Title Health Literacy Community Outreach Interventions Are More Effect Than Existing Interventions in Improving Oral Health Outcomes Among Refugee Populations
Clinical Question Do health literacy interventions in the form of community outreach programs improve oral health outcomes compared to existing interventions executed at healthcare centers among refugee populations in the United States?
Clinical Bottom Line For refugee populations living in the United States, health literacy community outreach programs are more effective than existing interventions that are executed at healthcare clinics and facilities in improving oral health literacy and outcomes. This is supported by a meta-analysis of several studies conducted over the span of 9 years in which health literacy interventions implemented as a part of community outreach programs were shown to be more effective than traditional means of disseminating information by healthcare professionals at private offices and other healthcare facilities. Implementation of community outreach programs can be organized and implemented by dental schools, community healthcare centers, and state and local government public health officials among refugee populations.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27548669Reza/201632 studies on refugee children in North America Meta-Analysis
Key resultsAlthough the focus of this paper was on the oral health status of refugee children as newcomers and those who have been in the United States for more than 5 years, the included studies also highlighted the means by which attempts were made to improve the study group’s health status overall. Such methods as community outreach programs, communication at healthcare centers, and distribution of pamphlets at refugee centers were compared. Questionnaires were administered in all studies to the guardians or parents of the children being studied in order to assess their oral health status. Interventions that included the physicians and healthcare professionals traveling to refugee centers and communities in order to disseminate information regarding oral health hygiene were shown to be generally more effective in improving health literacy than those that included refugee patients coming into healthcare facilities to seek information.
24923308Nicol/2014Pre-school refugee children and their parents (N=44)Qualitative study
Key resultsThe study emphasizes the importance of understand the refugee experience by healthcare professionals and public health officials seeking to disseminate oral health information to refugee populations. Such efforts to understand the refugee experience made by the authors included conducting focus groups and traveling into refuge centers and communities and speaking with refugee children and their guardians. Oral health status and literacy of the study participants were measured by assessing their “understanding of Early Childhood Caries, experiences of accessing dental health services, and their barriers and enablers for achieving improved oral health.” It was concluded that the most effective way to educate the study participants and refugee populations in general is to establish empathy among those disseminating information and for them to attempt to develop an understanding of the refugee-lived experience. It was concluded that the best way to achieve that is for healthcare professionals and officials to enter refugee spaces and to observe and witness their life experiences.
23327248Geltman/2013439 adult Somalis who had lived in the United States 10 years or lessCross-sectional study
Key resultsStudy participants’ oral health status was assessed at the onset by measuring the amount of tooth decay in the participants. Although the focus of the study was not healthy literacy among a refugee population, but rather their health status, the authors do highlight the importance of community outreach programs in improving the oral health status of the participants. The authors discuss ways in which community outreach programs implemented by the Massachusetts Refugee Center and public health department have aided in improving oral health status, as measured through the participants’ caries risk before and after the study. The authors briefly mention the significance of officials meeting with refugees and their families and disseminating information to them directly. Such measures are briefly compared with traditional means of health education such as distributing handouts and pamphlets at healthcare centers and facilities. The authors generally agree that directly traveling to communities with majority refugee inhabitants has been shown to be more effective than disseminating information at healthcare facilities.
Evidence Search “oral health literacy among refugees”
Comments on
The Evidence
Validity: The paper by Reza et al. on refugee children in North America is the strongest evidence found on comparing outreach intervention programs. This study shows compelling evidence that outreach programs that aim to increase health literacy among refugee populations are more effective than traditional means of disseminating information that are healthcare centered. This study’s methodology ensures its validity by including a sufficiently large sample group to make it generalizable to the population of interest. Perspective: Something of importance to consider is that education alone is not sufficient to improve a population’s overall health and wellbeing. Many other factors come into play, including socioeconomic factors that affect one’s access to healthcare, living conditions, etc. The study conducted by Reza et al. recognizes this and takes it into consideration. The other two studies overemphasize and overestimate the importance of health literacy and education in accessing healthcare and fail to mention other variables that are also important.
Applicability Overall, the studies selected include methodologies that ensure a certain level of applicability to the refugee population living in the United States. The dental health status of the participants was measured before and after the studies using parameters widely known and used by the dental healthcare professionals. Factors that would limit applicability include the cost of implementing the intervention, the existence of conventional means of information dissemination, and the low feasibility of providing the means for healthcare professionals to travel to refugee communities.
Specialty (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords refugee, health literacy, outreach, intervention
ID# 3171
Date of submission 03/23/2017
E-mail abaei@livemail.uthscsa.edu
Author Delaram Abaei
Co-author(s) e-mail
Faculty mentor Magda De La Torre, RDH, MPH
Faculty mentor e-mail DELATORREM@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available