The Implication of Culture on Oral Health Practices in Migrant Head Start Programs

By Tracy Finlayson

Migrant Head Start families face many of the same challenges that other low-income families living in isolated, rural areas face when seeking health and oral care services. These challenges include a lack of health care providers who accept Medicaid, long waiting times for appointments, and having to travel in excess of 30 miles to obtain health and oral health care services. However, Migrant Head Start families face other challenges unique to their population, such as lack of health insurance, mobility factors, language barriers, and varying cultural beliefs.

Sandra Carton, Migrant Programs Acting Branch Chief for the Head Start Bureau, cites access to health services and communication issues as primary concerns among migrant families. Most migrant families do not have Medicaid coverage, primarily due to the lengthy eligibility process and the mobility of migrant families. Also, families coming from a country where medicine is socialized may not understand the need to obtain health care insurance while they are residing in this country. Lack of insurance inhibits a family's ability to obtain health and oral health services when they are needed.

If a health care provider does not speak the same language as the family, then the trust and responsiveness that is crucial to building a strong relationship between the family and health care provider cannot take place. In many cases, translators are needed. This further complicates building a trusting relationship. Even if interpreters are not needed, there is still no guarantee that the provider and patient understand each other and have the same ideas or beliefs about the course of treatment. Other cultural differences in child-rearing practices may also come into play and affect treatment.

Cultural beliefs govern people's values and daily practices, and there are several areas in oral health where cultural practices seem to conflict with the traditionally recommended courses of action promoted by American health providers. An example of this would be timing of weaning.

Oral Health Forum authors Norman Tinanoff and Carol Palmer include several nutritional recommendations to help decrease the risk of dental caries in young children. One of the practices they encourage is weaning at the appropriate time, which most pediatricians agree to be around one year of age. However, this practice is not universally accepted by all cultures. For instance, Hispanic communities have a cultural value of dependence on family and would not be eager to practice a pediatrician's recommendation for early weaning or toilet training, as this would promote independence of the baby from the family.

For recommendations to become integrated into daily routines, the medical evidence and reasoning must be clearly expressed to the family. Telling a parent to do something contrary to their cultural beliefs without explanation is not an
effective way to get someone to change health behaviors. Often, there is no way of knowing what recommendations health providers in other countries may have made to a family. According to Sandra Carton, "Health providers should be bicultural, not just bilingual."

Migrant Head Start Programs are the bridge between the family and health care providers, and depend on the trust and rapport they have developed with the family. As Sandra Carton points out, "They don't do just what is required, they do what is needed to work with families–with less time than most Head Start programs." Often this translates into meetings with families during evenings or weekends, or more home visits. Migrant Head Start programs serve as advocates for children by establishing collaborative relationships with health care providers to increase their sensitivity to cultural differences and other barriers migrant families often face.

During the regional breakout session of the Oral Health Forum, these and other issues affecting Migrant Head Start families were discussed. Several action steps were identified, including educating staff and parents in their own languages about current trends and changes to Medicaid and SCHIP; building relationships with dentists so they will accept children referred from Migrant Head Start programs; developing a list of key points that staff can discuss when making contact with health care providers; and building and expanding contacts with local community and migrant health centers to obtain information about available services.

Participants in the breakout session summarized their approach with this tag line: "Champions in partnerships: challenging the dental and medical professionals and Head Start in meeting the needs of infants, toddlers, and preschool children, especially migrants, homeless, and other populations."

Tracy Finlayson was an Intern, Head Start Bureau.