Term of Award

Summer 2019

Degree Name

Doctor of Public Health in Community Health Behavior and Education (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Raymona Lawrence

Committee Member 1

Bettye Apenteng

Committee Member 2

Adrienne Cohen

Committee Member 3

Georgia Dounis

Committee Member 3 Email


Committee Member 4


Committee Member 4 Email



The older population in the United States is growing at an unprecedented rate. Majority of older Americans reside in rural communities. Currently, only a small proportion of the population reside in nursing homes, while most older adults continue living in their current homes and communities as they age. There is growing evidence on the bidirectional association between chronic diseases and oral diseases. As multiple chronic diseases are reportedly more prevalent in older adults, it follows that they are at an increased risk of developing oral diseases. Poor oral health can impact quality of life by affecting their physical, psychological, and social well-being. The purpose of this study was: (a) To assess determinants of preventive oral health behavior in noninstitutionalized older adults living in rural/medically underserved communities of southeast Georgia; and (b) To determine essential components of a community-based oral health promotion program for this population. A mixed methods sequential explanatory design was used to complete this two-phased study. Firstly, surveys were administered to a convenience sample of 206 older adults through community-based supportive services in five rural/medically underserved counties in southeast Georgia. Secondly, phone interviews were conducted with 22 individuals from the survey sample and 11 key informants. The older adult participants included were either fully or moderately functionally independent. Results from multivariate logistic regression analysis informed the development of the interview guide used in the second phase of the study. Key findings from the survey included the significant association - between the older adult participants’ preventive oral health behavior and oral health knowledge; and between living alone and preventive oral health behavior. Interview findings revealed that older adult participants did not perceive support from their family, friends, neighbors, and community at large with regards to oral care. Cost was perceived as a major barrier for accessing oral care by older adults and they believed that if one could afford the care, it did not matter whether one lived in a rural or nonrural community. The older adult participants also had a general understanding of the connection between oral health and general health although they did not understand how one affected the other. Key-informants believed a deeper understanding of the oral-systemic link would lead older adults to prioritize oral health more. Other recommended topics for the oral health education program included signs and symptoms of oral diseases, ways to prevent oral diseases, and available oral care resources and associated costs. Key-informants mentioned current challenges with reimbursement of preventive oral care services and with limited scope of practice for dental auxiliaries. Lastly, key-informants also recommended further integration of oral health care with health care in training, practice, financing and delivery of services.

Research Data and Supplementary Material


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