Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Deborah Slawson

Committee Members

Roger Blackwell, Judy McCook


Older adults are living longer than ever before. By 2060, the U.S. population aged 65 or older is projected to reach 98 million. As adults age, the prevalence of chronic diseases and disabilities increases. The need for Meals on Wheels (MOW) services is growing alongside the aging population. Yet, little is known about the geographic variation of services. Little is documented about the organizational capacity of MOW organizations in terms of geography. The current policies supporting home-and community-based services, including MOW, may be insufficient to support all older adults in all types of communities. An analysis of the More Than a Meal® Comprehensive Network Study was conducted to determine geographic variation in services delivered through MOW programs and to document organizational capacity by geography. Chi-squared analyses were performed to identify relationships between twenty services offered through MOW organizations and categorial offerings within nutrition, in-home safety, socialization, and community connections categories. Spidergrams were created to document organizational capacity holistically and for three individual organizations for each of the geographic areas: Rural Only, Partial Rural, and Non-rural Service Areas. Using these findings, a policy analysis was conducted to determine policy recommendations to inclusively support rural older adults.

Older adults living in rural areas access the full complement of services provided by MOW programs differently than do their non-rural counterparts. Specifically, a statistically significant relationship was found between the stratified component of in-home safety for rural, partial rural and non-rural service areas. When evaluated on the individual service offering level, statistically significant relationships between rurality and congregate meals, nutrition education, nutrition assessment, coordination of USDA food assistance programs, and telephone reassurance were seen. Spidergram documentation of capacity created visual representations of geographic similarities and differences. The policy analysis produced three potentially viable policy additions for the Older Americans Act around a provision for innovation programs, a report on in-home safety, and business acumen provisions. This work lays the foundation for further analysis of existing data with a lens of geographic specificity, as well as articulates the importance of looking at organizational capacity as a part of policy recommendations for understanding rural community-based organizations.

Document Type

Dissertation - unrestricted


Copyright by the authors.