Integration of Oral Health into Primary Health Care Organization in Cree Communities: A Workshop Summary

Integration of oral health in primary care is a promising avenue to improve oral health and dental care of Canadians, and specifically rural and remote Indigenous communities.^1,2 With this perspective, as a pioneer in Quebec, the Cree Board Health Social Services of James Bay (CBHSSJB) has implemented Primary Oral Health Care (POHC) as part of its Strategic Regional Plan of 2004–2014.³ Since 2009, the Public Health Department of the CBHSSJB, in collaboration with the Community Miyupimaatisiiun Centres (CMCs), or local health and social service centres in each community, and the First Nations Councils of the nine communities have initiated a strategic planning process named the IIyuu (Cree) Ahtaawin Miyupimaatisiiun Planning,⁴ in order to channel Cree approaches and values into an integrated health care service approach for planning, prevention, and service delivery.⁵ In spite of the existing infrastructure of the CBHSSJB, the process of making an integrated services framework operational raises new challenges which require specific support.

In order to achieve this, a group of researchers and CBHSSJB professionals are working together to examine the strengths and challenges of the CBHSSJB's strategic planning in the implementation of POHC programs and providing models of best practices and recommendations for such programs. In this regard, to facilitate future evaluation, the working group organized and hosted a two-day interdisciplinary real-time video-conference workshop entitled "Let's Look at How We Are Collaborating for Oral Health and Oral Health Care in the CBHSSJB and Community Miyupimaatisiiun Centres."

This workshop was held simultaneously in Montreal and Mistissini and brought together a broad range of representatives from a team of interdisciplinary Cree community members, community health and oral health care service providers and administrators, community and public health organization representatives as well as researchers and their trainees.

Research team members and Cree Community partners

During the workshop, the research group and Cree stakeholders gave presentations on integrated care and oral health, Eeyou oral health and oral health care in Eeyou Istchee, primary care and oral health, and engaging the patient in oral health. These presentations were interactive and were followed by round-table formats with in-depth discussion. The discussions highlighted the perspective and expectations of the Cree people regarding dental care services; Cree visions and values; and the key and broad role of community-based primary health care⁶ in primary prevention and primary care services within the community, which includes health promotion, disease prevention, diagnosis, treatment and management of chronic diseases such as oral diseases. There was also emphasis on the front line experience of dental practices in primary care settings within an Indigenous community which is mainly focused on a patient-centred care approach. It was emphasized that this approach plays an important role in an integrated care system since it encourages the continuity of care between the health care providers and patients.

The presentation and discussions revealed t hat incorporation of Cree culture, values and practices into health care decision-making are fundamental for strengthening the continuity of care, as is effective and empathic communication within the health care team. In the long term, these strategies will lead to better performance of community health care organizations. During the workshop, strengths, challenges and ways to improve the performance of oral health care in Cree communities, as well as various evaluation models, were discussed. Strategies for the collection of community-based data were proposed by workshop participants and included community mapping, observations, document review, focus group discussions and individual interviews.

Participants provided positive feedback on the workshop, noting it was successful in achieving its main objectives:

1. Consolidation of the prior research partnership with the CBHSSJB and several Quebec Cree communities: The workshop provided an opportunity to revise common goals and specific objectives of partnership around a comprehensive evaluation project.
2. Knowledge exchange and dissemination on integrated care: The workshop enabled the sharing of evidence, knowledge, expertise and experience related to the integration of oral health into primary health care.
3. Shaping interdisciplinary and participatory research: The two-day workshop empowered and strengthened the interdisciplinary and participatory research concepts by introducing Cree traditions, practices and visions to researchers from various fields, revealing how the history and life experiences of First Nations peoples can shape their perceptions and expectations in regard to oral health and oral health care. The meeting guided the design of the evaluative research based on the needs of Cree communities. Finally, the workshop provided training for new investigators and research trainees in the field of Indigenous research. The workshop raised key points for further consideration and research.

THE AUTHORS

	Dr. Emami is associate professor, faculty of dentistry, School of Public Health and Institut de recherche en santé publique de l'université de Montréal (IRSPUM), University of Montréal, Montreal, Canada
	Dr. Couturier is professor, Canada Research Chair in professional practices for integrating gerontology services, school of social work, University of Sherbrooke, Sherbrooke, Canada.
	Mr. Girard is assistant professor, faculty of dentistry, University of Montréal, Montreal, Canada.
	Ms. Torrie is director of specialised services and assistant director of public health, Cree Board Health Social Services of James Bay.

Correspondence to: Dr. Elham Emami, Faculty of Dentistry, University of Montreal, P.O. Box 6128, downtown branch, Montreal, QC H3T 1J4. Email: elham.emami@umontreal.ca

Acknowledgments We would like to acknowledge Cree community and research team members, as well as the students, for their active participation and contributions to the workshop. We are thankful to our speakers Christine Loignon, Mary Ellen Macdonald, Susan Law, Ashley Iserhoff, Lucie Papineau, Manon St-Pierre, Taria Matoush, Dianne Reid and Yionna Wesley. Special thanks to Tracy Wysote and Evelyne Lefebvre for helping to organize this workshop. We also acknowledge Nadia Verenna Bendezu Aguirre, Richa Shrivastava and Jasmin Ramze Rezaee for their help and efforts in assisting in the preparation of the workshop materials and manuscript.

The workshop was supported financially by the Cree Board of Health and Social Services of James Bay, Canadian Institutes of Health Research (Grant #143962), Quebec Network for Oral Health and Bone Research as well as University of Montreal.

The views expressed are those of the authors and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.