Health care utilization behavior of elders in a multicultural urban environment

The objective of this research is to determine the influences of social, environmental, behavioral, and economic forces on the health care service utilization of four racial/ethnic groups of non-institutionalized elders in a multicultural urban environment. To address these issues this dissertation examines three intertwined themes of culture, aging, and health, using a sample of elders residing in Miami-Dade County, FL in four racial/ethnic groups: white non-Hispanic; black non-Hispanic English speakers; Cuban; and non-Cuban Hispanic. ^ The research questions were analyzed using both quantitative and qualitative data. Data for the quantitative component uses telephone survey data from the Dade County Needs Assessment. The purpose of this component is to develop a more comprehensive model of elder health care utilization behavior. The qualitative component uses data from focus groups from Dade County Needs Assessment, archival data and a literature review of previous ethnographic research. The purpose of this component is to gain a better understanding of the social construction of the terms “age”' and “aging,” as well as to place issues of health and health care in the lives of elders. ^ The findings raised several important issues. First, just because people share a common chronological age does not mean that they are the same in every other respect. Examining elders as a homogeneous group of users of formal health care services in a community is simplistic. Placing “aging” and “health” in a cultural context is important. My findings confirm that the meaning of “aging” and “old” are socially constructed. Further, the term “aging” is NOT synonymous with ill health or frailty. This was a consistent finding in both the quantitative and qualitative results. ^ While all aging individuals share a mutual orientation toward aging (i.e., biological process), they do not age the same way (i.e., social construction of “aging”). Thus, policymakers and others serving the elder population must be aware of the particular cultural context, as well as the previous life experiences of the individuals that they serve. This analysis documents the importance of culture and geographic community in understanding health care service utilization of elders. ^

The Ghana National Service Scheme: Perceptions of former educational personnel, students and guardians

The purpose of this inquiry was to investigate the perceptions of former service personnel, students and their parents about the organizational effectiveness of the Ghana National Service Scheme (GNSS). The inquiry addressed the following questions: How do the participants perceive the effectiveness of the national service program on the Ghanaian society? What are the perceptions of school administrators who worked with service personnel, parents and students vis-à-vis the over all impact of the GNSS on the educational system? What are the perceptions of former service personnel, students and their parents in regard to the impact of the GNSS on them? ^ The GNSS is a part within the ministry of education, which is also part in the Ghanaian social structure. Hence, a systems theory approach which asks, “How and why a system as a whole functions as it does” (Patton, 1990), was utilized in the study. Methodologies included purposive sampling; interviews; participant observation, and follow-up interviews. The study was conducted over a six-moth period. ^ A cross-sectional survey design was used to generate data. The survey was followed up with an ethnographic study where in-depth, face-to-face interviews were conducted together with observations. The results were described and interpreted. ^ The summary of findings concludes that perceptional determinants of the effectiveness of the GNSS were biased by the age and zone of origin but not gender. This partially agrees with Marenin's (1990) except for gender. A significant difference was detected between the responses of those who were officials of the National service Secretariat and of former service personnel. The administrators defended the status quo and demonstrated their deeper knowledge about the scheme. The former personnel and parents freely criticized the program when necessary and did not seem to know much about the GNSS. Respondents mostly stressed the need for the secretariat to focus on the following areas: (1) involvement in the agricultural sector of the economy, (2) involvement in rural mass, civic and health education, (3) adequacy of remuneration and personnel welfare, and (4) ensuring posting of personnel to areas of their expertise. Recommendation for further research concluded the study. ^

The effects of government disability benefits, accessibility laws and rehabilitation on employment choices by individuals with spinal cord injuries

