Does Where We Live Matter To Oral Health?

Tensions Between Rural Older Adults’ Concept of Community and Health Individualism

Authors

  • Swaha Pattanaik University of Minnesota
  • April M. Schueths Georgia Southern University
  • Raymona H. Lawrence Georgia Southern University
  • Bettye Apenteng Georgia Southern University
  • Georgia Dounis University of Nevada - Las Vegas

DOI:

https://doi.org/10.18060/26118

Keywords:

Rural, older adults, oral health, community, self-reliance, qualitative, rural, older adults

Abstract

Oral health is essential to overall health; however, structural obstacles influence older rural residents' oral health outcomes, especially those from disadvantaged backgrounds in the South. Poor oral health is typically attributed to individual choices, shifting the focus from the inconspicuous community influences, making it more difficult for older rural people to obtain oral healthcare. This qualitative study explores how older adults in rural Georgia understand the community's role in shaping their oral health. Twenty-two older adults were interviewed from five rural communities in southeast Georgia. Participants defined their community in geographic terms. Community barriers and self-reliance emerged as themes of how living in a rural community affects oral health. The concepts of community and one's oral health were perceived as distinct. Participants did not see how where they lived could matter to their oral health, even when they identified critical community barriers to oral health. In collaboration with rural healthcare systems, social workers can support healthy self-reliance, moving beyond a health individualism lens, by helping bolster older adults' social supports, an essential function of social relationships that positively influences a sense of community. Additionally, social workers can advocate for equitable policies to create opportunities for rural communities to support and maintain oral health.

References

Assari, S., & Bazargan, M. (2019). Educational attainment and self-rated oral health among American Older Adults: Hispanics' diminished returns. Dentistry Journal, 7(4), 1-10. https://doi.org/10.3390/dj7040097

Au, A., Lai, D., Yip, H. M., Chan, S., Lai, S., Chaudhury, H., Scharlach, A., & Leeson, G. (2020). Sense of community mediating between age-friendly characteristics and life satisfaction of community-dwelling older adults. Frontiers in Psychology, 11, 1-10. https://doi.org/10.3389/fpsyg.2020.0008

Aubrun, A., Brown, A., & Grady, J. (2006). Health individualism: Findings from cognitive elicitations among Californians. A FrameWorks Research Report. https://www.frameworksinstitute.org/publication/health-individualism-findings-from-cognitive-elicitations-among-californians/

Azhari, A. A. (2021). A national cross-sectional study of social workers’ knowledge, attitudes, and practices about oral health disparities and dental care (Doctoral dissertation, Barry University).

Bacsu, J. R., Jeffery, B., Abonyi, S., Johnson, S., Novik, N., Martz, D. J., & Oosman, S. (2014). Healthy aging in place: Perceptions of rural older adults. Educational Gerontology, 40, 327-337. https://doi.org/10.1080/03601277.2013.802191

Barth, R. P., Messing, J. T., Shanks, T. R., & Williams, J. H. (Eds.). (2022). Grand challenges for social work and society. Oxford University Press. https://doi.org/10.1093/oso/9780197608043.001.0001

Batra, M., Tangade, P., Rajwar, Y. C., Dany, S. S., & Rajput, P. (2014). Social capital and oral health. Journal of Clinical and Diagnostic Research, 8(9), ZE10-ZE11. https://doi.org/10.7860/JCDR/2014/9330.4900

Bell, R. A., Arcury, T. A., Anderson, A. M., Chen, H., Savoca, M. R., Gilbert, G. H., & Quandt, S. A. (2012). Dental anxiety and oral health outcomes among rural older adults. Journal of Public Health Dentistry, 72(1), 53-59. https://doi.org/10.1111/j.1752-7325.2011.00283.x

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Buys, L., Burton, L., Cuthill, M., Hogan, A., Wilson, B., & Baker, D. (2015). Establishing and maintaining social connectivity: An understanding of the lived experiences of older adults residing in regional and rural communities. The Australian Journal of Rural Health, 23(5), 291-294. https://doi.org/10.1111/ajr.12196

