Advancing equity in dementia care through community health workers

The rising prevalence of Alzheimer’s disease and related dementias (ADRD) in the United States disproportionately affects underrepresented groups, such as African American and Latinx/Hispanics. These groups encounter systemic healthcare disparities, cultural barriers, and discrimination, leading to mistrust toward the healthcare system and underutilization of services. Given the limited culturally sensitive dementia interventions and cultural humility in the healthcare settings, employing Community Health Workers (CHWs) emerges as an important strategy for advancing dementia equity. Therefore, the purpose of this dissertation research was to investigate cultural factors impacting cognitive health of historically underrepresented populations and the feasibility of integrating the CHW model as a culturally appropriate dementia intervention for these groups. To address this overarching goal, three complimentary studies were conducted, focusing on the following objectives: (1) to examine the association between acculturation, a cultural factor and cognitive performance among Hispanic/Latinx older adults in the United States; (2) to examine the perspectives of healthcare professionals about the potential opportunities of employing CHWs in dementia care across African American and Latinx communities; (3) to examine the perspectives of healthcare professionals about challenges of employing CHWs in dementia care across the same groups. For study 1, cross-sectional data of 616 older Hispanic participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 was analyzed. Cognitive performance was measured by two cognitive tests: Animal Fluency Test and Digit Symbol Substitution Test. Two single-item proxy measures were used to quantify acculturation: nativity status and language acculturation. Adjusted linear regression was used to evaluate associations between acculturation and cognitive performance. For study 2 and 3, an exploratory qualitative approach was adopted using a semi structured questionnaire to interview a total of 15 healthcare professionals. Reflective thematic analyses were conducted to identify the emerging themes in both studies. Results from study 1 indicated significantly poorer cognitive performance in both tests among the low-acculturated groups for both nativity and linguistic measures. Results from study 2 identified four areas of CHW roles including: empowering connections in the communities through education and community building, navigating pathways of healthcare access and utilization, enhancing patient care in healthcare settings fostering cultural sensitivity and improving patients’ holistic health at home to clinic. In study 3, three themes were identified as potential challenges, including: lack of familiarity about CHWs among both health professionals and community individuals, challenges in CHWs’ preparedness for complex patient care needs, and sustainability challenges at policy or system level in the integration of CHWs. These dissertation research findings demonstrate that individuals in the low acculturated Hispanic group exhibit poorer cognitive performance, thereby, highlight acculturation to be an important consideration while investigating culturally diverse groups. By revealing these within group variations, this work emphasizes the need for designing affordable programs that are culturally tailored to Latinx subgroups. This work also provides understandings of opportunities and challenges of employing CHWs and supports their integration as a promising avenue of sustainable and culturally sensitive health intervention. From the perspectives of healthcare professionals, this research sheds light on ways CHW can provide support to dementia patients and caregivers and identifies multilevel challenges and actionable measures. Overall, this research advocates for dementia care equity among culturally diverse underrepresented populations in the United States.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Community Health

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2024

Author dc:creator

• Alam, Rifat Binte

Contributors dc:contributor

• Schwingel, Andiara
• Chodzko-Zajko, Wojtek
• Aguinaga, Susan
• Bobitt, Julie

• Dementia
• Community Health Workers

Statement dc:rights

• Copyright 2024 Rifat Alam

Language dc:language

eng, en

Handle dc:identifier

https://hdl.handle.net/2142/124672

OAI identifier oai:identifier

oai:www.ideals.illinois.edu:2142/124672