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The Influence of Culture on the Oral Health-Related Beliefs and Behaviours of Elderly Chinese Immigrants: A Meta-Synthesis of the Literature

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Abstract

Neglect of the mouth can lead to impairment, disability, and discomfort; as a result, it can have a negative impact on quality of life in old age. Some minority groups in North America shoulder a disproportionate burden of dental impairment compared to people of European origins, possibly because of different cultural beliefs and a distrust of Western oral healthcare. This paper explores these factors in elderly Chinese immigrants through a meta-synthesis of selected literature that reveals a dynamic interplay of traditional Chinese beliefs about oral health, immigration, and structural factors mediating access to Western dentistry. It also identifies several conceptual issues and gaps in knowledge, offers avenues of research including the cross-cultural application of two recent models of oral health, and discusses various strategies for improving access to dental services for minority populations.

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Notes

  1. We included papers that reported on psychometric measures only if they mentioned culture-specific understandings of oral health as an aspect of the development of such measures; we excluded papers that focused exclusively on the statistical validation of measures. We also excluded the few papers that reported on rare and complex oral health conditions (e.g., oral cancer, cleft palate). For papers on non-elderly Chinese populations, we included those that specifically mentioned oral beliefs in relation to aging (e.g., younger participants’ views about oral health in old age).

  2. Moxibustion involves the burning of a small amount of moxa, an herb derived from mugwort plant’s leaves, on top of acupuncture points to stimulate the flow of qi and maintain good health. Qigong is a form of meditation that incorporates deep breathing to increase oxygen flow in the body. A Qigong specialist advises patients on specific Qigong exercises most suited to address the root of particular ailments and illnesses. Bone-setting involves the treatment of soft tissue injuries, bone fractures and joint dislocation through the use of massage, joint manipulation, poultices, and medicinal herbs. (Ergil and Ergil 2009; Yue 2005)

  3. By acculturation, we mean “those phenomena which result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original culture pattern of either group” (Redfield et al. 1936, p. 149).

  4. TCM has roots in a system of family-based apprenticeship in which sons learn from fathers about herbal remedies developed from local ingredients and refined over time (Wu and Lü 2007). The practice of TCM changed in the 1950s under state-directed efforts to modernize China’s healthcare system along Western biomedical lines. Expert panels sought to aggregate TCM knowledge and practices into diagnostic and treatment guidelines similar to those of Western medicine, which helped to promote TCM globally (Taylor 2004). TCM is often associated with a strong sense of cultural identity in the Chinese diaspora (Xu and MacEntee 1994).

  5. The first model (Fig. 3a) evolved from an earlier existential model of oral health conforming to the language of the World Health Organization’s (2001) International Classification of Functioning, Disability and Health’s (ICF) framework and developed from in-depth interviews with community-based older adults (MacEntee 2006). The second model (Fig. 3b) is a later iteration incorporating additional components that account for the influences of diet, economic priorities, expectations, and health values and beliefs. In its final iteration, the model takes into account how culture, health beliefs and values, and coping and adapting abilities are mediated by socio-cultural variables (Brondani et al. 2007).

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Acknowledgements

This research was supported by a grant (#77375) from the Canadian Institutes of Health Research. We are very grateful to Phil Feeley, Ruth Kampen, and Olivia Guerra for their assistance.

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Authors and Affiliations

  1. Department of Sociology and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada

    André Smith & Karen Kobayashi

  2. Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada, V6R 2X3

    Michael I. MacEntee, Mario Brondani & Ross Bryant

  3. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    B. Lynn Beattie

  4. Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada

    Peter Graf

  5. Library, University of British Columbia, Vancouver, British Columbia, Canada

    Kathryn Hornby

  6. School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada

    Sabrina T. Wong

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  1. André Smith
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Smith, A., MacEntee, M.I., Beattie, B.L. et al. The Influence of Culture on the Oral Health-Related Beliefs and Behaviours of Elderly Chinese Immigrants: A Meta-Synthesis of the Literature. J Cross Cult Gerontol 28, 27–47 (2013). https://doi.org/10.1007/s10823-013-9187-4

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