Carver, L. F., Beamish, R., Phillips, S. P., & Villeneuve, M. (2018). A scoping review: Social participation as a cornerstone of successful aging in place among rural older adults. Geriatrics (Basel, Switzerland), 3(4), 1-16. https://doi.org/10.3390/geriatrics3040075

Centers for Disease Control and Prevention. (2021). Disparities in oral health. https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm

Centers for Medicare & Medicaid Services. (2021). Chronic conditions charts: 2018. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Chartbook_Charts

Crall, J. J., Pourat, N., Inkelas, M., Lampron, C., & Scoville, R. (2016). Improving the oral health care capacity of federally qualified health centers. Health Affairs (Project Hope), 35(12), 2216-2223. https://doi.org/10.1377/hlthaff.2016.0880

Cromartie, J. (2018). Rural aging occurs in different places for very different reasons. U.S. Department of Agriculture. https://www.usda.gov/media/blog/2018/12/20/rural-aging-occurs-different-places-very-different-reasons

Cromartie, J., & Bucholtz, S. (2008). Defining the “rural” in rural America. USDA ERS. https://www.ers.usda.gov/amber-waves/2008/june/defining-the-rural-in-rural-america/

Daniel, H., Bornstein, S. S., Kane, G. C., Health and Public Policy Committee of the American College of Physicians, Carney, J. K., Gantzer, H. E., Henry, T. L., Lenchus, J. D., Li, J. M., McCandless, B. M., Nalitt, B. R., Viswanathan, L., Murphy, C. J., Azah, A. M., & Marks, L. (2018). Addressing social determinants to improve patient care and promote health equity: An American College of Physicians position paper. Annals of Internal Medicine, 168(8), 577-578. https://doi.org/10.7326/M17-2441

Dye, B., Thornton-Evans, G., Li, X., & Iafolla, T. (2015). Dental caries and tooth loss in adults in the United States, 2011-2012. NCHS Data Brief. https://www.cdc.gov/nchs/products/databriefs/db197.htm

Eitner, S., Wichmann, M., Paulsen, A., & Holst, S. (2006). Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health. Journal of Oral Rehabilitation, 33(8), 588-593. https://doi.org/10.1111/j.1365-2842.2005.01589.x

Eriksson, M. (2011). Social capital and health implications for health promotion. Global Health Action, 4, 1-11. https://doi.org/10.3402/gha.v4i0.5611

Fleming, E., Frantsve-Hawley, J., & Minter-Jordan, M. (2022). Health equity needs teeth. AMA Journal of Ethics, 24(1), 48-56. https://doi.org/10.1001/amajethics.2022.48

Foutz, J., & Artiga, S. (2018). The role of Medicaid in rural America. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/

Gao, S. S., Yon, M. J. Y., Chen, K. J., Duangthip, D., Lo, E. C. M., & Chu, C. H. (2019). Utilization of a mobile dental vehicle for oral healthcare in rural areas. International Journal of Environmental Research and Public Health, 16(7), 1-8. https://doi.org/10.3390/ijerph16071234

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice. John Wiley & Sons.

Glasgow, N., & Brown, D. L. (2012). Rural aging in the United States: Trends and contexts. Journal of Rural Studies, 28(4), 422-431. https://doi.org/10.1016/j.jrurstud.2012.01.002

Griffin, S. O., Jones, J. A., Brunson, D., Griffin, P. M., & Bailey, W. D. (2012). Burden of oral disease among older adults and implications for public health priorities. American Journal of Public Health, 102(3), 411-418. https://doi.org/10.2105/AJPH.2011.300362

Health Resources Services & Administration. (2022). HRSA fact sheets. https://data.hrsa.gov/data/fact-sheets

Heaney, C. A., & Israel, B. A. (2008). Social networks and social support. In K. Glanz, B. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 189-210). John Wiley & Sons.

