Oral Health Service Utilization Behavior and Its Influencing Factors Among Older Adults: An Empirical Study Based on the Composite Health Behavior Model

Background China's aging population faces significant unmet oral healthcare needs, and delays in seeking care exacerbate the disease burden. Currently, there is a lack of empirical research applying comprehensive health behavior models to understand the pathway relationships among influencing factors in this population. Methods A cross-sectional study was conducted between July and September 2023 among 356 community-dwelling older adults in Foshan and Guangzhou, using a theory-driven questionnaire. Group comparisons employed independent t-tests or ANOVA for sociodemographic variables. Structural equation modeling (SEM) validated pathways. Results Significant differences were observed: 1) Sex and age affected individual model variables; 2) Education, residence location, and economic status influenced multiple variables; 3) Living arrangement showed no significant effects. Only 33.7% of older adults proactively sought oral health knowledge, while 65.7% did not receive regular dental check-ups. Merely 51.2% sought treatments (e.g., scaling, fillings, extractions, dentures, implants). When acute oral pain disrupted daily life, 24.7% still delayed seeking care. SEM revealed: 1) Behavioral Intention/Control had the strongest total effect on utilization behavior ( β  = 0.593); 2) This was followed by Perceived Benefits ( β  = 0.404); 3) Subjective Norms exerted only indirect effects ( β  = 0.216); 4) Both Subjective Norms ( β  = 0.365) and Perceived Benefits ( β  = 0.282) directly influenced Behavioral Intention/Control. Conclusion Oral health service utilization among older adults in China remains largely passive. Our model identifies three key modifiable factors: Behavioral Intention/Control, Perceived Benefits, and Subjective Norms. Strategies to improve service utilization should focus on strengthening social support and addressing unrealistic health perceptions.