Greater inclusion of individuals with disabilities into mainstream society is an important goal for society. One of the best ways to include individuals is to actively promote and encourage their participation in the labor force. Of all disabilities, it is feasible to assume that individual with spinal cord injuries can be among the most easily mainstreamed into the labor force. However, less that fifty percent of individuals with spinal cord injuries work. ^ This study focuses on how disability benefit programs, such as Social Security Disability Insurance, and Worker's Compensation, the Americans with Disabilities Act and rehabilitation programs affect employment decisions. The questions were modeled using utility theory with an augmented expenditure function and indifference theory. Statically, Probit, Logit, predicted probability, and linear regressions were used to analyze these questions. Statistical analysis was done on the probability of working, ever attempting to work after injury, and on the number of years after injury that work was first attempted and the number of hours worked per week. The data utilized were from the National Spinal Cord Injury Database and the Spinal Cord Injuries and Labor Database. The Spinal Cord Injuries and Labor Database was created specifically for this study by the author. Receiving disability benefits decreased the probability of working, of ever attempting to work, increased the number of years after injury before the first work attempt was made, and decreased the number of hours worked per week for those individuals working. These results were all statistically significant. The Americans with Disabilities Act decrease the number of years before an individual made a work attempt. The decrease is statistically significant. The amount of rehabilitation had a significant positive effect for male individuals with low paraplegia, and significant negative effect for individuals with high tetraplegia. For women, there were significant negative effects for high tetraplegia and high paraplegia. ^ This study finds that the financial disincentives of receiving benefits are the major determinants of whether an individual with a spinal cord injury returns to the labor force. Policies are recommended that would decrease the disincentive. ^

A qualitative study of an interagency relationship: Education interventions for foster children

The Interagency Agreement between the Broward County School System and District 10 Department of Children and Families (DCF) was implemented to improve the organization's relationship and in turn improve education interventions for foster children. The purpose of this study was to examine and describe key decision-makers' perspectives of this interagency relationship after implementing mutual policy. ^ The research questions which drove this study were: (a) from the perspectives of the participants, what was the relationship between the decision-makers of the Department of Children and Families and the Broward County School System, after the implementation of a unification plan that was influenced by the court system? and, (b) how was the relationship between the school system and DCF reflected in the Interagency Agreement? ^ Data were obtained through a case study that included interviews, document analysis and field observations. Participants were key decision-makers in their respective institutional settings and were chosen using criterion sampling. The researcher analyzed and interpreted data from the District 10 DCF commissioned assessment of foster care, the State of Florida Management Plans (education section), the Interagency Agreement, and participant interviews. ^ This study focused on the following five contextual areas regarding the Interagency Agreement: interagency cooperation, interagency coordination, interagency collaboration, traditional organizational linkages, and organizational climate. The results of this study suggest that the organizations' improved relationship improved the educational system for foster children. ^ This researcher recommends that the Interagency Agreement shares the leadership structure with an active parent organization of 15 foster parents who would be divided into three subcommittees. These subcommittees would perform specific tasks such as involving other foster parents, and writing mini proposals to address the social and tutoring needs of foster children. A Wraparound process including community organizations (clubs, businessmen and concerned community groups, Big Brothers/Big Sisters, Boys and Girls Clubs) is also recommended in order to engage foster children in activities to build their social skills, friendships and self-esteem. This researcher also recommends that the Broward County School System consider a role that would provide for the development of curriculum for inservice for teachers. This would empower teachers and allow them to better address the academic and social needs of the foster children. ^

On the fundamentals of research and development (R&D) spillovers in competitive markets

Rivals may voluntarily share Research and Development (R&D) results even in the absence of any binding agreements or collusion. In a model where rival firms engage in non-cooperative independent R&D process, we used optimization and game theory analysis to study the equilibrium strategy of the firms. Our work showed that, while minimal spillover is always equilibrium, there may be another equilibrium where firms may reciprocally choose high, sometimes perfect, spillover rates. The incentive for sharing R&D output is based on firms' expectations of learning from their rivals' R&D progress in the future. This leads to strategic complementarities between the firms' choices of spillover rates and thus policy implication follows. ^ Public research agencies can contribute more to social welfare by providing research as public goods. In a non-cooperative public-private research relationship where parallel R&D is conducted, by making its R&D results accessible, the public research agency can stimulate private spillovers, even if there exists rivalry among the private firms who can benefit from such spillovers. ^

The impact of the juvenile intervention facility on the adjudication of delinquent youth in Broward County

