Oral Health Programmes in Indigenous Communities Worldwide-Lessons learned from the field: A qualitative systematic review.

Objectives: This systematic review examines the evidence on the effectiveness of programmes that aim to improve the oral health of Indigenous populations worldwide, as well as presents a qualitative analysis to explore the design and implementation of these initiatives.

Methods: MEDLINE and EMBASE were searched. Studies were included if they described an oral health programme for an Indigenous population in any country worldwide. A thematic synthesis of the qualitative findings was undertaken for each study's results and discussion sections.

Results: Nineteen studies were included. Sixteen studies reported positive results, twelve of which reported statistically significant findings. Three themes regarding design and implementation emerged from the qualitative analysis: (i) elements of successful programmes, (ii) challenges and barriers to successful interventions and (iii) suggestions for improvements.

Conclusions: Successful programmes considered cultural appropriateness in their design-including extensive community engagement before, during and after implementation to enhance ownership of, and thus participation in the programme. Collaborative approaches were seen as an advantage, not only with Indigenous communities, but also with local health providers and organizations, with particular emphasis on incorporation into existing services. Challenges included low community participation, unstable funding and staffing issues. In addition, future programmes should also incorporate advocacy and community development, focus on changes to public policy, utilize evidence-based interventions that include traditional models of health, attempt to secure a stable funding base, target strategies to ensure staff retention and develop interventions that target the multilevel causes of general and oral health. This review provides an evidence base that can aid in the successful design, implementation and sustainability of oral health programmes for Indigenous people in the future.