Table 2.

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

Author, year and country	Type of Study	Study objective	Setting	Data collection	Indicators	Study outcomes
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