Author ORCID Identifier

https://orcid.org/0000-0002-6794-110X

Semester

Fall

Date of Graduation

2022

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Not Listed

Committee Chair

Ubolrat Piamjariyakul

Committee Member

Roger Carpenter

Committee Member

Usha Sambamoorthi

Committee Member

Rebecca Schmidt

Committee Member

Mary Jane Smith

Abstract

Introduction: Approximately 786,000 Americans are currently diagnosed with end-stage renal disease, 71% of whom are undergoing hemodialysis (HD) treatment. There is a bidirectional relationship between chronic kidney disease and periodontal disease. Among HD patients, poor oral health is prominent and can negatively impact general health and health-related quality of life. Appalachian residents experience extreme health and poverty inequities and limited access to healthcare and dental providers.

Method: The study was designed based on the Andersen Behavioral Model of Health Services Use. 120 participants from 6 outpatient HD centers were enrolled. Data were collected using a 34-item questionnaire including oral health and demographic questions. Electronic medical record review was also completed which provided additional demographic data and Kidney Disease and Quality of Life-36 scores. Data were analyzed using SAS 9.4 with alpha set at .05. Statistical analyses included chi-square tests, t-tests, multivariable logistic regression, and ordinary least squares regression.

Results: The study sample was almost evenly male and female (51.7% vs. 48.3%), mostly white (92.5%), and over half had not been to the dentist in the last three years (51.7%). Among study participants, those with obesity reported better oral health status, while those reporting self-consciousness about the teeth/mouth reported poorer oral health status. In the study, females, those with self-reported depression, current smokers, and individuals drinking alcohol reported lower overall health-related quality of life scores.

Conclusion and Implications: The findings support reinforcement of recommended nursing interventions for smoking cessation, health-related quality of life and depression screening, and oral health literacy education.

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