Term of Award

Spring 2019

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy and Management (COPH)

Committee Chair

Bettye Apenteng

Committee Member 1

Raymona Lawrence

Committee Member 2

Adrienne Cohen

Committee Member 3

Kate Beatty

Committee Member 3 Email



The people of Appalachia have less access to healthcare resources subsequently leading to deficits in healthcare, health education, and health research. There is a need to address the communication of healthcare resources among populations with low economic status such as the Appalachian communities in Northeast Tennessee. Alzheimer’s disease and related dementias (ADRD) uniquely challenges the healthcare industry while further dividing communities already experiencing hardship in healthcare resources. The Baby Boomer generation is advancing into the age range frequently affected by ADRD, 65 and over. In preparation, healthcare continuum must acknowledge and set out to address dementia-specific care challenges. “Keep something in the shadows, and people are not gonna even realize it is a problem.” This study uniquely supplements current research by exploring how communication influences acceptability, accessibility, affordability, availability (the 4A's) of dementia-specific health resources and services in Northeast Tennessee. The study is a qualitative study utilizing classic grounded theory (CGT). Together with cataloging the number and types of dementia-specific health resources and services existing in Northeast Tennessee, sixteen one-on-one interviews with organization leaders, caregivers, and healthcare providers took place between May 2018 and September 2018. The study revealed that the number of organizations offering dementia-specific resources and services in Northeast Tennessee is abundant. Nevertheless, they remain unaccepted by some and unknown by many because PLWD and their caregivers experience multifaceted barriers, which constrains access to resources and services. Individual-level influences such as denial, control, and perceived stigma encumber on the likelihood of willingness to seek dementia-related assistance. Providers’ and organizations’ readiness to be the patient advocates enhances care delivery. Positive influencing factors and readiness among dementia care organizations and providers serve as the link for patients and their loved ones to the starting point of dementia care navigation, which is the secured point in time when a patient begins seeking resources and services and is guided by a knowledgeable professional to find the best available options to suit his or her individual needs. According to the findings from the study, refining access and improving communication requires awareness, knowing where to start, and working within and across disciplines and stakeholders. Accordingly, a two-pronged approach for addressing the communication gaps from both ends – provider and consumer – is needed. The suggested means of action to address these gaps include a peer health communication intervention, and implementation of a patient navigation care coordination model designed explicitly for ADRD. Further, community organizations offering dementia-specific health resources and services must continue to market themselves to expand their visibility and to increase provider, patient and caregiver awareness about their services while strengthening their relationships with healthcare providers and other clinicians.

OCLC Number


Research Data and Supplementary Material