All ETDs from UAB

Advisory Committee Chair

Dori Pekmezi

Advisory Committee Members

Robin Lanzi

Suzanne Perumean-Chaney

Kerri Vanderbom

Brooks C Wingo

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Background: People with disabilities (PWDs) have poorer health outcomes, yet are they are underserved by public health initiatives. PWDs face numerous barriers to participation in community-based health programs despite mounting evidence about these barriers along with recommendations and guidelines to become more inclusive of disability. Policy, system, and environmental (PSE) changes that are inclusive of PWDs can help create access to health promotion programs for PWDs. Systematically implementing inclusive PSE changes using implementation science principles can support effective and sustainable changes are implemented for each unique community context. The purpose of this dissertation is to explore the experiences of public health and disability health professionals in developing and implementing PSE changes inclusive of PWDs and identify determinants of implementation behavior that support successful inclusive PSE changes. Methods: Interviews conducted with community coaches (n=19) representing 10 communities that were a part of The Reaching People with Disabilities through Healthy Communities (DHC) project were coded into the Theoretical Domains Framework (TDF) and the COM-B framework (capabilities, opportunities, and motivations to lead to behaviors), to identify emerging themes related to the determinants of implementation behavior. Coaches also completed a questionnaire based in the TDF to determine self-reported determinants of implementation behaviors. Finally, using the Knowledge-to-Action Framework, we explore the use of a systematic implementation framework in implementing inclusive changes in a specific context. Results: We found that the opportunities domain, consisting of environmental context and resources and social influences, was reported to have the greatest perceived effect on implementation processes of inclusive PSE changes. Conclusion: Systematically navigating the environment, both social and physical, to build opportunities for inclusive PSE changes can assist in facilitating implementation of inclusive public health initiatives. Creating opportunities through allocation of resources and engaging the community members to implement inclusive changes within the community is a step towards addressing the health disparities faced by PWDs.

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