Hombrados-Mendieta, I., Millán-Franco, M., Gómez-Jacinto, L., Gonzalez-Castro, F., Martos-Méndez, M. J., & García-Cid, A. (2019). Positive influences of social support on sense of community, life satisfaction and the health of immigrants in Spain. Frontiers in Psychology, 10, 1-17. https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02555/full

Jones, E., Shi, L., Hayashi, A. S., Sharma, R., Daly, C., & Ngo-Metzger, Q. (2013). Access to oral health care: The role of federally qualified health centers in addressing disparities and expanding access. American Journal of Public Health, 103(3), 488-493. https://doi.org/10.2105/AJPH.2012.300846

Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31(12), 721-727. https://doi.org/10.1111/j.1532-5415.1983.tb03391.x

Katz, S., Downs, T. D., Cash, H. R., & Grotz, R. C. (1970). Progress in development of the index of ADL. Gerontologist, 10(1), 20-30. https://doi.org/10.1093/geront/10.1_part_1.20

Kirkwood, T. (2017). Why and how are we living longer? Experimental Physiology, 102(9), 1067-1074. https://doi.org/10.1113/EP086205

Kitchen, P., Williams, A. M., & Gallina, M. (2015). Sense of belonging to local community in small-to-medium sized Canadian urban areas: A comparison of immigrant and Canadian-born residents. BMC Psychology, 3(1), 1-17. https://doi.org/10.1186/s40359-015-0085-0

Lawrence, R. H., Apenteng, B. A., Schueths, A. M., Pattanaik, S., & Gibson, R. W. (2018). Defining "Community" from the perspectives of individuals with sickle cell disease in rural Georgia. Journal of Health Care for the Poor and Underserved 29(4), 1438-1454. https://doi.org/10.1353/hpu.2018.0105

Lyons, S., Schrader, S., Galyean, E., Romito, L., Everidge, C., Smith, M., & Mandapati, S. R. (2021). A collaborative assessment of barriers to oral health care: Are social workers needed? Advances in Social Work, 21(1), 115-134. https://doi.org/10.18060/23681

Mao, W., Wu, B., Chi, I., Yang, W., & Dong, X. (2021). Psychological sense of community and oral health problems among older Chinese Americans: Family reunification matters. Aging and Health Research, 2021(1), 1-7. https://doi.org/10.1016/j.ahr.2021.100004

McMillan, D. W., & Chavis, D. M. (1986). Sense of community: A definition and theory. Journal of Community Psychology, 14(1), 6-23. https://doi.org/10.1002/1520-6629(198601)14:1<6::AID-JCOP2290140103>3.0.CO;2-I

Michalski, C. A., Diemert, L. M., Helliwell, J. F., Goel, V., & Rosella, L. C. (2020). Relationship between sense of community belonging and self-rated health across life stages. SSM-Population Health, 12, 1-9. https://doi.org/10.1016/j.ssmph.2020.100676

Moeller, J., Starkel, R., Quiñonez, C., & Vujicic, M. (2017). Income inequality in the United States and its potential effect on oral health. Journal of the American Dental Association, 148(6), 361-368. https://doi.org/10.1016/j.adaj.2017.02.052

Napeñas, J. J., Brennan, M. T., & Elad, S. (2020). Oral manifestations of systemic diseases. Dermatologic Clinics, 38(4), 495-505. https://doi.org/10.1016/j.det.2020.05.010

National Institutes of Health. (2021). Oral health in America: Advances and challenges. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf

Neville, S., Adams, J., Napier, S., Shannon, K., & Jackson, D. (2018). “Engaging in my rural community": Perceptions of people aged 85 years and over. International Journal of Qualitative Studies on Health and Well-being, 13(1), 1-7. https://doi.org/10.1080/17482631.2018.1503908

Northridge, M. E., Kumar, A., & Kaur, R. (2020). Disparities in access to oral health care. Annual Review of Public Health, 41, 513-535. https://doi.org/10.1146/annurev-publhealth-040119-094318