Considerable funds have been allocated in the area of juvenile justice in attempts to reduce and prevent the problem of juvenile delinquency. Much of these funds have been funneled to various community-level intervention programs. This dissertation reports the results of a study that examined the effects of one such program, the Juvenile Intervention Facility (JIF) in Broward County, Florida, on reducing the number of cases handled judicially by the Juvenile Court in that county. ^ Juvenile justice policy, which precipitated the creation of the JIF program, assumed that more structured and integrative efforts at the point of entry into the juvenile justice system would lead to greater diversion from the courts to much needed intervention services. By virtue of this process, the number of juveniles handled judicially by the courts was expected to decrease and future delinquent behavior would be prevented. Archival data from four fiscal years were examined, two years pre-JIF, two years post-JIF, a third-year follow-up, and a concurrent outcome measure corresponding to the first year of JIF operations. Data included all juvenile cases referred during the fiscal years defined for Broward and St. Lucie Counties, the state of Florida, and the United States. The study tested four hypotheses: (a) the JIF would reduce the number of cases handled judicially in Broward County Juvenile Court, (b) the decrease in judicially handled cases would be greater for females than for males, (c) there would be greater decreases in judicially handled cases for whites than non-whites, (d) there would be greater decreases in judicial handling for younger than older offenders. Bivariate analyses were conducted, consisting of chi square tests, to test the hypotheses. ^ Results indicate that the impact of the JIF was in the opposite direction of what was expected in that more juvenile offenders were handled judicially through juvenile court. This fact points to the possibility that the JIF has failed to provide the intended consequences of the policy. In the discussion, these “unintended” consequences are addressed in the context of juvenile justice policy creation and the competing constituencies involved in such policy development. ^

A quantitative application of symbolic interactionism to advance directive completion by older adults

This study examined contextual and situational influences on older adults' decision to complete advance directives by means of a conceptual framework derived from symbolic interactionist theory and a cross-sectional, correlational research design. It was hypothesized that completion of advance directives among older adults would be associated with visiting or participating in the care of a terminally ill or permanently incompetent individual sustained by technology. Using a 53-item questionnaire, computer assisted telephone interviews (CATI) were conducted with 398 community dwelling adults between September and October 2003. Respondents were contacted using random-select dialing from a listed sample of 99% of household telephone numbers in one South Florida census tract. Over 90% of households in this tract include an individual age 65 or older. ^ The results revealed that contrary to most reports in the literature a substantial proportion of older adults (82%) had completed advance directives and that the link between older adults and document completion was mainly through attorneys and not mandated agents, health care professionals. Further, more than one third of older adults reported that religion/spirituality was not an important part of their life, suggesting that the recommended practice of offering religious/spiritual counseling to all those approaching death be reexamined. The hypothesis was not supported (p > .05) and is explained by the situational emphasis on the variables rather than on structural influences. In logistic regression analysis, only increasing age (p = .001) and higher education (p = < .001) were significant but explained only 10% of the variance in document completion. ^ Based on the findings, increased interdisciplinary collaboration is suggested with regard to the advance directive agenda. Since attorneys play a key role in document completion, other professions should seek their expertise and collaboration. In addition, the inclusion of a religious/spiritual preference section in all living wills should be considered as an essential part of a holistic and individually appropriate document. Implications for social work education, practice, and advocacy are discussed as well as suggestions for further research. ^

Organizational culture, organizational climate, and collaborative capacity for planning

The objective of this study was to investigate the relationship of organizational culture and organizational climate on participant perceptions of collaborative capacity for planning, within the context of the Florida School Readiness Coalitions (FSRCs). Three hypotheses were proposed for study: First, that organizational culture would be correlated to organizational climate; second, that organizational culture would be correlated to collaborative capacity for planning; and the third that organizational climate would be correlated to collaborative capacity for planning. ^ A cross-sectional survey research design was used to obtain data from participants in 25 Florida School Readiness Coalitions. Pearson product-moment correlations were used to examine the association between the dependent variable, collaborative capacity for planning, and the independent variables, organizational culture and climate. Bivariate analyses revealed a significant level of association for five culture indicators to collaborative capacity for planning: motivation, interpersonal, service, supportive and individualistic indicators, and four climate indicators: cooperation, job satisfaction, organizational commitment, and role clarity. Findings suggest (a) a constructive culture and positive climate were present within the FSRCs during the period of study and (b) participants perceived that the collaborative capacity for planning existed. Hierarchical multiple regression, controlling for effects of participant demographics, were used to examine the degree to which organizational culture and climate predict collaborative capacity. The culture indicators, supportive and individualistic, and the climate indicator job satisfaction accounted for 46% of the variance in collaborative capacity for planning. No other indicators of the independent variables demonstrated significance. The findings suggests that (a) culture and climate should be studied together, (b) culture and climate are two constructs that may provide knowledge about the way community groups work together, and (c) the collaborative capacity of groups planning services such as the FSRCs may benefit through consideration of how culture and climate affect service planners' relationships, communication, and ability to achieve a mission or goal. Culture and climate may offer social workers new information about internal factors affecting the collaborative process. Further investigation of these constructs with other types of groups is warranted. ^

