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Philosophiae Doctor - PhD / Oral diseases are a major public health problem in the Seychelles, amidst a contracting budget coupled by a lack of national oral health policy and strategic plan to promote oral health. The oral disease burden is attributed to numerous determinants operating at different levels –macro, population and community, and at the person level. The study set out to examine the determinants that contribute to poor oral health in the Seychelles through an exploration of the social, cultural, economic and environmental factors influencing the oral health of adults. The purpose of the study was to develop an evidence-based theoretical framework that would inform future policy and practice for oral health. Set in the mixed research paradigm, a qualitative and quantitative research approach was used to obtain a deeper understanding of the pathways and mechanisms operationalizing determinants. Using a purposive sampling approach, individual and group interviews were conducted with patients, dental staff and a representative of the upper management.

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

When adolescents forgo oral health treatment, factors that hinder them from obtaining these services put them at risk of detrimental consequences in their oral and overall health. The purpose of this qualitative phenomenological study was to identify the various barriers that adolescents encounter causing them to defer oral treatment. Through this study, public health officials, school health care providers, the state, and parents could be made aware of these factors and work together to implement programs and supplemental aid to help adolescents become more knowledgeable of the importance of oral care and encourage them to desire and seek treatment. The oral health and behavioral conceptual models provided foundations for the development of the research questions, and they highlighted the selection of risk factors on the deferment process. Twenty adolescents who had oral health treatment/services in the past 12 months participated in the study. Interviews were transcribed verbatim and analyzed thematically. The results of this study show that oral health beliefs, as well as personal, behavioral, and environmental factors, shaped adolescents' decision to forgo oral health treatment. Financial barriers, dental fear, and transportation obstructed their capacity to seek care for themselves. The positive social change implications of this study include increasing the proportion of adolescents receiving oral health treatment yearly through the development of targeted interventions (such as school programs) that are designed to increase the adolescents' access to and use of dental care services. Such efforts would support the strategies implemented to achieve Healthy People 2020 objectives.