Brief description:

Purpose of the study
This research aims to investigate the effectiveness of cultural awareness in motivating oral selfcare among refugees, also to examine whether or not this motivation, along with the usual
method of health education, can actually improve oral self-care. Given the fact that our study
will be performed in refugee communities, it will likely also reveal possible correlation between
the country of origin and oral health problems. If such a correlation exists, it can be used to
customize oral health care guidelines based on the countries of origin. By examining
aforementioned questions, we are aiming to establish effective guidelines for refugees’ oral
health promotion.
In this context” Cultural awareness" refers to a body of knowledge that is given to the refugees.
It consists of two distinct components. First, it emphasizes the benefits of good oral health in
building better emotional, social and business relationships in the host community. Second, it
aims to identify the root causes for a lower level of oral health among the refugee population.
The latter is obtained via in-depth interviews that identify the motivational barriers to oral selfcare, followed by the analysis of data in order to find methods of improving these motivational
barriers.
Research Methodology
The survey will be conducted in a refugee camp and a target population would be selected for
this study. In the first stage of research, we assess both acculturation rate through Bicultural
Involvement Questionnaire (BIQ), which is available from prior literature (1, 2), and oral hygiene
score (OHS) of our target group. This is followed by in-depth interviews with those participants
who had low scores in both acculturation rate and OHS, in order to find key motivational barrier
to self-care. The first stage is designed to prepare qualitative information which can be called
"cultural awareness". It includes both the cultural and the intellectual characteristics for both
refugees and the host community. This information can then be used to make a change in the
attitude regarding oral self-care.
The second stage of research is a clinical trial. The target group will be randomized into 3
different sub groups, and all participants will get a proper instrument for oral self-care. The
control group would receive oral hygiene instruction and a proper technique to oral self-care
(For example modified Bass technique), in addition to some information about the benefits of
oral health in their overall health.The case group 1 would receive "cultural awareness" along with the intervention in control
group. The case group 2 would only receive "cultural awareness" and same proper instruments
for oral self-care as other participants. After a time period (one month and three month) the
motivation success rate to oral self-care will be calculated. Below, the way to assess motivation
success rate and OHS is explained.
Plaque index (PI), gingival index (GI) and calculus index (CI); which have a scoring between 0-3
would be assessed prior to our intervention in both groups. Ramfjord teeth (16, 21, 24, 36, 41,
and 44) could be selected in order to predict the full-mouth oral hygiene status and potentially to
shorten the examination time. The total value of the PI, GI, and CI indices is used as the oral
hygiene score (OHS) of the individuals (PI + GI + CI = OHS; ranges between 0-9). The
concomitance of these indices will give accurate results for assessment of oral hygiene.
According to this score, the oral hygiene conditions of individuals could be determined as
follows:
• OHS < 1: Optimum oral hygiene,
• 1 ≤ OHS < 3: Good oral hygiene,
• 3 ≤ OHS < 6: Insufficient oral hygiene,
• 6 ≤ OHS: Poor oral hygiene.
After that, we use OHS score to calculate Motivation success rate (MSR) as follows:
MSR = (OHS-1 - OHS-2) ÷ OHS-1 × 100
Where, OHS-1 is the OHS value before intervention and OHS-2 is the OHS value after
intervention. This formula will provide the percentile improvement of MSR.
After a pre-determined period (at least4 weeks, which is sufficient for the formation of tartars
and its clinical presentation) MSR is measured again to observe the effectiveness of cultural
awareness in motivating oral self- care. We can also evaluate the effect of our intervention on
their quality of life by (OHRQoL) questionnaire before and after intervention. While doing the
survey we could also measure the relationship between oral health problems and the country of
the origin. The obtained data would be analyzed by appropriate statistical testing methods.
Significance of the Study
Little is known concerning the extent of oral health burden experienced by the growing number
of refugees and asylum seekers globally. However, research to inform policy makers and
practitioners concerning their oral health needs and access to oral health care remains limited.
Poor oral health adversely affects quality of life and imposes high economic burden on the health
system in the host country. Investing in oral hygiene improvement can potentially offer a muchhigher rate-of-return compared to other investments the governments make to properly integrate
refugees into the society.
Theoretical basis in research methodology and target group
(Why "cultural awareness"? Why refugee population?)
Maslow's theory of motivation contends that people act to satisfy their unmet needs. Needs that
have different levels which he has expressed in his famous pyramid. In communities where
physiological needs as well as concerns for livelihood and security are met, high-level needs
arise, while in societies challenged for their livelihoods and security, high-level needs are less
likely to become important. In the refugee communities there are different levels of needs: On
the one hand, there is a concern for livelihood and security, and on the other hand there is a
concern to be accepted the host community, to gain respect, to succeed, and to actualize one’s
potentials. The refugee community seems to be better than other communities in terms of
diversity of different levels of needs, and that is among different reasons that this community has
been selected for proposed research.
Two methods of education in this research will be tried in the target community. One is based on
motivation to meet biological needs which is related to the lower levels of the hierarchy of needs.
In this method the effects of oral health on improving health and a proper technique of brushing
are discussed. In the second method, the effect of oral health on social communication, respect
and self-esteem are discussed. This information is regarded as "cultural awareness" in present
study. In other words, Maslow's motivation needs are met at a higher level. The possible
correlation of the type of educational method and the level of need in which an individual
motivates can be statistically analyzed in both groups. If the effectiveness of the type of
educational method and the level of individual needs is confirmed, it can provide a basis for
choosing a more efficient method of education. Although this survey will be conducted in a
refugee community, but the results could be generalizable.
1. Rissel C. The development and application of a scale of acculturation. Australian and New Zealand journal
of public health. 1997;21(6):606-13.
2. Marin G, Gamba RJ. A new measurement of acculturation for Hispanics: The Bidimensional Acculturation
Scale for Hispanics (BAS). Hispanic Journal of Behavioral Sciences. 1996;18(3):297-316.

Added to catalogue on: 13-09-2020