Improving Access to Alzheimer's disease and Related Dementias care services for Latinx individuals at Community Health Clinics. A multiphase mixed methods study.

项目摘要/摘要 拉丁裔人罹患阿尔茨海默病和相关痴呆症的可能性是后者的1.5倍 (ADRD)比非拉丁裔白人成年人。然而，与非拉丁裔白人相比，他们的人数较少 有可能得到诊断，当他们得到诊断时，他们更有可能处于 疾病过程。这是限制获得健康的个人和背景因素的结果 老年拉丁裔成年人的护理服务，导致患者和照顾者的健康状况更差- 艾尔斯。为了改善拉丁裔个人获得护理的机会，有必要考虑拉丁裔个人-- 不同的背景和社会经济特征，发展创新的互动。 在服务不足的地区实施可行的措施。拟议的K99阶段包括 为填补我的知识空白而进行的培训--影响获得ADRD的组织因素 医疗保健服务，行为改变理论和设计思维在卫生干预中的应用 以及在ADRD研究中进行实用主义试验。这样做的首要目标是 建议是通过执行一项压缩计划来增加获得符合文化背景的ADRD服务的机会 对美国五个地点存在的障碍进行全面评估，并与一个 利益相关者在以人为中心的过程中制定系统级别的干预措施，以增加 使用ADRD服务。为了实现这些目标，我们提出了一种多阶段混合方法 研究过程。目标1(K99阶段)包括对测量 影响寻求治疗认知症状的意图的信念。这台乐器将会是一台- 描述在后续阶段维持健康差异的个人信念的重要工具。 目标2(K99-R00阶段)包括与不同城市的五(5)家社区卫生诊所合作 以确定影响Latinx访问的个人和背景因素 ADRD医疗服务。为此，我们将使用BEIC工具来描述 拉丁裔患者，与患有ADRD的拉丁裔患者及其照顾者举行五个焦点小组，以及 与关键信息利益相关者进行最多50次面谈。AIM 3(R00阶段)将涉及以下部分- 与一家社区卫生诊所共同设计以人为中心的干预措施，促进 为ADRD提供Latinx医疗服务。在这个项目结束时，我们将有一个 有效的调查工具来评估ADRD信念与健康寻求行为的联系 异质拉丁裔人群和增加获得ADRD机会的干预原型 服务。未来的研究将对干预措施进行试点，并随后评估其有效性。 这是一场内嵌的务实审判。

PROJECT SUMMARY/ABSTRACT Latinx individuals are 1.5 times more likely to develop Alzheimer's disease and related dementia (ADRD) than non-Latinx White adults. However, compared with non-Latinx Whites, they are less likely to receive a diagnosis, and when they do, they are more likely to be at late stages in the disease process. This is a result of individual and contextual factors that limit access to health care services in older Latinx adults, resulting in worse health outcomes for patients and caregiv- ers. To improve access to care for Latinx individuals, it is necessary to account for Latinx individ- uals' diverse backgrounds and socioeconomic characteristics, and develop innovative interven- tions that are feasible to implement in underserved areas. The proposed K99 phase includes training to fill my gaps in knowledge—the organizational factors affecting access to ADRD healthcare services, the use of behavior change theories and design thinking in health interven- tions, and the conduct of pragmatic trials in ADRD research. The overarching objective of this proposal is to increase access to culturally appropriate ADRD services by performing a compre- hensive assessment of the barriers existing at five locations in the US and engaging a team of stakeholders in a human-centered process to develop a systems-level intervention for increasing access to ADRD services. To achieve these goals, we propose a multiphase mixed methods research process. Aim 1 (K99 Phase) includes the validation of a survey instrument that measures beliefs that affect intentions to seek care for cognitive symptoms. This instrument will be an im- portant tool to describe the individual beliefs that sustain health disparities in subsequent stages. Aim 2 (K99-R00 phase) includes partnering with five (5) community health clinics in different cities around the US to characterize the individual and contextual factors that affect Latinx access to ADRD healthcare services. For this, we will use the BESIC instrument to describe beliefs among Latinx patients, hold five focus groups with Latinx patients with ADRD and their caregivers, and conduct up to 50 interviews with key informant stakeholders. Aim 3 (R00 Phase) will involve part- nering with one community health clinic to co-design a human-centered intervention for promoting Latinx access to healthcare services for ADRD. At the conclusion of this project, we will have a validated survey instrument to assess ADRD beliefs linked to health care seeking behaviors in heterogeneous Latinx populations and a prototype of an intervention to increase access to ADRD services. Future studies will pilot the intervention and subsequently evaluate its effectiveness us- ing an embedded pragmatic trial.