# Qualitative and Quantitative Analysis of a Novel Dental Health Education Program to Improve Dental Care Utilization by Bhutanese-, Burmese-, and Swahili-Speaking Refugees in a Midwestern United States City

## TL;DR

A new dental education program was tested to improve dental care use among Bhutanese-, Burmese-, and Swahili-speaking refugees in Kansas.

## Contribution

The study introduces a culturally tailored dental education program and evaluates its impact using mixed methods.

## Key findings

- Post-intervention, participants showed improved dental knowledge and behavior.
- Dental education alone did not fully address all barriers to dental care utilization.
- World Café sessions and accessibility improvements may better support refugee dental health.

## Abstract

Objectives: Refugees have greater oral disease than native-born populations, yet underutilize dental healthcare resources. Few studies have evaluated the impact of health services and interventions seeking to improve dental care utilization among refugees, and dental healthcare utilization and outcome information for Bhutanese-, Burmese-, and Swahili-speaking refugees is sparse. This study aims to evaluate the impact of a novel culturally tailored education program on refugee dental knowledge, beliefs, behavior, and utilization in Wyandotte County, Kansas, United States.

Methods: Mixed methods, including discussion groups, World Café sessions, and structured pre-post intervention surveys, were used. Thematic analysis identified themes from qualitative data collected through community discussion groups (n = 14) and a World Café session (n = 22) with refugee community members. McNemar's chi-squared test and Wilcoxon signed-rank tests were used to evaluate changes in primary and secondary outcomes from quantitative data collected through preintervention surveys (n = 48) and postintervention surveys (n = 37).

Results: Pre-intervention, participants had dental knowledge and behaviors comparable to low-income Kansas populations. Postintervention, more participants knew correct brushing and check-up frequency, believed they lacked appropriate dental care, chose the dentist's office for their dental care, reported correct teeth brushing behavior, and completed dental visits than they did preintervention.

Conclusions: Providing dental education improved many parameters of dental refugee health; however, dental education alone did not increase all dental health knowledge, beliefs, behaviors, and utilization sufficiently. Rather, using the World Café methodology for refugee patient feedback, and assisting refugees with dental healthcare accessibility, affordability, and accommodation during insurance registration and dental clinic attendance may more effectively improve oral healthcare utilization and dental health outcomes in refugee populations.