Dissertations & Theses (Open Access)

Date of Award


Degree Name

Doctor of Philosophy (PhD)


Deanna M. Hoelscher

Second Advisor

Katherine Froehlich-Grobe

Third Advisor

Harold W. Kohl


Background: People with disabilities experience higher rates of chronic disease and poor health status compared to those without disability. People with disabilities do not participate in community health programs to the same degree as those without disability due to social, programmatic, and environmental barriers. The Community Health Inclusion Index (CHII) is a community health assessment tool which evaluates the degree to which community-level health promoting opportunities to promote nutrition and physical activity are inclusive and accessible to people with disabilities. The CHII assess barriers to inclusion across five domains: build environment, equipment, program/services, staff, and policies. Objective: The purpose of this study was to use the CHII to assess the inclusiveness and accessibility of nine San Antonio senior centers which provide nutrition and physical activity programs to local seniors and identify the barriers and facilitators to inclusion of seniors with disabilities. Methods: Assessment of CHII survey items related to the built environment and equipment was conducted through an observational audit of the nine senior centers. Survey items under the domains of program and services, staff, and policies were completed through interviews with a City leadership and community organizations which provide services to people with disabilities. Pilot data on the usability and feasibility of the CHII survey tools were collected. Results: The top barriers to inclusion included a lack of health promotion materials available in accessible formats, lack of accessible equipment in healthcare exam rooms, and neighborhood characteristics that make travel to the sites on foot unappealing. Top facilitators to inclusion included a robust nutrition and transportation program available at no cost to qualifying seniors, accessible site layouts, and an organization and community willingness to identify and improve inclusion and accessibility for people with disability in the San Antonio. Conclusion: San Antonio senior centers provide an array of services with the majority being inclusive of seniors with disabilities. Partnerships with local transit, food bank, and YMCA/YWCA organizations help ensure nutrition and physical activity programs are inclusive and accessible to local seniors. Future considerations include adding questions to assess leisure/recreational activities. Future initiatives to improve accessibility and make health-promoting opportunities more inclusive of people with disabilities should use an established framework such as Guidelines, Recommendations, Adaptions Including Disabilities (GRAIDs).