Table 2: Key issues and challenges identified through informal interviews.

Key issue/challengesAssociated issues/barriers identified

Difficulty contacting patientsFrequent change of address
Irregular use of letterboxes
Appointment cards returned to sender
Patients moving towns at a high rate, sometimes leaving Pt Augusta and returning months later—clinic not notified
Patients not on telephone or frequent change of number
Children changing schools
Nonattendance at school
Schools unable to release contact details
Patients may use more than one surname

High rate of failure to attend appointmentsDifficulties with transport
Priority placed on oral health in combination with other physical, social, and emotional well-being issues of individuals and families
Wednesdays and Thursdays are “money days” when pensions are paid, bringing with it other priorities for adults
Lack of understanding of the importance of dental care

Attendance patternsAttend for relief of pain
Nonattendance for routine and preventative care
Lack of understanding of the importance of preventative care in contrast to relief of pain

Consent issuesPatient may be residing with someone who is not parent or legal guardian
Difficulty contacting parent or guardian when treatment decision needs to be made
Cultural differences and rules in regard to consent not understood and accepted by mainstream policies

Difficulty communicating with parents and guardiansParents and guardians often seem uncomfortable in the dental clinic
Parents seem uncomfortable communicating with dental service staff
Lack of understanding of dental disease, prevention and importance of dental care
Different approach to and understandings of treatment decision making (different between staff and patients/parents)
Lack of Aboriginal staff in the mainstream dental clinic