# Mapping the barriers and facilitators of oral healthcare access for vulnerable migrants across high-income countries: a scoping review

## TL;DR

This scoping review identifies barriers and facilitators to oral healthcare access for vulnerable migrants in high-income countries, highlighting the need for inclusive policies and culturally competent care.

## Contribution

The study systematically maps barriers and facilitators to oral healthcare access for vulnerable migrants using the Social Determinants of Health framework.

## Key findings

- Financial barriers were the most commonly reported across socio-economic, cultural, and environmental levels.
- Cultural and religious norms significantly influenced care-seeking behaviors for oral health.
- Structural and personal-level factors, such as language difficulties and gender roles, also impacted access to dental services.

## Abstract

According to the World Health Organisation, oral health (OH) diseases are a major global health issue and outcomes are consistently poorer among refugees and migrants than host populations in many high-income countries (HICs). In the UK, the Office for Health Improvement and Disparities recognises asylum seekers, refugees, undocumented migrants, low-wage migrants, unaccompanied minors, and victims of trafficking as vulnerable migrants. These groups face worse OH outcomes due to systemic, socio-economic, cultural, and lifestyle-related factors, alongside barriers to accessing dental services. This scoping review explores the barriers and facilitators to oral healthcare experienced by vulnerable migrants in HICs.

We conducted a scoping review using the Arksey and O’Malley framework and reported findings in line with PRISMA-ScR. Embase and MEDLINE were searched from inception until April 30th 2024, for studies examining factors influencing access to oral healthcare services. Data were charted and thematically mapped onto the Dahlgren and Whitehead model of Social Determinants of Health (SDH).

Of 3894 identified records, 17 studies (10 qualitative, 5 quantitative, and 2 mixed-methods) were included, covering 2653 participants across 8 HICs (USA, UK, Australia, Austria, Germany, Finland, Saudi Arabia and Canada). Barriers and facilitators were present across all SDH layers. At the socio-economic, cultural, and environmental level, financial barriers were most commonly reported (12/17 studies). Language difficulties, low awareness of services, and mistrust of healthcare providers mapped to living and working conditions, while acculturation and social support aligned with the social and community networks layer. Limited knowledge of prevention was noted under lifestyle factors, and lastly, gender roles under personal characteristics. Cultural and religious norms also shaped care-seeking, with spirituality and religious traditions supporting positive OH practices.

We identified barriers and facilitators to oral healthcare access across personal, behavioural, social, and structural levels, contextualised within the SDH framework. Addressing these requires policies and practices that address structural barriers, integrate OH into national public health strategies, and emphasise inclusive, culturally competent care to improve access to OH services for these groups.