What factors affect the ability of refugees to access dental care services?

Design: This was a systematic review of the quantitative evidence for which factors influence the ability of refugee populations to access dental care services.

Data Sources: Searches were performed using broad search terms on the electronic databases MEDLINE (via Ovid), Embase (via Ovid), Web of Science (all databases) and American Psychology Association PsycINFO with no time, language, or regional restrictions.

Study Selection: Studies examining factors associated with access to dental care amongst refugees were eligible. Outcomes relating to any aspect of access were included. Quantitative observational or intervention studies including quantitative components of mixed method studies, were eligible for inclusion. Studies not published in English were excluded.

Data Extraction And Synthesis: Data extraction was performed by a single author, with a random sample of 10% reviewed by a second. Quality was assessed utilising the National institute for Health's Quality Assurance tool for observational studies and were identified as being either fair (n = 7) or poor (n = 2). Factors identified as influencing access were synthesised using the Behavioural Model of Health Services Use.

Results: In total, 69 full-text articles were screened. Nine were included in the final narrative synthesis, including refugee populations across 10 countries (5 individual countries and one including multiple countries). Designs were cross sectional (n = 6) or retrospective (n = 3). Different populations were investigated, including children (n = 4) and adults (n = 5). Refugee populations included Somali (n = 2), Tibetan (n = 1), Palestinian (n = 1), Bhutanese (n = 1), Burmese (n = 1) and mixed groups (n = 4). Common measurements of access included self-reported past dental visits (n = 5), use of dental services (n = 1), perceived barriers to access (n = 1) and missed appointments (n = 1). Untreated decay was used as a proxy measure (n = 1). Common factors identified influencing access related to demography, socio-economic status, acculturation, health and dental literacy and oral health status of refugees. At an individual level, English language proficiency was associated with increased access to dental care.

Conclusions: There is limited evidence on the effects of various factors on influencing access to dental services for refugees. The authors suggest that on an individual level, English language proficiency, acculturation, health and dental literacy and oral health status of refugees may influence access to dental services.