Youth health promotion in countries affected by forced migration: The role of mHealth technologies

Issue/problem

Young refugees often face barriers in accessing youth-friendly health information and care. Differing cultural norms, languages, laws, financial difficulties, gender disparities, and stigma pose additional challenges for youth in forced migration settings.

Description of the practice

REACH is a regional initiative of Columbia University, which aims to bridge the gap in health literacy and health care access among refugee and disadvantaged youth in Turkey, Lebanon, and Jordan, which are heavily affected by the Syrian conflict. Supported by TaiwanICDF, Blue Chip Foundation, and Columbia University, the REACH Project uses a community-based participatory action research approach and aims to assess the impact of mHealth technologies on improving health literacy and health care access among youth in host countries. With a strong adult-youth partnership, the project includes stakeholder meetings, mixed-methods studies with youth, health service providers and policy makers, in addition to health advocacy, communication and dissemination activities such as photo exhibitions, panels, and production of policy briefs and scientific publications. REACH has been working with youth, software developers, health professionals, academia, and I/NGOs to develop the multilingual and freely available REACH4Health app to promote youth health.

Results

Findings from three countries show that mHealth technologies have the potential to provide innovative, youth-friendly and widely used solutions to address the health education, health communication, and health care needs of disadvantaged and marginalized youth.

Lessons

Youth-adult partnerships, working with mixed groups of refugee and local youth, using community-based participatory research, peer-to-peer methodologies, and co-design approaches, as well as using social media tools contribute to the overall success of mHealth and health promotion interventions for disadvantaged youth in countries affected by forced migration.

Key messages

• mHealth technologies have a strong potential to improve health literacy and health care access of refugee and disadvantaged youth in countries affected by forced migration.

• Youth-adult partnerships, working with mixed groups of refugee and local youth, using participatory approaches and peer-to-peer methodologies significantly contribute to youth health interventions.

Photovoice as a research, advocacy, and harmonization tool for refugee and local youth in Turkey

Background

Turkey has millions of refugee and local youth, who share common youth health problems. As part of the REACH Project, this study aimed to assess youth's access to health information, health care, and healthy environments, in addition to their perspectives on using digital health technologies.

Methods

We used photovoice, a community based participatory research approach, and worked with 4 mixed (refugee and local) youth groups between the ages of 15 to 24 in Istanbul. Each youth group met with the research team and a professional photographer before data collection. Young people then took photos of barriers and facilitators regarding their access to health information, health care, and digital health technologies, in addition to their health problems. This was followed by focus group-like discussions, where young people discussed the photos and their meanings for them. Content analysis was used for data analysis and findings were shared with stakeholders via photo exhibits, panels, and policy briefs for advocacy purposes. The study was funded by TaiwanICDF and Columbia University.

Results

Findings showed that youth had a wide range of physical, social and mental health problems coupled with problems in accessing health information and youth-friendly services. Problems with social determinants of health were more prominent for refugees. Although youth often used the internet to access information, their experiences with digital health technologies were very limited.

Conclusions

Our study findings indicated that despite legal rights to access health care for all youth, refugee youth faced more barriers in accessing information and services. On the other hand, refugee and local youth showed similarities regarding common youth health problems and access to youth-friendly services. The photovoice approach enabled active participation and created a shared environment for refugee and local youth to discuss their mutual problems and understand each other.

Key messages

Photography is a communication tool that acts as a bridge between participants, researchers, and decision makers. Photovoice, as a participatory approach, creates a learning environment for both participants and researchers.

An educational programme designed for the evaluation of effectiveness of two tooth brushing techniques in preschool children

AIM

This study aimed to evaluate oral and dental health status of preschool children, to teach them two different brushing techniques, and to determine the effectiveness of such techniques.

