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. ^

Social service provision, efficiency labor and economic development

This dissertation provides a theory of the effects and determinants of an economy's level of social services. The dissertation focuses on how the provision of social services will affect the effort decisions of workers, which will ultimately determine the economy's level of output. A worker decides on how much effort to contribute in relation to the level of social services he/she receives. The higher the level of social services received, the lower the cost—disutility—from providing effort will be. The government provides public infrastructure and social services (i.e. health services) in accordance with the economy's endowment of effort. In doing so, the government takes the aggregate effort endowment as given. Since, with higher individual work effort the higher the economy's total level of effort, failure by workers to coordinate effort levels will result in possible instances of low effort, low social services and low output; and, other instances of high effort, high social services and high output. Therefore, this dissertation predicts that in the context of social services, coordination failures in effort levels can lead to development traps. ^

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. ^

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. ^

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. ^

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.^

Process of privatization: Benefits of *reform in management of public housing

The study of the private management of public housing is an important topic to be critically analyzed as the government search for ways to increase efficiency in providing housing for the poor. Public Housing Authorities must address the cost for repairing or replacing the deteriorating housing stock, the increase in the need for affordable housing, and the lack of supply. There is growing pressure on efficient use of public funds that has heightened the need for profound structural reform. An important strategy for carrying out such reform is through privatization. Although privatization does not work in every case, the majority position in the traditional privatization literature is that reliance on private organizations normally, but not always, results in cost savings. ^ The primary purpose of this dissertation is to determine whether a consensus exist among decision-makers on the efficiency of privatizing the management of public housing. A secondary purpose is to review the techniques (best practices) used by the private sector that results in cost-efficiencies in the management of public housing. The study employs the use of a triangulated research design utilizing cross-sectional survey methodology that included use of a survey instrument to solicit responses from the private managers. The study consists of qualitative methods using interviews from key informants of private-sector management firms and public housing agencies, case studies, focus groups, archival records and housing authorities documents. ^ Results indicated that important decision-makers perceive that private managers made a positive contribution to cost-efficiencies in the management of public housing. The performance of private contractors served as a yardstick for comparison of efficiency of services that are produced in-house. The study concluded that private managers made the benefits of their management techniques well known creating a sense of competition between public and private managers. Competition from private contractors spurred municipal worker and management productivity improvements creating better management results for the public housing authorities. The study results are in concert with a review of recent research and studies that also concluded private managers have some distinct advantages to controlling costs in the management of public housing. ^

A case study of the Ellison model's use of mentoring as an approach toward inclusive community building

The Ellison Executive Mentoring Inclusive Community Building (ICB) Model is a paradigm for initiating and implementing projects utilizing executives and professionals from a variety of fields and industries, university students, and pre-college students. The model emphasizes adherence to ethical values and promotes inclusiveness in community development. It is a hierarchical model in which actors in each succeeding level of operation serve as mentors to the next. Through a three-step process—content, process, and product—participants must be trained with this mentoring and apprenticeship paradigm in conflict resolution, and they receive sensitivity and diversity training through an interactive and dramatic exposition. ^ The content phase introduces participants to the model's philosophy, ethics, values and methods of operation. The process used to teach and reinforce its precepts is the mentoring and apprenticeship activities and projects in which the participants engage and whose end product demonstrates their knowledge and understanding of the model's concepts. This study sought to ascertain from the participants' perspectives whether the model's mentoring approach is an effective means of fostering inclusiveness, based upon their own experiences in using it. The research utilized a qualitative approach and included data from field observations, individual and group interviews, and written accounts of participants' attitudes. ^ Participants complete ICB projects utilizing The Ellison Model as a method of development and implementation. They generally perceive that the model is a viable tool for dealing with diversity issues whether at work, at school, or at home. The projects are also instructional in that whether participants are mentored or serve as apprentices, they gain useful skills and knowledge about their careers. Since the model is relatively new, there is ample room for research in a variety of areas including organizational studies to determine its effectiveness in combating problems related to various kinds of discrimination. ^

Sustainable rural development through alternative economic networks: Redefining relations in the commodity chain for export vegetables in western Guatemala

The current research considers the capacity of a local organic food system for producer and consumer empowerment and sustainable development outcomes in western Guatemala. Many have argued that the forging of local agricultural networks linking farmers, consumers, and supporting institutions is an effective tool for challenging the negative economic, environmental, and sociopolitical impacts associated with industrial models of global food production. But does this work in the context of agrarian development in the developing world? Despite the fact that there is extensive literature concerning local food system formation in the global north, there remains a paucity of research covering how the principles of local food systems are being integrated into agricultural development projects in developing countries. My work critically examines claims to agricultural sustainability and actor empowerment in a local organic food system built around non-traditional agricultural crops in western Guatemala. Employing a mixed methods research design involving twenty months of participant observation, in-depth interviewing, surveying, and a self-administered questionnaire, the project evaluates the sustainability of this NGO-led development initiative and local food movement along several dimensions. Focusing on the unique economic and social networks of actors and institutions at each stage of the commodity chain, this research shows how the growth of an alternative food system continues to be shaped by context specific processes, politics, and structures of conventional food systems. Further, it shows how the specifics of context also produce new relationships of cooperation and power in the development process. Results indicate that structures surrounding agrarian development in the Guatemalan context give rise to a hybrid form of development that at the same time contests and reinforces conventional models of food production and consumption. Therefore, participation entails a host of compromises and tradeoffs that result in mixed successes and setbacks, as actors attempt to refashion conventional commodity chains through local food system formation.^

