JCDA - Canadian Dental Association

• Issues in Brief •
––– News & Updates –––
The Oral Health Care Professional and the Immigrant Patient
Dr. Christophe Bedos, DCD, PhD
Objective
Provide oral health professionals with information on immigration, acculturation and a
patient-centred approach.
Immigration in Canada 1
• Canada is a land of immigrants: it welcomes approximately 180,000 new immigrants every
year; in 2001, 18% of the population was foreign born.
• Whereas Europe constituted the main source of immigrants until the 1960s, Asia is now the
leading continent of origin. Between 1991 and 2001, Asia provided 58% of all immigrants
in Canada.
• Chinese constitute the main visible minority group in Canada, with over 1 million people
in 2001.
The acculturation process 2
• Acculturation is the process by which an immigrant acquires the culture of the society that he
or she inhabits. Acculturation applies to oral health-related beliefs and behaviours.
• Acculturation can take 4 forms according to Berry 2 :
1) marginalization means that the immigrant values neither heritage nor host community
cultures
2) separation implies that the immigrant values only heritage culture
3) integration means that the immigrant values both heritage and host community cultures
4) assimilation signifies that the immigrant rejects the heritage culture and adopts the culture
of the host community.
Cultural competence and patient-centred approach 3
• Cultural competence — a growing concern for health care professionals — means sensitivity
to the culture of patients in order to provide high-quality services.
• Taking patients’ culture into account may be done through a patient-centred approach that
includes the following steps:
1) exploring disease but also illness experience (how the patient experiences the symptoms)
2) understanding the whole patient (the person; his/her context; his/her culture)
3) finding common ground when treatment planning.
• The patient-centred approach demands time, patience and good communication skills from
the oral health professionals.
An example of acculturation related to oral health beliefs 4
• Objective: Understand how oral illness is perceived by Chinese immigrants.
• Methods: Semi-structured interviews conducted in 2005 with 12 well-educated, recent,
Chinese immigrants living in Montreal.
• Results: These immigrants’ beliefs are a mix of biomedical and cultural knowledge:
a) fairly good understanding of caries in terms of etiology as well as means to prevent and
treat them
b) strong traditional beliefs concerning periodontal problems or “swollen gums” which, as
they say, are associated with “internal fire” (Table 1).
JCDA • www.cda-adc.ca/jcda • September 2008, Vol. 74, No. 7 • 587