Advisor(s)

Geoffrey Silvera

Committee Member(s)

Michelle Brown
Monica Aswani
Nancy Borkowski
Philip Cendoma

Document Type

Dissertation

Date of Award

6-1-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Health Professions

Department

Administration/Health Services

Abstract

Federally Qualified Health Centers (FQHCs) are a vital provider of comprehensive healthcare for vulnerable and underserved communities. They serve populations that are disproportionately impacted by chronic health conditions and socioeconomic related barriers to healthcare. To provide adequate support and reduce barriers faced by patients, some FQHCs deliver not only primary and preventative care but also a range of enabling services. These enabling services range from providing transportation to health education and case management. This dissertation includes three studies that examine how environmental conditions are related to the use of enabling services in FQHCs, the relationship between enabling services and process measures, and the role of non-federal funding in supporting these services. The purpose of the first study was to explore whether market characteristics indicating resource availability and resource demands are related to the utilization of enabling services workers providing health education and community outreach in FQHCs. The findings revealed variability in resource availability and resource demand factors that are related to the utilization of enabling services workers with several factors not found to be significant. The purpose of the second study was to examine the degree to which enabling services are associated with cancer and BMI screenings. This study found that enabling services is not significantly associated with the screening rates and that physicians currently play a more significant role in cancer and BMI screening rates in FQHCs. The third study examined the degree to which non-federal grants are related to the scope and utilization of enabling services in FQHCs. Key results indicate that additional funding is significantly, positively associated with the scope of enabling services, but is not associated with the utilization. Findings from this work aim to inform policy and practice related to prioritizing and supporting the sustainability and expansion of enabling services to meet the needs of underserved populations.

Keywords

Chronic Diseases;Enabling Services;Federally Qualified Health Centers (FQHCs);Health Care Access;Preventive Care;Underserved Populations

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