Multilevel insights on promoting oral health equity for older adults

• Honestly communicating with patients about treatment options establishes trust • Caregiver support for oral hygiene improves oral health through multiple pathways • General health leads to oral health; a functional dentition enables a healthy diet • Oral health increases social engagement leading to greater social connectivity • Community workforce development increases the availability of dental providers Structured exercises and interdisciplinary approaches may uncover insights regarding longstanding and intractable concerns, including barriers to and opportunities for achieving oral health for impoverished older adults. This study integrates qualitative social and systems science approaches to identify leverage points at individual, interpersonal, community, and societal levels with which to develop interventions that promote oral health equity for racial/ethnic minority older adults living in disadvantaged northern Manhattan neighborhoods of New York, NY, USA. Twenty-four focus group sessions were conducted at community sites with African American, Dominican, and Puerto Rican older adults, and 16 key informant interviews were conducted at senior centers with staff. Group model-building workshops were held annually in person with the research team to articulate feedback mechanisms across various levels that reflected insights from qualitative data analysis. Among the feedback mechanisms identified was a reinforcing loop that explicates the relationship between oral health and social engagement , and consequences of communication by word of mouth for patient oral health awareness . An intervention affecting this feedback loop is caregiver support for oral hygiene at the interpersonal level that has a positive impact on oral health at the individual level, enabling this reinforcing loop to operate as a virtuous cycle. Conversely, lack of caregiver support could induce a vicious cycle of deteriorating oral health. These insights contributed to conceptual and computational simulation models. Multilevel insights on promoting oral health equity for older adults arose from community-based research involving qualitative data analysis, group model-building activities, and dynamic simulation modeling.