Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Health Sciences

First Committee Member

Michelle Chino

Second Committee Member

Doris L. Watson

Third Committee Member

Sheniz Moonie

Fourth Committee Member

Carolee Dodge Francis

Number of Pages



Previous studies have been conducted to assess the barriers that limit access to health care services for people with disabilities. However, no study has been conducted to understand why barriers exist. Do practice administrators lack knowledge of the Americans with Disabilities Act (ADA) or is cost the issue? The purpose of this study was to examine why structural and equipment barriers exist that limit access to primary health care for people with disabilities.

A convergent parallel mixed methods design was employed. Practice administrators were selected for this study because of their oversight of the budget, equipment purchasing, facility operations and patient flow. Primary care practices were selected for this study as they are typically the point of entry into the health care system for patients. Participants in this study were Southern Nevada primary care practice administrators or primary care practice administrators who were members of the Medical Group Management Association (MGMA). The survey was constructed using ADA construction guidelines, the ADA's Access to Medical Care for Individuals with Mobility Disabilities, the Adaptive Environment Center's Checklist for Existing Facilities, and published literature. Eighty-one practice administrators completed the survey. Mann-Whitney U, chi square, Guttman scale, and linear regression were utilized for the data analyses.

The total number of barriers for each practice was calculated. The mean number of barriers were calculated for the total sample and each group of administrators. Southern Nevada practice administrators reported significantly fewer barriers than MGMA administrators. There was no significant difference in total ADA knowledge scores between groups and the proportions of affirmative answers did not show significant differences between groups. Total ADA knowledge scores for practice administrators conformed to a valid Guttman Scale and summed knowledge scores were found to be a significant predictor of the total number of barriers using linear regression (p = 0.01). Administrators' knowledge of accessible equipment was significantly correlated with the amount of accessible equipment in their practices (p = 0.02). Less than half of the administrators had inquired about the cost of bringing their practice into compliance with the ADA or about the cost of accessible equipment. From this study, it could not be determined if cost was a reason for access barriers reported in the clinics.

Multiple linear regression analyses were conducted using characteristics of the administrator and characteristics of the practice. A final model (p < 0.01) was achieved that explained 36% of the variability in the total number of barriers using independent variables: group, ADA knowledge, building built before 1993, age of administrator and number of patients as significant independent variables. Hypotheses concerning knowledge were supported by the findings while hypotheses about cost and responsibility were not supported by the findings of this study.

This study revealed that administrators' lack of knowledge about the ADA was significantly related to the total number of barriers in their clinic while knowledge of accessible equipment was significantly related to the amount of accessible equipment in their clinic. Interventions to improve primary care practice administrators' knowledge of the ADA may result in a reduction in access barriers in their clinics and diminish health disparities experienced by people with disabilities.


Access; Disabilities; Healthcare; Health services accessibility; Nevada; People with disabilities


Public Health

File Format


Degree Grantor

University of Nevada, Las Vegas




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