Date of Award


Document Type


Degree Name

Doctor of Philosophy


College of Education and International Services


Leadership PhD

First Advisor

Erich W. Baumgartner

Second Advisor

Jay Brand

Third Advisor

David Penner


The Problem

The world is facing a tsunami of chronic diseases of the brain such as dementia, Parkinson's, and stroke. But all populations are not affected equally. Though we are all at greater risk of developing these diseases, minority communities such as the Black and Hispanic populations are at much greater risk of succumbing to these conditions. To date we have spent billions of dollars on research and public health measures that have repeatedly failed, but over the last decade it has become evident that much of these diseases can simply be averted through effective public health and community-based measures such as lifestyle change at home and the community. Though these public health measures have made some inroads in certain communities, in others such as the Black and Hispanic communities which are already at greater risk for these diseases because of unhealthy lifestyle and environmental factors, the public health measures have not made any inroads.

The Purpose

In this analysis we wanted to understand (1) the perception of the elderly population in three communities (Black, Hispanic, and White) with regards to access to care and how they see themselves being taken care of, (2) their perceptions of the effect of lifestyle on their risk for cognitive diseases, and (3) where they see the best path to greater access to information and resources.


Our approach to answer these questions was a mixed qualitative and quantitative method involving community members at different levels. This approach is called a community-based participatory research model. For this dissertation we focused on the quantitative data, which was constructed using our qualitative community-based conversations.


Our analysis demonstrated that all three communities believed that they had access to care, and that neither insurance issues, physical access, or communication with their physicians was a limitation. We also found out that all three communities believed that lifestyle is an effective way to reduce one's risk for cognitive diseases of aging, but the three populations perceived different loci where they could access care and education related to cognitive diseases and health. Whites found the clinics and the healthcare community to be the most effective locus of healthcare education and access, whereas the Hispanic population found the faith community to be the optimal location for healthcare education. The Black community found the church and other community gathering locations, such as businesses, to be the best locations for healthcare education and resources.


What is valuable about our findings is that understanding where people connect to a community in view of their health care needs, and where they perceive to find the most effective means of health education is a prerequisite for determining how to bring about change and ultimately avert the tsunami that is devastating these communities. As health care leaders our objective is to be effective in bringing about positive change. The most effective model of behavior change with regards to cognitive diseases is through the community-based participatory approach to research and project implementation, which empowers communities to truly make change.

Subject Area

Minority older people--Diseases; Older people in mental health; Brain--Diseases; Minority older people--Mental health services; Community health services; Health services administration

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