Understanding and Addressing Oral Health Disparities in Ethnic Minority and Migrant Communities in Leicester, UK

• Professor Manish Pareek mp426@leicester.ac.uk
• Dr Harriet Walter hw191@leicester.ac.uk

Project Description:

Summary
Oral health conditions such as dental caries, periodontal diseases, tooth loss, and oral cancer are preventable and treatable if addressed early. In the UK, one in three adults has tooth decay, 74% have had a tooth extracted, and over 8,772 new cases of oral cancer are reported annually (1). Approximately 11 million individuals face unmet dental needs due to barriers and long waiting lists, exacerbating oral health outcomes (2). Major causes of these conditions include poor oral hygiene, high-sugar diets, lack of fluoride, tobacco use, and excessive alcohol consumption (3, 4). Another contributor to oral cancer specifically is delayed diagnosis due to the lack of early symptoms and late presentation (5). Compounding this issue, 90% of dentists in the United Kingdom (UK) are not accepting new NHS patients, worsening oral health outcomes (6). Socio-economic status and ethnicity impact caries and periodontal disease by influencing oral health habits, with minority groups experiencing higher rates of decay and risk factors such as tobacco use and diabetes (7, 8).

In Leicester, where half the population belongs to ethnic minority and migrant groups, there are significant oral health disparities. Adults in Leicester have higher rates of active decay compared to the national average, and the city has the highest burden of childhood dental disease and higher oral cancer incidence and mortality rates (9). Cultural practices such as the use of paan and smokeless tobacco products contribute to these disparities (10). Minority ethnic groups also face challenges due to cultural differences in oral health perceptions, lack of knowledge on prevention and symptoms, language barriers, and fear of costs (11-13).

The proposed PhD project aims to explore how socio-economic and cultural determinants influence oral health across the life course in diverse ethnic and migrant communities in the UK. 

Research Objectives
1. To determine the effectiveness of oral health-related behaviour change interventions in diverse age, ethnic and migrant groups.
2. To understand the prevalence of oral health conditions, risk factors and their association with general physical health in ethnic minority and migrant communities.
3. To assess barriers to accessing oral health care and their impact on oral health inequalities within these communities.
4. To understand beliefs, attitudes, and cultural practices influencing oral health behaviours by targeting diverse age and ethnic groups.
5. To co-design an educational intervention with community champions, PPI leads, and key stakeholders to improve awareness of common oral health conditions.

Work Packages:

WP1: Systematic Literature Review (0-4 months)
- Objective: Determine the effectiveness of oral health-related behaviour change interventions in diverse age, ethnic, and migrant groups.
- Outcome: Synthesise findings on interventions, identify key themes and theoretical frameworks to inform future interventions.

WP2: Quantitative Data Collection and Analysis (5-10 months)
- Objective: Understand the prevalence of oral health conditions, risk factors, and their association with general physical health in ethnic minority and migrant communities.
- Method: Conduct a cross-sectional survey targeting schools, colleges, and community organizations. Analyse self-reported oral health status, dietary habits, tobacco and alcohol use, access to dental care, and socio-demographic data.

WP3: Community-Based Participatory Research (11-16 months)
- Objectives: Understand beliefs, attitudes, and cultural practices influencing oral health behaviours and assess barriers to accessing oral health care.
- Method: Conduct focus groups and in-depth interviews with diverse community members to understand the influences on oral health behaviours across the life course. 

WP4: Experience-Based Co-Design (EBCD) (17-22 months)
- Objective: Co-design an educational intervention to improve awareness of common oral health conditions.
- Method: Utilise data from CBPR and the systematic review to inform intervention design. Disseminate and refine existing resources published by Leicester City Council with community feedback. Train local peer experts to deliver oral health education through participatory demonstrations.

WP5: Pilot Assessment (29-36 months)
- Objective: Assess the effectiveness of educational materials in improving knowledge levels in targeted communities.
- Method: Pilot the materials using questionnaires and semi-structured interviews in study-naïve and non-naïve communities, with a follow-up period of six months.

References: 
1. Oral Health Foundation. Oral health statistics in the UK [Internet]. [cited 2024 Jun 6]. Available from: https://www.dentalhealth.org/oral-health-statistics 
2. British Dental Association. Half of dentists have cut NHS commitment with more to come [Internet]. 2023 [cited 2024 May 7]. Available from: https://www.bda.org/news-and-opinion/news/half-of-dentists-have-cut-nhs-commitment-with-more-to-come/
3. World Health Organization. WHO. 2023 [cited 2024 Jun 6]. Oral Health. Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health
4. Mathur R, Singhavi HR, Malik A, Nair S, Chaturvedi P. Role of Poor Oral Hygiene in Causation of Oral Cancer—a Review of Literature. Indian J Surg Oncol. 2019 Mar 7;10(1):184–95. 
5. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009 Apr;45(4–5):309–16.
6. BBC. 90 percent of NHS dental practices in the UK are not accepting new patients, BBC survey finds. 2022 Aug 8 [cited 2024 May 7]; Available from: https://www.bbc.co.uk/mediacentre/ninety-percent-of-nhs-dental-practices-not-accepting-new-patients
7. Thomson WM. Social inequality in oral health. Community Dent Oral Epidemiol. 2012 Oct 21;40(s2):28–32. 
8. 8. Ahmed N. General Dental Council. 2022 [cited 2024 Jun 6]. Improving access to oral health and dental services for BAME communities. Available from: https://www.gdc-uk.org/news-blogs/blog/detail/blogs/2020/09/08/improving-access-to-oral-health-and-dental-services-for-bame-communities#:~:text=Minority%20children%20have%20higher%20levels,to%20greater%20oral%20health%20risks. 
9. Leicester City Council. Oral Health Needs Assessment. 2022.
10. Wright K, Brodie C, Perera G. Report on Paan and Smokeless Tobacco Product Use amongst Bangladeshi Women. London; 2013 May.
11. Office for Health Improvement and Disparities. GOV.UK. 2021. Dental health: migrant health guide. 
12. Cancer Research UK. Mouth and Oropharyngeal cancer risk and causes [Internet]. [cited 2023 Nov 22]. Available from: https://www.cancerresearchuk.org/about-cancer/mouth-cancer/risks-causes 
13. Nellums L, Rustage K, Hargreaves S, Friedland J. Access to healthcare for people seeking and refused asylum in Great Britain. 2018 Nov.