Psychosocial factors and oral health outcomes amongst Aboriginal adults in regional South Australia

Abstract

Aboriginal people in Australia continue to suffer from the impacts of ongoing colonisation, with impacts experienced across a multitude of factors which are known to affect health and oral health. The literature describing the relationship of psychosocial factors with oral health outcomes among Aboriginal adults in Australia is sparse. This research therefore aimed to quantify self-reported oral health outcomes and examine associations between these oral health outcomes and general and oral health-specific psychosocial factors for a convenience sample of Aboriginal adults in regional South Australia (SA) participating in the Indigenous Oral Health Literacy Project (IOHLP). The first original research paper presented in this thesis describes the impacts of oral health conditions amongst this sample of Aboriginal adults and compares findings with nationally representative data from the National Survey of Adult Oral Health (NSAOH) 2004-2006. The impact of oral disease was measured using the short form of the Oral Health Impact Profile, OHIP-14. Individual items as well as the three summary measures for OHIP-14 were assessed. For each measure, the impact was greater for the participants of the IOHLP when compared with both Aboriginal and non-Aboriginal participants of NSAOH. The second paper describes the proportion of Aboriginal adults from regional SA rating their oral health and general health highly and compares these findings with nationally representative data from the NSAOH. For each variable reported, regional SA Aboriginal participants were worse off when compared with non-Aboriginal participants at a national level and had lower levels of selfrated general health and oral health than Aboriginal participants of NSAOH. This finding suggested that national level data may underestimate the proportion of regional Aboriginal Australians with poor oral health, an important consideration when planning for prevention and intervention strategies. The third paper assesses the validity of measures of oral health-related self-efficacy and fatalism among Aboriginal adults. The scales used to measure oral health-related self-efficacy and fatalism demonstrated community acceptability, acceptable face, content, criterion and known-groups validity, and internal reliability. The fourth paper quantifies levels of the two dimensions of the Perceived Stress Scale, perceived distress and perceived coping, determined associations with key measures of self-reported oral health and general health and assessed where associations remain after controlling for sociodemographic characteristics. Perceived coping showed no associations with outcome measures. The association between levels of stress and oral health impacts persisted despite controlling for multiple sociodemographic and economic measures. The gradient of increasing oral health impacts and prevalence of poor self-rated general and oral health across levels of stress indicated that experiences of stress was an important determinant of health and oral health in this Aboriginal community. The final original research paper quantifies levels of oral health-related self-efficacy and identifies associations with oral health outcomes, determining if these associations remain after controlling for a broad range of sociodemographic measures, perceived stress, perceived coping and oral healthrelated fatalism. Oral health-related self-efficacy remained associated with poor self-rated oral health and oral health impact severity in all models, suggesting that further investigation, including longitudinal studies with culturally safe interventions aimed at improving self-efficacy are warranted.