An ethnographic study on the oral health and access to dental care of Indigenous people in Montreal

Abstract

Background: Although the population of Indigenous people living in urban centres has significantly increased over the past decades, limited research exists about their oral health and access to dental services. We thus know very little about their perspectives, experiences, and needs concerning oral health. However, this knowledge is needed to guide oral health policies and service delivery for urban Indigenous people. Objectives: Our objectives were to (i) understand how urban Indigenous people perceived and experienced oral health and (ii) describe their dental care pathway, including their experiences with dental professionals. Methodology: We conducted a focused ethnography, a useful and practical approach that is sensitive to cultural and social diversity and enables researchers to understand how people from certain cultures integrate health beliefs and practices into their lives. We organized individual in depth interviews with a purposeful sample of 20 Indigenous people living in Montreal, Québec. The interviews were in English, lasted approximately 90 minutes, and were audio-recorded to be transcribed verbatim and analyzed. In addition, we conducted participant observation of various Indigenous cultural events and health conferences in Montreal. Field notes were taken during these events and analyzed. The data analytic process comprised several stages, including summarizing the text, coding it into categories, and merging these categories to create themes. Findings: The participants had a bicultural perception of oral health, although the Western perspective seemed to dominate the Indigenous culture. Through the Indigenous lens, participants tended to understand oral health around the concepts of holism and balance. According to them, good oral health was important to achieve well-being and equilibrium between the physical, mental, emotional, and spiritual aspects of life. Applied to oral health, participants emphasized eating and drinking in moderation to maintain equilibrium and stressed the role of teeth in eatingtraditional diets. In agreement with Western culture, they mentioned the importance of teeth for function and aesthetics and valued personal oral hygiene as well as regular visits to the dentist. Concerning access to dental care, participants reported experiencing challenges in their lives, such as discrimination, unemployment, or chaotic life experiences, which prevented them from searching for a dentist. Finding a dentist was another issue, with participants indicating a shortage of dentists who accepted Non-Insured Health Benefits (NIHB) program beneficiaries. Because of this limited availability of dentists, some participants would return to their home communities to access dental services. Regarding the dental care episode, participants mentioned preferring dental professionals who knew and respected Indigenous culture and had good interpersonal skills. While the NIHB covered the cost of most dental treatments, some participants were required to pay for ineligible services, and some dentists refused to accept NIHB eligibility documents. Conclusions and recommendations: Urban Indigenous people face challenges and needs that require recognition by oral health professionals and policymakers. We invite these stakeholders to draw on our findings to support policies and services that facilitate access to and improve the oral health of urban Indigenous people