ABSTRACT Introduction Oral diseases have a severe impact on rural and remote Indigenous communities of Australia with widespread, severe dental caries leading to a significant number of Indigenous children requiring multiple dental extractions under general anaesthesia each year; a scenario rarely seen elsewhere in Australia. This burden of oral disease occurs in these communities in the context of very limited availability of dental personnel and access to oral health care. The rural and remote Indigenous communities of Australia rely on Indigenous Health Workers as key primary health care personnel. Experience in Western Australia and the Northern Territory suggests that the oral health role of these personnel can be developed to improve community oral health and reduce the burden of oral disease in Indigenous communities. The development of the Indigenous Health Worker oral health role is supported by major stakeholders including: the peak Indigenous health organisation, the National Aboriginal Community Controlled Health Organisation; the peak dental health organisation, the Australian Dental Association; and by Australia’s National Oral Health Plan. Yet limited progress has been made in the development of this role. Why? This case study seeks to answer this question through the exploration of the complex, multiple factors influencing the development of the oral health role of Indigenous Health Workers in the Cape York region and so support the development of this role among Indigenous Health Workers. Methodology This research was conducted in accordance with the National Health and Medical Research Council’s Statement and Guidelines for ethical conduct of Indigenous health research. Ongoing consultation took place with key Indigenous health organisations of the region. including Apunipima Cape York Health Council, Gurriny Yealamucka Health Service and the Queensland Aboriginal and Torres Strait Islander Health Worker Training Aboriginal Corporation, to confirm that the research focus was a priority of the communities of the region and to gain input into the design and implementation of the project. With the support of these Indigenous health organisations the study focused on the three communities in which an initial introduction to oral health promotion was provided to Indigenous Health Workers by Queensland Health through its Crocodile Smiles Project. Qualitative methodologies were used with data collection in the region undertaken through semi-structured interviews with 58 health personnel in the remote Indigenous communities of Hopevale, Napranum and Yarrabah; and in the regional centres of Cairns, Cooktown and Weipa. These interviews explored the perceptions of Indigenous Health Workers, dental personnel and their co-workers regarding the priority, characteristics and support needs of the development of the Indigenous Health Worker oral health role in the region. Results Interviews with rural and remote health personnel highlighted the severe impact of oral disease in these communities and on their health services and the high priority given to the development of the Indigenous Health Worker oral health role. These health personnel are seen as key to Indigenous health promotion in the region. Contrasting perspectives were found among rural and remote health personnel regarding the characteristics of an appropriate Indigenous Health Worker oral health role with consistent support being given to the development of the oral health promotion role and varied perspectives found concerning the development of a clinical oral health role. Rural and remote health personnel also highlighted the significant barriers to the development of the Indigenous Health Worker oral health role existing at the clinic and regional levels. Conclusion This study identifies drivers of role development as including oral health needs and oral health skills shortages in rural and remote Indigenous communities of Cape York. Facilitators to role development were found to include: the legislative and policy environment; the support of Indigenous Health Workers and their co-workers; and the policies and plans of Queensland Health and the Indigenous Community Controlled Health Organisations of the region. Significant barriers include: the existing work burden of Health Workers; the lack of clarity of Health Worker role definition; and the difficulties inherent in the development of appropriate inter-professional and cross-cultural training and management support strategies which are able to be implemented in remote settings. The research highlights the complexity of factors to be considered in achieving the system¬wide changes needed to support the development of this role and makes recommendations in the areas of policy, training, management and research to best support the development of this role. In focusing on the development of the oral health role of Indigenous Health Workers the study has examined an area of significance to the Indigenous community using culturally sensitive research methods in remote settings and has addressed a significant though little explored area of dental research – the development of the oral health role of non-dental personnel.

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2017-09-01T21:33:19Z No. of bitstreams: 1 DISS_2014_Jackelyne de Souza Pontes.pdf: 11674355 bytes, checksum: 4416113ef3f9e25af02a42fc100413a5 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-12T13:14:45Z (GMT) No. of bitstreams: 1 DISS_2014_Jackelyne de Souza Pontes.pdf: 11674355 bytes, checksum: 4416113ef3f9e25af02a42fc100413a5 (MD5) / Made available in DSpace on 2017-09-12T13:14:45Z (GMT). No. of bitstreams: 1 DISS_2014_Jackelyne de Souza Pontes.pdf: 11674355 bytes, checksum: 4416113ef3f9e25af02a42fc100413a5 (MD5) Previous issue date: 2014-08-29 / Este trabalho tem como objetivo difundir conhecimento sobre as condições de saúde bucal através de um estudo epidemiológico da cárie dental entre o povo do DSEI Xavante/MT, buscando melhor compreender a configuração do padrão bucal do referido povo. Objetivo: Analisar os fatores associados à prevalência da doença cárie da população do DSEI Xavante/MT Polo Base Água Boa, residente em Mato Grosso, em 2012. Método: Trata-se de estudo transversal da população Xavante atendida de janeiro à junho de 2012 na Fase I do Projeto Brasil Sorridente Indígena. As variáveis dependentes foram: o índice CPO-D (dente cariado, perdido e obturado) e o ceo-d (dente cariado, extraído e obturado) do tipo contínua (que permite mensuração) e as variáveis independentes: sexo, faixa etária, aspectos culturais (uso de tabaco, hábitos alimentares, práticas de autocuidado, adorno ou modificação na cavidade bucal), acesso à área urbana (distância da aldeia em relação à cidade, meios de locomoção). Os dados serão analisados por estatística descritiva, análise bivariada e regressão múltipla de Poisson, sendo considerado um nível de significância de 5%. Resultados: A prevalência da cárie dentária na população Xavante estudada foi de 99,38%, enquanto a média do índice de CPO-D encontrado foi de 11,59(±8,11). O componente obturado constituiu apenas 1,72% do índice, ao passo que os componentes cariado e perdido constituíram, respectivamente, 69,83% e 28,45%. Houve associação bruta significativa entre desigualdade na distribuição da doença e o tipo de dentição sendo que ambas se mantiveram associadas significativamente no modelo ajustado. A severidade da doença cárie também associou-se significativamente com a faixa-etária e o tipo de dentição. / This paper aims to disseminate knowledge about oral health conditions through an epidemiological study of dental caries among the people of DSEI Xavante / MT, seeking to better understand the configuration of oral patterns referred people. Objective: To analyze factors associated with the prevalence of caries of the DSEI Xavante / MT Base Good Water Polo, residing in Mato Grosso, in 2012 population factors. Method: This cross-sectional study of the Xavante population served from January to June 2012 in phase I of the Project Smiling Brazil Indigenous. The dependent variables were the CPO-D index (decayed tooth, missing and filled teeth) and the ceo-d (decayed tooth extracted and filled teeth) of the continuous type (which allows measurement) and the independent variables: gender, age, aspects cultural (tobacco use, dietary habits, self-care practices, adornment or modification in the oral cavity), access to the urban area (away from the village to the city, means of locomotion). Data will be analyzed using descriptive statistics, bivariate analysis and multiple Poisson regression, and the level of significance of 5%. Results: The prevalence of dental caries in Xavante population studied was 99.38%, while the average of the CPO-D index was found to be 10.40. The fillings constituted only 1.72% of the index, whereas decayed and lost parts formed, respectively, 69.83% and 28.45%. There was a significant association between gross inequality in the distribution of the disease and the type of dentition and both remained significantly associated in the adjusted model. The caries severity was also significantly associated with age group and type of dentition.