In God we trust: Faith-based development, spiritual transformation, and economic change in southern Andean indigenous communities

In communities throughout the developing world, faith-based organizations (FBOs) focus on goals such as eradicating poverty, bolstering local economies, and fostering community development, while premising their activities and interaction with local communities on theological and religious understandings. Due to their pervasive interaction with participants, the religious ideologies of these FBOs impact the religious, economic, and social realities of communities. This study investigates the relationship between the international FBO, World Vision International (WVI), and changes to religious, economic, and social ideologies and practices in Andean indigenous communities in southern Peruvian. This study aims to contribute to the greater knowledge and understanding of (1) institutionalized development strategies, (2) faith-based development, and (3) how institutionalized development interacts with processes of socio-cultural change. Based on fifteen months of field research, this study involved qualitative and quantitative methods of participant-observation, interviews, surveys, and document analysis. Data were primarily collected from households from a sample of eight communities in the Pitumarca and Combapata districts, department of Canchis, province of Cusco, Peru where two WVI Area Development Programs were operating. Research findings reveal that there is a relationship between WVI’s intervention and some changes to religious, economic, and social structure (values, ideologies, and norms) and practices, demonstrating that structure and practices change when social systems are altered by new social actors. Findings also revealed that the impacts of WVI’s intervention greatly increased over the course of several years, demonstrating that changes in structure and practice occur gradually and need a period of time to take root. Finally, results showed that the impacts of WVI’s intervention were primarily limited to those most closely involved with the organization, revealing that the ability of one social actor to incite changes in the structure and practice of another actor is associated with the intensity of the relationship between the social actors. The findings of this study should be useful in ascertaining deductions and strengthening understandings of how faith-based development organizations impact aspects of religious, economic, and social life in the areas where they work.

Community Development Districts: The entrepreneurial side of government

In an effort to reduce the cost and size of government public service delivery has become more decentralized, flexible and responsive. Public entrepreneurship entailed, among other things, the establishment of special-purpose governments to finance public services and carry out development projects. Community Development Districts (CDDs) are a type of special-purpose governments whose purpose is to manage and finance infrastructure improvements in the State of Florida. They have important implications for the way both growth management and service delivery occur in the United States. This study examined the role of CDDs for growth management policy and service delivery by analyzing the CDD profile and activity, the contribution of CDDs to the growth management and infrastructure development as well as the way CDD perceived pluses and minuses impact service delivery. The study used a mixed methods research approach, drawing on secondary data pertaining to CDD features and activity, semi-structured interviews with CDD representatives and public officials as well as on a survey of public officials within the counties and cities that have established CDDs. Findings indicated that the CDD institutional model is both a policy and a service delivery tool for infrastructure provision that can be adopted by states across the United States. Results showed that CDDs inhibit rather than foster growth management through their location choices, type and pattern of development. CDDs contributed to the infrastructure development in Florida by providing basic infrastructure services for the development they supported and by building and dedicating facilities to general-purpose governments. Districts were found to be both funding mechanisms and management tools for infrastructure services. The study also pointed to the fact that specialized governance is more responsive and more flexible but less effective than general-purpose governance when delivering services. CDDs were perceived as being favorable for developers and residents and not as favorable for general-purpose governments. Overall results indicated that the CDD is a flexible institutional mechanism for infrastructure delivery which has both advantages and disadvantages. Decision-makers should balance districts’ institutional flexibility with their unintended consequences for growth management when considering urban public policies.

