Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Dr. Kendra L. Ratnapradipa

Second Committee Member

Dr. Hongmei Wang

Third Committee Member

Dr. Lisa C. Smith


Background: Healthcare access disparities exist among individuals with and without disabilities (IWD, IWoD). There is a scarcity of studies focused on Nebraskans living with disabilities.

Methods: Access to Care Nebraska surveyed adults (age 19+) in Oct 2020-Mar 2021. We used Andersen’s model of healthcare utilization to group risk factors for non-compliance with routine care and recommended cancer screening. A multivariate log-binomial regression compared the non-compliance between IWD and IWoD to compute adjusted prevalence ratios (aPR) for risk factors.

Results: Of the 1101 participants,96(8.7%) were IWD. IWD had a higher proportion of non-compliance to routine preventive care (61.7% vs 54.1%) and recommended cancer screenings (68.4% vs 57.6%).

Non-compliance to routine care was higher in younger adults (aPR=2.74, 1.51-4.97; P<.001) and among those with transport barriers (aPR=13.48, 3.31-54.8; P<.001). Recommended cancer screening results showed age and chronic conditions had significant interaction (P=0.01). Younger adults were 0.06 times less likely to be non-compliant (95% CI 0.01-0.68; P=0.02), whereas non-Whites (aPR=1.76, 1.04-3.00; P=0.04) and those with transport barriers (aPR=3.13, 1.13-7.34; P=0.02) had higher non-compliance.

Conclusion: Despite continued efforts to improve health accessibility for IWD, this study finds there still a significant gap in screening uptake for this population in Nebraska based on age, transport barrier, and race/ethnicity. The study underscores the need to increase health promotion activities to change screening behaviors and programs to close the healthcare gaps among IWD.

Available for download on Thursday, April 24, 2025