Nov 4th 2013

1. Improving Access To Oral Health
Of Underserved Immigrants By
Stakeholder Collaboration
Quality Improvement Survey & Literature Review
Report
Ahthesham (Practicum Student)

2. Canada- Land of Immigrants
• Cultural diversity
• Skilled employment
• Contribution to arts, literature,
research
• Improved trade and commerce
• Innovation – risk takers
• “Saskatoon- Youngest, fastest growing city”
(National Post, Epoch Times, Stats Can)

3. Source: http://www.statcan.gc.ca/pub/91-214-x/91-214-x2009000-eng.pdf

4. Why Do So Many Immigrate To Canada?

5. Healthy Immigrant Symbiosis Cycle
Successful
Symbiotic
Relationship
Optimal
Contribution
to Canadian
Economy
Aspirant
Screened for Good Health
Low Disease
Burden
Immigrates

6. What Actually Could Be Happening
Symbiosis Fails
Poor
Quality of
Life
Aspirant
Screened for
Good Health
Oral Effects
General Health
Deteriorating
Oral Health
Immigrates
Barriers to
Oral Health
Access

7. Objectives Of The Project
1. To establish the disparities in oral health conditions of new
immigrants
2. To identify barriers that lead to disparities
3. To identify collaborative approaches by partners to mitigate
barriers
4. To assess stakeholder receptiveness to participate in opening
access to care
5. To formulate recommendations based on findings

8. Source Countries
Source country
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1
Philippines
11,011 11,987 13,303 17,525 17,718 19,067 23,727 27,277 36,580 34,991
2
China, People's
Republic of
33,304 36,251 36,429 42,292 33,078 27,013 29,337 29,051 30,195 28,696
3
India
28,838 24,594 25,573 33,141 30,746 26,047 24,548 26,117 30,252 24,965
4
United States
5,294
6,013
7,507
9,263 10,943 10,449 11,216
9,723
9,245
8,829
5
Iran
7,889
5,651
6,063
5,502
7,073
6,663
6,010
6,064
6,815
6,840
6
United Kingdom
4,724
5,199
6,062
5,864
6,541
8,128
9,243
9,565
9,499
6,550
7
Haiti
2,217
1,945
1,657
1,719
1,650
1,614
2,509
2,085
4,552
6,208
8
Pakistan
14,173 12,351 12,793 13,575 12,329
9,545
8,051
6,213
4,986
6,073
9
France
3,962
4,127
5,028
5,430
4,915
5,526
6,383
7,299
6,934
5,867
10
United Arab Emirates
4,444
3,321
4,358
4,053
4,100
3,368
4,695
4,640
6,796
5,223
Source: Citizenship and Immigration Canada
http://www.cic.gc.ca/english/resources/statistics/facts2011/permanent/10.asp

9. Disparities Among New Immigrants
• Have a higher rate of unmet dental needs
• Lower rates of visiting a dental office
• Are less likely to have oral health insurance
• Children of immigrants bare a disproportionate burden of oral
diseases

10. Barriers To Oral Health Access
• Age of Immigrants
– Negatively correlated
• Financial Barriers
– Dental Care rated 4th most expensive disease to treat- WHO
• Language
– China, India, Philippines do not speak English or French as their
primary language
• Gender
– Barrier in male dominated societies
• Educational Background
– Less educated have lesser access to oral health care

11. Stakeholders in Collaboration
Government Agencies
– Norway and Japan ~ 75% public borne
– 5 to 6% of Canadians covered under public
insurance
– Saskatchewan has limited public sponsored oral health
programs

12. Stakeholders in Collaboration Cont..
Dental Professionals
– Disproportionate distribution of dentists
– Long waiting period
– Expensive
•
•
•
•
Dental Therapists
Dental Assistants
Dental Hygienists
Oral Health Educators
…under Dentist’s supervision/ partnership
Researchers
– Research on dentistry needs a boost

13. Quality Improvement Survey
Immigration and Settlement Agencies – Key Partners
Methodology
I.
Pilot Interviews
2 prominent agencies approached for focus discussions
ll.
Paper Based
10 Question Survey
Target Audience: The users of services- New immigrants and
the University Students
lll.
Social Media
7 Question Survey
Target Audience: The providers of integration services
E-mail

14. Results
•
•
•
•
77% of respondents were in Canada for < 2yrs
93% Good oral health is important
22% do not know where to seek information
63% of the respondents have Dental insurance
Top 3 Barriers
COST
ACCESS
TIME CONSUMING

15. The 7 Question Survey
• Methodology
– 13 Settlement agencies contacted- phone
– A fillable macros word document (tool) was developed
– Disseminated as an email attachment
• Results
– 2 Responses!
– Agreed on the importance of opening access

16. Limitation and Discussion
•
Sampling
– Convenience Sampling
•
10 Question Survey
Discontinuation of key partner pinned down the number of participants for
the 10 Question Survey
– Change in implementation plan
– Probability of bias
•
7 Question Survey
Low response rate from target agencies
– No conclusive results
•
Participation was completely voluntary
– No incentives offered
•
Results were self reported
– Chances of over reporting (bias)

17. Recommendations
1. Continue to advocate for continuation of fluoridation of water in
Saskatoon by involving and educating the residents.
2. Establish new immigrant families as an underserved group with
'unique barriers' and advocate for a dedicated, sustainable, need
centric public sponsored oral health care program.
3. Involve the researchers in identifying the 'unique barriers' using
this evidence based approach, collaborate with appropriate
partners in reducing barriers.
4. Establish integration and settlement agencies as 'key partners' in
acting as important facilitation centers: to disseminate oral health
education, identify and mitigate barriers and open access to any
information to dental care.

18. 5. Train the trainer- Identify one champion from integration and
settlement services to be trained and certified by SHR in
disseminating oral health education/information to its
clients.
6. Explore the opportunity to pilot train registered nurses to
identify dental needs in immigrant domains they serve.
7. Encourage collaborations between dental students and
student therapists/hygienists to conduct periodic screening
camps in immigrant communities

19. Median Age by Census Metropolitan Area-2010 (Immigrants Included)