Date of Conferral

2-17-2026

Degree

Ph.D.

School

Public Health

Advisor

Joseph Robare

Abstract

Community health worker (CHW) programs are an increasingly important strategy for addressing social determinants of health (SDOH) within Medicaid systems. However, evidence on how specific SDOH impact healthcare utilization remains limited. In this quantitative, correlational study, the relationship between SDOH factors like housing instability, food insecurity, and transportation barriers, and primary care utilization among adult Medicaid recipients aged 18–65 who participated in a Medicaid managed care organization’s CHW program in Clark County, Nevada, during 2023 were examined. Retrospective administrative data from 441 participants were analyzed using negative binomial regression to assess associations between SDOH factors and postintervention primary care visits while controlling for baseline utilization and age, and a sign test to examine changes in utilization across pre and postenrollment periods. Results showed the overall regression model significantly predicted postintervention primary care utilization (likelihood ratio χ²(5) = 92.47, p < 0.001). Transportation barriers were the only SDOH factor independently associated with higher postintervention utilization. Participants receiving transportation-related CHW support demonstrated a 34.0% higher expected rate of primary care visits. Food insecurity and housing instability were not statistically significant predictors in the fully adjusted model. The sign test indicated a statistically significant directional increase in primary care utilization following enrollment (z = 4.52, p < 0.001). These findings highlight the value of transportation-focused CHW interventions and inform efforts to advance health equity.

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