Date of Award


Degree Name

Doctor of Philosophy


Public Affairs and Administration

First Advisor

Dr. James A. Visser

Second Advisor

Dr. Victoria Ross

Third Advisor

Dr. Amy Curtis


This research study evaluated the replication and implementation of Project Access (a nongovernmental, structured program providing physician and health care services to the working-poor) in Grand Rapids, Michigan. A mixed methodological approach was used and included quantitative and qualitative methodologies. The qualitative method used was a self-administered mailed survey of all Project Access enrollees. This survey evaluated the enrollee's perceived health and lifestyle function, access to physician services, access and adherence to prescribed medication regimen, and barriers to physician services during the year pre- and post-enrollment in Project Access. The survey also evaluated the amount enrollees were able or willing to pay for similar services and their satisfaction with the program. Survey results were evaluated by a frequency distribution and a Wilcoxon sign rank sum test to evaluate the differences between 10 pre- and post-enrollment pairs of questions. The enrollees reported improved health, improved lifestyle function, decreased visits to hospital emergency departments, increased physician visits, and decreased total number of emergency department and physician visits. Additional reported results include increased adherence to prescribed medication regimens, a willingness to pay for similar services (52%), and satisfaction with the program (95%).

Access Setting

Dissertation-Open Access