Uncovering Oral Health Inequities in Rural Appalachia through Systems Thinking
Abstract
Uncovering Oral Health Inequities in Rural Appalachia through Systems Thinking Sana Hasan Department of Health services Management & Policy, College of Public Health East Tennessee state University Objectives: This study aimed to identify systemic variables contributing to oral health inequities in rural Appalachia using a systems thinking approach. It explored how social, economic, cultural, and policy-level factors interact to influence oral health outcomes and examined potential leverage points for equitable, sustainable interventions. Methods: The analysis was guided by five conceptual frameworks: the Iceberg Model, the Community Readiness Model, the Socio-Ecological Model, the Andersen Model of Healthcare Utilization, and a Systems Framework for Health Equity. Primary data were collected through semi-structured interviews with four key stakeholders, a community partner, practitioner, researcher, and a patient. Methodological pluralism and boundary critique were applied to ensure inclusion of multiple viewpoints and to challenge conventional boundaries around healthcare delivery. Results: Findings revealed five reinforcing and balancing loops contributing to inequities: (1) low awareness and health literacy, (2) limited insurance coverage, (3) socioeconomic constraints, (4) workforce shortages, and (5) policy barriers limiting preventive care access. Stakeholders emphasized that low reimbursement rates and fragmented medical-dental integration perpetuate access gaps. Community readiness was rated at the vague awareness stage, indicating the need for targeted education, stronger inter-professional collaboration, and increased policy incentives. Interview narratives highlighted the importance of culturally competent providers, school-based programs, and mobile dental clinics to bridge service gaps. Conclusions: Systems thinking illuminated how reinforcing cycles of socioeconomic hardship, low awareness, and limited infrastructure sustain oral health inequities in Appalachia. Multi-level interventions, combining policy reforms, workforce incentives, integrated care, and community engagement are essential to advance oral health equity and strengthen preventive care delivery.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
37
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Jodi Southerland
Uncovering Oral Health Inequities in Rural Appalachia through Systems Thinking
Culp Ballroom 316
Uncovering Oral Health Inequities in Rural Appalachia through Systems Thinking Sana Hasan Department of Health services Management & Policy, College of Public Health East Tennessee state University Objectives: This study aimed to identify systemic variables contributing to oral health inequities in rural Appalachia using a systems thinking approach. It explored how social, economic, cultural, and policy-level factors interact to influence oral health outcomes and examined potential leverage points for equitable, sustainable interventions. Methods: The analysis was guided by five conceptual frameworks: the Iceberg Model, the Community Readiness Model, the Socio-Ecological Model, the Andersen Model of Healthcare Utilization, and a Systems Framework for Health Equity. Primary data were collected through semi-structured interviews with four key stakeholders, a community partner, practitioner, researcher, and a patient. Methodological pluralism and boundary critique were applied to ensure inclusion of multiple viewpoints and to challenge conventional boundaries around healthcare delivery. Results: Findings revealed five reinforcing and balancing loops contributing to inequities: (1) low awareness and health literacy, (2) limited insurance coverage, (3) socioeconomic constraints, (4) workforce shortages, and (5) policy barriers limiting preventive care access. Stakeholders emphasized that low reimbursement rates and fragmented medical-dental integration perpetuate access gaps. Community readiness was rated at the vague awareness stage, indicating the need for targeted education, stronger inter-professional collaboration, and increased policy incentives. Interview narratives highlighted the importance of culturally competent providers, school-based programs, and mobile dental clinics to bridge service gaps. Conclusions: Systems thinking illuminated how reinforcing cycles of socioeconomic hardship, low awareness, and limited infrastructure sustain oral health inequities in Appalachia. Multi-level interventions, combining policy reforms, workforce incentives, integrated care, and community engagement are essential to advance oral health equity and strengthen preventive care delivery.
