Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

Gentleman bountiful: Repairing the patriarch

Illustrating a patient's use of the transference as a play-ground... an intermediate region between illness and real life through which the transition from one to the other is made (Freud, 1914), the author presents the case of a man in his late fifties attempting to transcend former male role stereotypes. Using the therapist as a transitional object, this patient experimented, both in therapy and in his social activities, with various patterns in relationships with women, becoming increasingly aware of his dominating benevolence and his concommitant denial of dependency needs. Several new ways for viewing both masochistic and acting-out behaviors are proposed, ways that lead to therapeutic responses tending to convert both to reparative regressions.     

Occupation and housing adjustment of migrants to Surabaya,Indonesia: the case of a second city

The adjustment of migrants to Surabaya, Indonesia was examined with respect to occupation and housing characteristics. The data are based on information obtained in interviews from a multistage random sample of 600 residents of Surabaya between the ages of 20-44. Both females and males were interviewed and information on occupation was also collected for the spouses of respondents. In the analysis, 3 comparison groups were used: migrants to the city within the 5 years previous to the survey; migrants who moved in 1969 or before; and lifetime residents of Surabaya who were either born there or moved before the age of 15. The analysis used 2 methods to determine the extent and nature of adjustment. In the first, migrants of short and long durations of residence were compared to determine if change on the aggregate level has taken place and to indicate the direction of change. A control group of lifetime residents was used to determine whether the migrants are coming to resemble the characteristics of the native urban population. The 2nd, and equally serious problem, involves outmigration, in which migrants selective of certain characteristics leave the city either to return to the rural area or to move to another city. Initial comparisons between recent migrants, longterm migrants, and lifetime residents revealed no significant differences for either employment status or occupational skill. By occupational skill, approximately 35% had unskilled occupations, 27% semiskilled occupations, and 37% skilled occupations, with no significant difference by migrant status group. Overall, the distributions showed this sample to have significant concentrations in traditional, labor intensive employment, with a large percentage self employed. Controlling occupational skill for education showed somewhat different results. Those with primary school or less did not show a significant difference by migrant status, while among those with more education there was a significant difference. The longterm migrants wree overwhelmingly employed in skilled occupations. Initial analysis showed no significant difference in housing quality for each of the 3 migrant status groups. Recent migrants to the city were having no more difficulty in finding housing than changing migrants and lifetime natives. Housing conditions appeared to improve with duration of residence in the city, either through residential mobility or through improvements to the dwelling. That housing showed improvement with time, while occupation did not, may be because of the nature of each of the markets.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Tailored program evaluation: Past, present, future

This paper discusses measurement issues related to the evaluation of computer-tailored health behavior change programs. As the first generation of commercially available tailored products is utilized in health promotion programming, programmers and researchers are becoming aware of the unique challenges that the evaluation of these programs presents. A project is presented that used an online tailored health behavior assessment (HBA) in a worksite setting. Process and outcome evaluation methods are described and include the challenges faced, and strategies proposed and implemented, for meeting them. Implications for future research in tailored program development, implementation, and evaluation are also discussed.     

Supportive parenting moderates the effect of discrimination upon anger, hostile view of relationships, and violence among African American boys

Studies have shown that exposure to discrimination increases the probability that African American adolescents will engage in delinquent behavior, especially acts of violence. The present study extended this research by examining the extent to which supportive parenting buffers a youth from these deleterious consequences of discrimination. Analyses based upon two waves of data from a sample of 332 African American adolescent males and their caretakers supported this hypothesis. Further the results indicated that there are two avenues whereby supportive parenting reduces the probability that discrimination will lead to violence. First, supportive parenting decreases the chances that discrimination will lead to anger and a hostile view of relationships. Second, supportive parenting lowers the risk that anger or a hostile view of relationships, when they develop, will result in violence.     

Guilty or not? A path model of women's sexual force fantasies

This study estimated a path model of women's forceful sexual fantasies. Constructs examined were childhood sexual abuse, feminist beliefs, sexual guilt, erotophilia, and sexual experience. The study clarifies how these factors mediate one another in relationship to forceful sexual fantasies, and is first to examine the effects of feminist beliefs on forceful sexual fantasy. Adult women (N = 261) participated by completing an online survey. A path from sex guilt to forceful sexual fantasy, mediated by erotophilia, was found, wherein low levels of sex guilt and high levels of erotophilia were found to predict forceful sexual fantasy. A direct path between childhood sexual abuse and forceful sexual fantasy was also found. The resulting model is discussed in relation to previously-proposed theories on the role of force in women's sexual fantasies.