Poirier B, Sethi S, Jamieson L, Hedges J
Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Australia.
JDR Clin Trans Res. 2024 Oct 11:23800844241286729. doi: 10.1177/23800844241286729.
The effects of racism, oppression, and colonization in Australia are reflected in the inequitable experience of chronic kidney disease (CKD) among Aboriginal and Torres Strait Islander peoples. Despite having the highest incidence of CKD, Aboriginal and Torres Strait Islander people have the lowest rate of kidney transplant, with poor oral health commonly being an obstacle to receiving a transplant. This research reflects the exploratory phase of a larger project aimed at maximizing oral health outcomes for Aboriginal and Torres Strait Islander people living with CKD in Australia through the provision of culturally secure dental care.
The present research uses reflexive thematic analysis to analyze qualitative data from yarns, interviews, and focus groups with dental, renal, and Aboriginal and Torres Strait Islander stakeholders to generate a conceptual understanding of equity at the nexus of oral health and kidney health. NVivo software was used for organizing data and an inductive line-by-line coding approach.
Twenty-eight stakeholders participated; 12 of the stakeholders identified as Aboriginal and/or Torres Strait Islander, and most were female. Factors at the nexus of oral health and CKD included the continuous effects of colonization, the centrality of cultural security for improved care, as well as several challenges and opportunities at a system level. Challenges included the luxury of oral health access, limited health care team involvement in oral health pathways, high-intensity engagement with medical systems, and no communication between dental and renal teams. Opportunities identified included the role of integrated care, cross-discipline knowledge sharing, Aboriginal and Torres Strait Islander leadership, clear referral pathways, prevention, and assistance with navigating the oral health system.
We argue that collective responsibility for the oral health of Aboriginal and Torres Strait Islander people living with CKD is required for improved health and eligibility for kidney transplant. Cross-discipline collaboration is required to overcome the rigidness of the current colonial and biomedical model that silos oral health and CKD.
The siloed approach to management of oral health for Aboriginal and Torres Strait Islander peoples with chronic kidney disease results in low knowledge sharing and communication across chronic disease management teams and can prevent kidney transplantation. Collective responsibility for oral health within this context is required to ensure that just and equitable access to kidney transplant can be achieved.
种族主义、压迫和殖民化对澳大利亚的影响反映在原住民和托雷斯海峡岛民慢性肾脏病（CKD）的不平等经历中。尽管原住民和托雷斯海峡岛民的CKD发病率最高，但他们的肾脏移植率却最低，口腔健康状况不佳通常是接受移植的障碍。本研究反映了一个更大项目的探索阶段，该项目旨在通过提供符合文化安全的牙科护理，使澳大利亚患有CKD的原住民和托雷斯海峡岛民的口腔健康结果最大化。
本研究采用反思性主题分析法，分析来自与牙科、肾脏科以及原住民和托雷斯海峡岛民利益相关者的故事讲述、访谈和焦点小组的定性数据，以在口腔健康和肾脏健康的交叉点上形成对公平的概念理解。使用NVivo软件来组织数据，并采用逐行归纳编码方法。
28名利益相关者参与其中；12名利益相关者被认定为原住民和/或托雷斯海峡岛民，且大多数为女性。口腔健康与CKD交叉点上的因素包括殖民化的持续影响、文化安全对改善护理的核心作用，以及系统层面的若干挑战和机遇。挑战包括获得口腔健康服务的奢侈性、医疗团队对口腔健康途径的参与有限、与医疗系统的高强度接触，以及牙科和肾脏科团队之间缺乏沟通。确定的机遇包括综合护理的作用、跨学科知识共享、原住民和托雷斯海峡岛民的领导力、明确的转诊途径、预防以及在口腔健康系统导航方面的协助。
我们认为，为了改善健康状况并提高肾脏移植的资格，需要对患有CKD的原住民和托雷斯海峡岛民的口腔健康承担集体责任。需要跨学科合作来克服当前将口腔健康和CKD分隔开来的殖民和生物医学模式的僵化性。
对患有慢性肾脏病的原住民和托雷斯海峡岛民的口腔健康采取分隔管理方法，导致慢性病管理团队之间的知识共享和沟通不足，并可能阻碍肾脏移植。在此背景下，需要对口腔健康承担集体责任，以确保能够实现公正和平等地获得肾脏移植。