Office of Health Indicators for Planning, Georgia Department of Public Health. (2020). Online Analytical Statistical Information System. OASIS | GA DPH | OHIP. https://oasis.state.ga.us/

O’Neil, M., Sweetland, J., & Ford, M. (2017). Unlocking the door to new thinking: Frames for advancing oral health reform. FrameWorks Institute. https://www.frameworksinstitute.org/publication/unlocking-the-door-to-new-thinking-frames-for-advancing-oral-health-reform/

Rural Health Information Hub. (2021). Asset-based community approaches. https://www.ruralhealthinfo.org/toolkits/sdoh/2/social-and-community-context/asset-based

Rural Health Information Hub. (2022a). Healthcare access in rural communities [Updated November 21, 2022]. https://www.ruralhealthinfo.org/topics/healthcare-access

Rural Health Information Hub. (2022b). Oral Health in Rural Communities [Updated July 18, 2022]. https://www.ruralhealthinfo.org/topics/oral-health

Office of Management and Budget. (2018). OMB Bulletin (18-03). https://www.whitehouse.gov/wp-content/uploads/2018/04/OMB-BULLETIN-NO.-18-03-Final.pdf

Otto, M. (2017). Teeth: The story of beauty, inequality, and the struggle for oral health in America. New Press.

Page-Carruth, A., Windsor, C., & Clark, M. (2014). Rural self-reliance: The impact on health experiences of people living with type II diabetes in rural Queensland, Australia. International Journal of Qualitative Studies on Health and Well-being, 9(1), 1-10. https://doi.org/10.3402%2Fqhw.v9.24182

Pipa, A., & Geismar, N. (2021). The new ‘rural’? The implications of OMB’s proposal to redefine nonmetro America. https://www.brookings.edu/research/the-new-rural-the-implications-of-ombs-proposal-to-redefine-nonmetro-america/

Polaceck, M. (2019, November). Combating elder abuse and hunger in Georgia. https://www.house.ga.gov/budget/Documents/2019_Session/2019_Policy_Brief_Elder_Abuse_and_Hunger.pdf

Pope, N. D., Loeffler, D. N., & Ferrell, D. L. (2014). Aging in rural Appalachia: Perspectives from geriatric social service professionals. Advances in Social Work, 15(2), 522-537. https://doi.org/10.18060/17059

QSR International. (2018). NVivo Qualitative Data Analysis Software [Software]. https://qsrinternational.com/nvivo/nvivo-products/

Ramos, A. K., Suarez, M. C., Leon, M., & Trinidad, N. (2017). Sense of community, participation, and life satisfaction among Hispanic immigrants in rural Nebraska. Kontakt, 19(4), e284-e295. https://doi.org/10.1016/j.kontakt.2017.09.005

Rouxel, P. L., Heilmann, A., Aida, J., Tsakos, G., & Watt, R. G. (2015a). Social capital: Theory, evidence, and implications for oral health. Community Dentistry and Oral Epidemiology, 43(2), 97-105. https://doi.org/10.1111/cdoe.12141

Rouxel, P., Tsakos, G., Demakakos, P., Zaninotto, P., Chandola, T., & Watt, R. G. (2015b). Is social capital a determinant of oral health among older adults? Findings from the English longitudinal study of aging. PloS One, 10(5), 1-17. https://doi.org/10.1371/journal.pone.0125557

Rouxel, P., Heilmann, A., Demakakos, P., Aida, J., Tsakos, G., & Watt, R. G. (2016). Oral health-related quality of life and loneliness among older adults. European Journal of Ageing, 14(2), 101-109. https://doi.org/10.1007/s10433-016-0392-1

Schroth, R. J., Wilson, A., Prowse, S., Edwards, J. M., Gojda, J., Sarson, J., Harms, L., Hai-Santiago, K., & Moffatt, M. E. (2014). Looking back to move forward: Understanding service provider, parent, and caregiver views on early childhood oral health promotion in Manitoba, Canada. Canadian Journal of Dental Hygiene, 48(3), 99-108.

