'The Letter Says I May or May Not Be Eligible… It Is a Big Doubt and Frustrating:' A Qualitative Study on Barriers and Facilitators to Children's Oral Healthcare From the Perspective of Karen Refugee Parents in Victoria

Abstract

Background: Australia has a longstanding tradition of resettling refugees and individuals in humanitarian need. Among these, the Karen community from Southeast Asia is rapidly growing in Australia. The absence of data on the barriers they face in accessing dental services is concerning. This study explores the barriers and facilitators Karen refugees encounter when seeking oral healthcare for their children in Australia, aiming to understand their experiences.

Methods: Using a qualitative research design with a phenomenological approach, we conducted semi-structured interviews with 23 parents (17 females and 6 males) who had been in Australia for 1-17 years. Each interview, lasting between 35 and 60 min, was audio-recorded and transcribed verbatim. The transcripts were thematically analysed through an inductive, data-driven approach, focusing on open coding and participant-based meanings.

Findings: Nine main themes were identified. At the individual level, cultural practices, parental behaviours and perceptions were the primary barriers. At the organisational level, long waiting lists in the public dental system were significant barriers. Additionally, a lack of knowledge about financial benefits and government support for children's dental care deterred refugees from seeking dental services. The results also highlighted the strengths of support networks, free dental care for children and school-based dental care programmes. Parents reported experiences of inadequate oral healthcare, citing issues such as insufficient cultural sensitivity training among dental service providers, interpreter problems and shortages. These experiences revealed gaps in the provision of oral healthcare services.

Conclusion: When designing tailored oral health promotion programs, all stakeholders must consider the lived experiences of refugees as valuable sources of information.

Patient or public contribution: The authors thank the parents and carers from the Karen refugee community for sharing their experiences with the oral healthcare of their children. Recruitment was facilitated by the Karen Organisation of Bendigo and Bendigo Community Health Services. An interpreter from the Karen refugee community assisted in all the interviews.

Keywords: Karen Refugee Community; access; children; oral healthcare; parents; qualitative research.

Figure 1

Barriers and facilitators to access dental services in Australia. Barriers to access appear in the inner and middle wheels, while the facilitators are presented in the outer wheel (underlined).

Figure 2

Dental care pathways for children from Karen Refugee Community.

Figure 3

Dental Care Episode showing the parents' experiences. Red boxes in the flowchart denote the negative experiences of parents with the dental service providers, interpreters and supporting clinical staff.