Assessing the Effects of Home-Based Primary Care on Alzheimer’s Caregivers and Support Organizations: An Application of the Health Equity Implementation Framework

Alzheimer's disease and related dementias (ADRD) pose significant challenges for care partners and community-based organizations (CBOs) involved in providing care. Home-based medical care (HBMC) models have emerged as a potentially equitable solution to support these individuals and organizations. Utilizing the Health Equity Implementation Framework (HEIF), this study explores the barriers and facilitators experienced by care partners and CBO staff in Black and Latino communities. Data were collected through thirteen semi-structured interviews and four focus groups, with participants recruited from those providing care to patients enrolled in the AHWFB house call program in Winston-Salem, North Carolina. Interviews were conducted in English and Spanish, and thematic analysis was applied to the data to identify key themes within the HEIF domains. I-Poems were presented to participants as a member-checking technique. The study identified historical mistrust and systemic racism, economic barriers, and logistical challenges as significant impediments to healthcare access. Cultural beliefs and care partner roles were explored in the context of Black and Latino care partners and their impact on approaches to care of PLWD. The HBMC model was valued for its convenience and personalized approach, though participants identified a need for improved communication with providers and greater cultural sensitivity. Additionally, participants from focus groups and caregiver interviews provided several actionable recommendations for enhancing the healthcare experiences of those dealing with ADRD.