Sales tax enforcement: An empirical analysis of compliance enforcement methodologies and pathologies

Most research on tax evasion has focused on the income tax. Sales tax evasion has been largely ignored and dismissed as immaterial. This paper explored the differences between income tax and sales tax evasion and demonstrated that sales tax enforcement is deserving of and requires the use of different tools to achieve compliance. Specifically, the major enforcement problem with sales tax is not evasion: it is theft perpetrated by companies that act as collection agents for the state. Companies engage in a principal-agent relationship with the state and many retain funds collected as an agent of the state for private use. As such, the act of sales tax theft bears more resemblance to embezzlement than to income tax evasion. It has long been assumed that the sales tax is nearly evasion free, and state revenue departments report voluntary compliance in a manner that perpetuates this myth. Current sales tax compliance enforcement methodologies are similar in form to income tax compliance enforcement methodologies and are based largely on trust. The primary focus is on delinquent filers with a very small percentage of businesses subject to audit. As a result, there is a very large group of noncompliant businesses who file on time and fly below the radar while stealing millions of taxpayer dollars. ^ The author utilized a variety of statistical methods with actual field data derived from operations of the Southern Region Criminal Investigations Unit of the Florida Department of Revenue to evaluate current and proposed sales tax compliance enforcement methodologies in a quasi-experimental, time series research design and to set forth a typology of sales tax evaders. This study showed that current estimates of voluntary compliance in sales tax systems are seriously and significantly overstated and that current enforcement methodologies are inadequate to identify the majority of violators and enforce compliance. Sales tax evasion is modeled using the theory of planned behavior and Cressey’s fraud triangle and it is demonstrated that proactive enforcement activities, characterized by substantial contact with non-delinquent taxpayers, results in superior ability to identify noncompliance and provides a structure through which noncompliant businesses can be rehabilitated.^

Women and development in Senegal: Microcredit and household well being

The challenging living conditions of many Senegalese families, and the absence of a providing spouse, have led women to covet new economic opportunities, such as microcredit loans. These loans offer Senegalese women the possibility to financially support their households and become active participants in their economies by starting or sustaining their micro businesses. The study takes place in Grand-Yoff, an overpopulated peri-urban area of the Senegalese capital city Dakar, where most people face daily survival issues. This research examines the impact of microcredit activities in the household of Senegalese female loan recipients in Grand-Yoff by examining socioeconomic indicators, in particular outcomes of health, education and nutrition.^ The research total sample is constituted of 166 female participants who engage in microcredit activities. The research combines both qualitative and quantitative methods. Data for the study were gathered through interviews, surveys, participant observation, focus-groups with the study participants and some of their household members, and document analysis.^ While some women in the study make steady profits from their business activities, others struggle to make ends meet from their businesses’ meager or unreliable profits. Some study participants who are impoverished have no choice but to invest their loans directly into their households’ dire needs, hence missing their business prerogative. Many women in the study end up in a vicious cycle of debt by defaulting on their loans or making late payments because they do not have the required household and socioeconomic conditions to take advantage of these loans. Therefore, microcredit does not make a significant impact in the households of the poorest female participants. The study finds that microcredit improves the household well-being - especially nutrition, health and education - of the participants who have acquired significant social capital such as a providing spouse, formal education, training, business experience, and belonging to business or social networks.^ The study finds that microcredit’s household impact is intimately tied to the female borrowers’ household conditions and social capital. It is recommended that microcredit services and programs offer their female clients assistance and additional basic services, financial guidance, lower interest rates, and flexible repayment schedules. ^

Living positive: Life in community among Puerto Rican men living with HIV in Boston

