Institute for Health Information, 2013. ISBN: 978-1-77109-222-7.
- 30.Kelly MD. Toward a new era of policy: Health care service delivery to First Nations. Int Indig Policy J. 2011;2(1):11. [Google Scholar]