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

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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.