Negative experiences of stigmatization, discrimination, and rejection are common among people living with HIV in the United States, and particularly when they are also members of a minority group. Some three decades after the first cases of AIDS were identified, people infected with HIV continue to be perceived and characterized negatively. While an HIV/AIDS diagnosis is typically associated with negativity, this study investigates the extent to which collective experiences among HIV-positive people result in healthy responses and positive social adjustment. This study is focused on the ways in which HIV-positive Puerto Rican men in Boston live positive despite being diagnosed with HIV. Rather than wrapping themselves in the social stigma of HIV and the isolation that entails, they participate in processes that affirm themselves and their peers. In so doing, they help generate both healthy and meaningful lives for themselves and others. The study examines the process in which Puerto Rican men living with HIV in Boston participate, promote, and reaffirm an HIV community, la comunidad, as a social entity with a unique culture and identity. This study also investigates how this community influences, supports, and encourages the adoption of positive transformations for living long term with HIV. On the basis of nine months of field research, this qualitative study employed both focus groups and interviews with fifty HIV-positive Puerto Rican men in Boston. These men were recruited, using convenience sampling, from different community-based organizations (CBOs) that provide HIV/AIDS services in Boston. The study finds that HIV-positive Puerto Rican men in Boston build community, not in response to social exclusion, but built on shared positive practices and strategies for living healthy with HIV. These men come together to negotiate and form a unique cultural community expressed in norms, beliefs, and practices that, although centered on HIV, are designed for living healthy. These expressions reaffirm a sense of community in everyday settings and transform the lives of these men with positive behaviors and healthy lifestyles. The findings reveal that this transformation takes place in the context of a community, with the support, encouragement, and at times, policing of others. La comunidad is where the lives of these men are transformed as they learn, adopt, and experience living positive with HIV.

Analysis of Housing Partnerships using the Balanced Scorecard framework

Housing Partnerships (HPs) are collaborative arrangements that assist communities in the delivery of affordable housing by combining the strengths of the public and private sectors. They emerged in several states, counties, and cities in the eighties as innovative solutions to the challenges in affordable housing resulting from changing dynamics of delivery and production. ^ My study examines HPs with particular emphasis upon the identification of those factors associated with the successful performance of their mission of affordable housing. I will use the Balanced Scorecard (BSC) framework in this study. The identification of performance factors facilitates a better understanding of how HPs can be successful in achieving their mission. The identification of performance factors is significant in the context of the current economic environment because HPs can be viewed as innovative institutional mechanisms in the provision of affordable housing. ^ The present study uses a mixed methods research approach, drawing on data from the IRS Form 990 tax returns, a survey of the chief executives of HPs, and other secondary sources. The data analysis is framed according to the four perspectives of BSC: the financial, customer, internal business, and learning and growth. Financially, revenue diversification affects the financial health of HPs and overall performance. Although HPs depend on private and government funding, they also depend on service fees to carry out their mission. From a customer perspective, the HPs mainly serve low and moderate income households, although some serve specific groups such as seniors, homeless, veterans, and victims of domestic violence. From an internal business perspective, HPs’ programs are oriented toward affordable housing needs, undertaking not only traditional activities such as construction, loan provision, etc., but also advocacy and educational programs. From an employee and learning growth perspective, the HPs are small in staff size, but undertake a range of activities with the help of volunteers. Every part of the HP is developed to maximize resources, knowledge, and skills in order to assist communities in the delivery of affordable housing and related needs. Overall, housing partnerships have played a key role in affordable housing despite the housing market downturn since 2006. Their expenses on affordable housing activities increased despite the decrease in their revenues.^

Framing infectious diseases and U.S. public opinion

The United States has been increasingly concerned with the transnational threat posed by infectious diseases. Effective policy implementation to contain the spread of these diseases requires active engagement and support of the American public. To influence American public opinion and enlist support for related domestic and foreign policies, both domestic agencies and international organizations have framed infectious diseases as security threats, human rights disasters, economic risks, and as medical dangers. This study investigates whether American attitudes and opinions about infectious diseases are influenced by how the issue is framed. It also asks which issue frame has been most influential in shaping public opinion about global infectious diseases when people are exposed to multiple frames. The impact of media frames on public perception of infectious diseases is examined through content analysis of newspaper reports. Stories on SARS, avian flu, and HIV/AIDS were sampled from coverage in The New York Times and The Washington Post between 1999 and 2007. Surveys of public opinion on infectious diseases in the same time period were also drawn from databases like Health Poll Search and iPoll. Statistical analysis tests the relationship between media framing of diseases and changes in public opinion. Results indicate that no one frame was persuasive across all diseases. The economic frame had a significant effect on public opinion about SARS, as did the biomedical frame in the case of avian flu. Both the security and human rights frames affected opinion and increased public support for policies intended to prevent or treat HIV/AIDS. The findings also address the debate on the role and importance of domestic public opinion as a factor in domestic and foreign policy decisions of governments in an increasingly interconnected world. The public is able to make reasonable evaluations of the frames and the domestic and foreign policy issues emphasized in the frames.