Aboriginal and Torres Strait Islander dental program evaluations: a mixed-methods systematic review.

Abstract

Objective: Over the last 20 years, the disparity in oral health between Aboriginal and Torres Strait Islander Australians and other Australians has continued to grow. This suggests that further programmes and programme improvements are needed to reach equitable oral health outcomes for Aboriginal and Torres Strait Islander Peoples. This mixed methods systematic review aims to assess Aboriginal and Torres Strait Islander Dental Programme Evaluations by measuring outcomes and cultural safety via the Lowitja Institute Evaluation Framework to Improve Aboriginal and Torres Strait Islander Health.

Methods: Databases searched were PubMed, Embase, Dentistry & Oral Sciences Source, Public Health Database and Scopus. All years were included. The date of the last search was the 1 May 2025. Published articles researching dental health programmes with Aboriginal and Torres Strait Islander participants in Australia were identified. Quantitative, qualitative and mixed methods studies were included. The Joanna Briggs Institute approach to Mixed-Methods Systematic Reviews was followed, except for a deviation in critical appraisal, which utilised the Quality Assessment for Diverse Studies (QuADs) instead. This review protocol was registered in PROSPERO (CRD42025637868) a priori.

Results: There were 54 studies included. New South Wales, South Australia, Queensland, Northern Territory and Western Australia were the states with the most data. The research designs included qualitative, quantitative and mixed-methods approaches. Most studies were of relatively high quality, as assessed by the QuADS criteria. Evaluations of dental programs for Aboriginal and Torres Strait Islander communities largely adhered to the Lowitja Framework, particularly in shared responsibility, partnerships and active engagement with Aboriginal and Torres Strait Islander peoples and their communities. Program effectiveness was primarily assessed through reductions in dental decay and participant feedback. Findings may be limited because the Lowitja Framework was developed via evaluation tenders, and the studies included were sourced from research articles.

Conclusions: Strong partnerships between programs, evaluation teams and Aboriginal and Torres Strait Islander communities are critical for cultural safety. Effective study designs should be used, and culturally relevant and holistic outcome measures should be chosen. Lessons learnt from this systematic review can be used to improve the effectiveness of Aboriginal and Torres Strait Islander dental programme evaluations.