Selection and passage of county land preservation voter referendum: The role of government

County jurisdictions in America are increasingly exercising self-government in the provision of public community services through the context of second order federalism. In states exercising this form of contemporary governance, county governments with "reformed" policy-making structures and professional management practices, have begun to rival or surpass municipalities in the delivery of local services with regional implications such as environmental protection (Benton 2002, 2003; Marando and Reeves, 1993). ^ The voter referendum, a form of direct democracy, is an important component of county land preservation and environmental protection governmental policies. The recent growth and success of land preservation voter referendums nationwide reflects an increase in citizen participation in government and their desire to protect vacant land and its natural environment from threats of over-development, urbanization and sprawl, loss of open space and farmland, deterioration of ecosystems, and inadequate park and recreational amenities. ^ The study's design employs a sequential, mixed method. First, a quantitative approach employs the Heckman two-step model. It is fitted with variables for the non-random sample of 227 voter referendum counties and all non-voter referendum counties in the U.S. from 1988 to 2009. Second, the qualitative data collected from the in-depth investigation of three South Florida county case studies with twelve public administrator interviews is transformed for integration with the quantitative findings. The purpose of the qualitative method is to complement, explain and enrich the statistical analysis of county demographic, socio-economic, terrain, regional, governance and government, political preference, environmentalism, and referendum-specific factors. ^ The research finds that government factors are significant in terms of the success of land preservation voter referendums; more specifically, the presence of self-government authority (home rule charter), a reformed structure (county administrator/manager or elected executive), and environmental interest groups. In addition, this study concludes that successful counties are often located coastal, exhibit population and housing growth, and have older and more educated citizens who vote democratic in presidential elections. The analysis of case study documents and public administrator interviews finds that pragmatic considerations of timing, local politics and networking of regional stakeholders are also important features of success. Further research is suggested utilizing additional public participation, local government and public administration factors.^

Defining failure in the nonprofit organization: The case of four human service agencies

Private nonprofit human service organizations provide a spectrum of services that aim to resolve societal problems. Their failure may leave needed and desired services unprovided or not provided sufficiently to meet public demand. However, the concept of organizational failure has not been examined for the nonprofit organization. This research addresses the deficiency in the literatures of organization failure and nonprofit organizations.^ An eight category typology, developed from a review of the current literature and findings from expert interviews, is initially presented to define nonprofit organization failure. A multiple case study design is used to test the typology in four nonprofit human service delivery agencies. The case analysis reduces the typology to five types salient to nonprofit organization failure: input failure, legitimacy failure, adaptive failure, management failure and leadership failure.^ The resulting five category typology is useful to both theory builders and nonprofit practitioners. For theory development, the interaction of the failure types extends the literature and lays a foundation for a theory of nonprofit organization failure that diffuses management and leadership across all of the failure types, highlights management and leadership failure as collective functions shared by paid staff and the volunteer board of directors, and emphasizes the importance of organization legitimacy.^ From a practical perspective, the typology provides a tool for diagnosing failure in the nonprofit organization. Using the management indicators developed for the typology, a checklist of the warning signals of potential failure, emphasizing the key types of management and leadership, offers nonprofit decision makers a priori examination of an organization's propensity for failure. ^

Stigma and homeless women

Homelessness among women is an increasing phenomenon. Past research has established the characteristics and the numbers of the homeless thus establishing the heterogeneity of the group. The focus of this work is to examine common experiences and explain how homeless women interpret their circumstances. Erving Goffman's classic work on stigma is combined with the meaning of home and its connection with personal identity. A number of case studies are used to further develop and explain the implications of the homeless state upon the women. ^

Activity streets as economic opportunity generators: Case study of the Langa Township, Cape Town, South Africa

The Republic of South Africa since the 1948 inception of Apartheid policies has experienced economic problems resulting from spatially dispersed growth. The election of President Mandela in 1994, however, eliminated the last forms of Apartheid as well as its discriminatory spatial, social, and economic policies, specially toward black Africans. In Cape Town, South Africa, several initiatives to restructure and to economically revitalize blighted and abandoned township communities, like Langa, have been instituted. One element of this strategy is the development of activity streets. The main questions asked in this study are whether activity streets are a feasible solution to the local economic problems left by the apartheid system and whether activity streets represent an economically sustainable approach to development. An analysis of a proposed activity street in Langa and its potential to generate jobs is undertaken. An Employment Generation Model used in this study shows that many of the businesses rely on the local purchasing power of the residents. Since the economic activities are mostly service oriented, a combination of manufacturing industries and institutionally implemented strategies within the township will have to be developed in order to generate sustainable employment. The result seem to indicate that, in Langa, the activity street depend very much on an increase in sales, pedestrian and vehicular traffic flow. ^

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. ^