Siegler, E. L., Lama, S. D., Knight, M. G., Laureano, E., & Reid, M. C. (2015). Community-based supports and services for older adults: A primer for clinicians. Journal of Geriatrics, 2015, 1-7. https://doi.org/10.1155/2015/678625

Simpson, J. Z., Muyot, A., Dounis, K., Han, D. H., Kim, S, Dounis, G. (2021). Oral Disorders and Systemic Diseases. In G. Warshaw, J. F. Potter, E. Flaherty, M. Heflin, M. McNabney, & R. J. Ham (Eds.), Primary care geriatrics: A case-based approach (7th ed., pp. 519-531). Elsevier.

Slovak, K., Sparks, A., & Hall, S. (2011). Attention to rural populations in social work’s scholarly journals. Journal of Social Service Research, 37(4), 428-438. https://doi/10.1080/01488376.2011.578035

Smith, A. S., & Trevelyan, E. (2019). Older population in rural America-In some states, more than half of older residents live in rural areas. The United States Census Bureau. https://www.census.gov/library/stories/2019/10/older-population-in-rural-america.html

Sungchul, P., Meyers, D., & Langellier, B. A. (2021). Rural enrollees in Medicare Advantage have substantial rates of switching to traditional Medicare. Health Affairs, 40(3), 469-477. https://doi.org/10.1377/hlthaff.2020.01435

Surdu, S., & Langelier, M. (2018). Trends in the provision of oral health services by federally Qualified Health Centers. Oral Health Workforce Research Center, Center for Health Workforce Studies, School of Public Health, SUNY Albany. https://www.oralhealthworkforce.org/wp-content/uploads/2018/02/OHWRC_Trends_in_Provision_of_Oral_Health_Services_by_FQHCs_2018.pdf

Swift, C. (2021). Diabetes, oral health and nutrition - What is the connection? Association of Diabetes Care & Education Specialists. https://www.diabeteseducator.org/news/perspectives/adces-blog-details/adces-perspectives-on-diabetes-care/2021/05/10/diabetes-oral-health-nutrition-connection

Talò, C., Mannarini, T., & Rochira, A. (2014). Sense of community and community participation: A meta-analytic review. Social Indicators Research, 117(1), 1-28. http://www.jstor.org/stable/24720902

Tanner, D. (2021). Rural Georgia in focus [PowerPoint Slides]. Carl Vinson Institute of Government, University of Georgia. https://www.house.ga.gov/Documents/CommitteeDocuments/2021/Rural_Development_Council/CVIOG%202020%20Census%20Data.pdf

United Health Foundation. (2018). America’s health rankings senior reports. https://www.americashealthrankings.org/

U.S. Census Bureau. (2021). U.S. Census Bureau QuickFacts: Georgia. Census Bureau QuickFacts. https://www.census.gov/quickfacts/GA

U.S. Department of Health and Human Services. (2000). Oral Health in America: A Report of the Surgeon General. U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health. https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf

U.S. Department of Health and Human Services, Office of Minority Health. (2021). Profile: Black/African Americans. https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

Valliant, J. C., Burris, M. E., Czebotar, K., Stafford, P. B., Giroux, S. A., Babb, A., Waldman, K., & Knudsen, D. C. (2021). Navigating food insecurity as a rural older adult: The importance of congregate meal sites, social networks and transportation services. Journal of Hunger & Environmental Nutrition, 17(5), 593-614. https://doi.org/10.1080/19320248.2021.1977208

Walker, B. L., & Raval, V. V. (2017). College students from rural hometowns report experiences of psychological sense of community and isolation. Journal of Rural Mental Health, 41(1), 66-79. https://doi.org/10.1037/rmh0000059

Warren, S., Puryear, E., Chapman, M., Barnett, T. M., & White, L. S. (2017). The role of social work in free healthcare clinics and student-run clinics. Social Work in Health Care, 56(10), 884-896. https://doi.org/10.1080/00981389.2017.1371097

Downloads

Published

2024-01-30