MATERIALS AND METHODS

One hundred sixty three healthy children from three preschools in Isparta (Turkey) that were willing to participate in the study were included. A questionnaire was distributed to the parents. All children were given an oral and dental health education. Examinations were done in the classrooms, and plaque index and dft-dfs values were recorded. In each preschool, the horizontal scrub technique was randomly taught to a group of children, and the Fones technique to other group, and children were asked to apply the technique taught. Plaque index scores were recorded again, measurements were repeated at 1 week, and 1, 3 and 6 months. Data were analysed statistically.

RESULTS

The questionnaires showed children's and parents' inadequate oral hygiene behaviours. Plaque index values for both techniques decreased from baseline at 1 week, and 1, 3 and 6 months. Values at month 6 were closer to baseline. The horizontal scrub technique was applied more easily and it provided an effective decrease on plaque index scores. No statistically significant difference was found for dft and dfs values.

CONCLUSION

The educational programme with regular repeated tooth brushing training presented significant improvements in the oral health behaviours. The horizontal scrub technique was deemed more suitable than the Fones technique for preschool children.

A long-term clinical study on individuals with amelogenesis imperfecta

BACKGROUND

The aims of this study are to present sociodemographic and familial characteristics, clinical and systemic findings, dental treatment needs, and concomitant dental anomalies in patients with amelogenesis imperfecta (AI) and to evaluate time-varying conditions in these long-term follow-up patients.

MATERIALS AND METHODS

Records of patients with AI who were examined in the Department of Pediatric Dentistry between 1999 and 2017 were reviewed. Information about sociodemographic characteristics, history of AI and consanguinity in family, systemic conditions, reasons for referral to the clinic, oral hygiene habits and gingival health, occlusion findings, and performed treatments were gathered. Dental anomalies in radiographs were also evaluated. Baseline and final situations of the patients were assessed. Statistical analyses were performed.

RESULTS

Of 75 patients aged 3-15 years with follow-ups up to 12 years, 34 had AI in their families and 15 were born from consanguineous marriages. Nephrocalcinosis has been observed in 5 patients. Main reasons for referral to the clinic were related to esthetic and hypersensitivity concerns. Twenty-two patients had gingivitis, and during follow-up process, gingival problems could not be completely prevented due to poor oral hygiene habits. Vertical dimension loss, open-bite, and cross-bite were seen in 16, 15, and 10 patients, respectively. Of the patients, 63% experienced restorative, 33% stainless steel crown, 17% endodontic, 8% prosthetic treatments, and 24% had retreatment needs. Concomitant dental anomalies were dens invaginatus, taurodontism, ectopic eruption, delayed eruption, hypodontia, and pulpal calcification.

CONCLUSION

Early diagnosis and interventions considering the time-varying conditions with long-term follow-ups provide significant improvements in clinical maintenance of patients with AI.

The prevalence of anterior teeth with dens invaginatus in the western Mediterranean region of Turkey

AIM

To assess the prevalence and type of dens invaginatus in anterior teeth of a selected population and to report associated dental complications.

METHODOLOGY

The records of patients examined in the Department of Paedodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey between 1999 and 2006 were screened and a total of 2477 patients who had complete records with satisfactory radiographs were selected. The type of dens invaginatus and the presence of apical pathosis was determined from radiographs. Other dental abnormalities, syndromes and systemic diseases were noted. Variations in crown shape were also recorded.

RESULTS

Dens invaginatus was detected in 300 out of 2477 patients, with a prevalence of 12%; 82% of affected patients had dens invaginatus bilaterally. Maxillary lateral incisors were the most affected teeth. The majority of the teeth had normal crown morphology (95%). The most commonly seen type of dens invaginatus was type I (94%). Overall 33% of the patients with type III dens invaginatus and 4% of the patients with type II dens invaginatus had apical pathosis. No associations with other systemic diseases and syndromes and some limited association with hypodontia and dens evaginatus were detected.

CONCLUSION

A careful oral examination, radiographs, a suitable treatment plan and follow-up programme are crucial for early diagnosis and treatment for teeth with dens invaginatus.