MARGINAL STATUS or CONSUMERS IN A VOLUNTARY ‘ ’ ' “ PLANNING AGENCY Thesis for the Degree of M. A. MICHIGAN STATE UNIVERSITY AMANDA ANN BECK 1972 LIBRARY ‘, Michigan Sate University Marginal Status of Consumers in a Voluntary Planning Agency BY AmandaAnnBeck The history of formal inclusion but ineffective participation in social planning agencies by recipients of the planning decisions was discussed. The marginal status of consumers vs. professionals in a re- gional calprehensive health planning agency was documented on the features of attendance, powerlessness, normlessness, social isola- tion, and socio-eooncmic status. The implications of these findings were discussed and a pro- gram designed to alleviate this narginal status was suggested. Thesis Camdttee: Dr. George W. Fairweather, Chairman Dr. Lawrence I. I'Kelly Dr. Louis G. Tornatzky rmé’fl “W App at )‘ f 134351: MARGINAL STATUS OF CONSUMERS IN A VOLUNTAIU PLANNING AGENCY By Pmanda Ann Beck A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTERGPAM‘S [eruinem¢.of Psychology 1972 I won their ass i: My col mral sqrzx Via'ing age Pay fat to succeed. My hos. his Patiend (Tr‘x WW8 I would like to express my deep gratitude to the follming for their assistance in this endeavor: My colleague, Peter C. Bishop, for his unselfish devotion of moral support, time, and expertise to developing these ideas, inter- viewing agency mem‘bers, and computer analyzing the data. My father, Charles J. Beck, for his unfailing faith in my ability to succeed. My boss in M.S.U. Residence Halls Programs, W. "Red" Knaak, for his patience and support in these long months of preparation. My committee merbers, George W. Fairweather, Lawrence I. O'Kelly, and Louis G. Tomatzky, for their assistance in developing the content and form of this document. Project secretary Tami L. Tyson, for her unselfish devotion of long hours and excellent assistance in preparation of this manuscript. Many friends who gave support when it was needed. M.S.U. Department of Psychology and U.S. Department of H.E.W., Division of H.S.M.H.A. for grant # CS - P(Ol) 552005-01-72 which pro- vided the necessary financial assistance. ii 11"" t“ I v C: L‘s-vi hUV‘D’V T" ‘|-“v-f V‘ C- .‘ ’l .—‘VD' L' ‘ ‘ ..-. 3.-.“.- UPC-"7 A “JV“. DISCUSS I C.‘ TABLE LIST OF TABLES . . . . . . . MOWCI‘I ON 0 O O O O O O O HYPOTHESES AND METHODS . . . RESULTS 0 O O O O O O O 0 O 0 DISCUSSION . . . . . . . . . BIBLIOGRAPHY . . . . . . . . APPENDIX QUESTIONNAIRE USED BY RESPONDENTS. OF CONTENTS iii 18 58 7A 75 Tables 10 12 13 1“ LIST OF TABLES Ctmmdttee by Attendance a. b. c. d. e. f. g. Overall . . . . . . Board of Trustees . Executive Committee (kmmfittee A . Committee B . Cknmdttee C . Ckmmdttee D . Neal-Seeman Powerlessness Neal-Seeman Powerlessness O O O O O O O O O O O O I O O O O O O O O O O O O I O O O O O I O O O Scale 0 O O O O O O O O O O O 0 Items by Participant Classifica— tion . . . Respondents Influence 7A by Participant Classification . Tannenbaum.Influence Items by Consumer Response . . . . . Tannenbaum.Influence Items by Provider Response . . . . . Powerlessness Scales by Combined Consumer and Provider Response. . Tasks by Task.Assignment-Consumer Response . . Items of Task Assignment by Participant Classification- Consumer Response Summary Participant Classification by Task Assignment- Consumer Response . Participant Classification by Task Assignment weighted Score-Consumer Response. Tasks by Task Assignment-Provider Response 'Items of Task.Assignment by Participant Classification- Provider Response . Summary Participant Classification by Task Assignment- Provider Response . . iv Page 19 20 21 22 23 2M 25 26 ' 27 29 30 30 32 33 36 37 38 H0 flh~.m. - N 21 22 23 2A Parti i:_ Partici; Jackson Partici; lnformrn | 0 Part1c1: Table 15 16 17 18 19 20 21 22 23 2A 25 26 27 Page Participant Classification by Task Assignment Weighted Score-Provider Response. an Participant Classification by Attraction to Committee as a Whole . . . . N5 Jackson Attraction-Acceptance by Participant Classification I+6 Participant Classification by Information Satisfaction Category . . 1+8 Information Category by Participant Classification .. . . . #9 Participant Classification by Satisfaction with Communi- cation Netwo'rrk Inclusion #9 Informal Communication Network by Participant Classification 51 Participant Classification by Formal Representation . . . . 52 Participant Classification by Constituency Effect . . . . . 52 Participant Classification by Constituency . . . . . . . . 53 Participant Classification by Health Education Category . . 51+ Participant Classification by Formal Education Category . . 56 Participant Classification by Family Income Category. . . . 57 INTRODUCTION It is now documented that participation in the decision-making process by the recipients of the decision generally leads to greater acceptance of the decision and, hence, more successful implementation (Collins and Guetzkow, 1964; Gilmer, 1961; Tannenbaum, 1968). In a governmental planning agency, the basic task is decision-making, and the recipients of such decisions are the consumers of the programs planned. In such agencies, citizen participation in the decision- making process plays a vital and powerful role in "monitoring" pro- fessional plans and making sure that the planning professionals and technical experts do not design programs with either disregard for citizen interest or simply for the interests of certain power groups (Altschuler, 1970; Dubey, 1970). While the concept of citizen participation as a valuable contri- bution to the decision-making process may have been accepted by many, incorporation as an operating concept in most planning agencies has been, on the whole, slow and ineffective. Sane voluntary efforts to encourage low imare participants in neighborhood social action were begun in the 1890's, 1900's, and 1930's. It was not, honever, until the early 1960's, that the requirements for Ford Foundation grants and government regulations of O.E.O. and H.U.D. programs forced a more active role on ccmmmity representatives in social reform decision making. The funding of Model Cities programs, for example, required that policy making boards consist of a majority of l 2 citizen representatives . The greatest attempt to expand the datain of citizen participation and provide for "maximum feasible participation of the poor" was incorporated in the Ecommic Opportunity Act of 1964 (mynihan, 1970) . Unfortunately, the confusion surrounding the defini- tion of the term "maximum feasible participation" and the methods by which this was implemented in various areas led to development of Can- munity Action Programs (C.A.P.) ranging from complete policy control and major political power afforded the citizens, all the way to a mere source of employment for the participants. As Sherry Amstein (1969) explained citizen participation has ranged from: a) token states of informing the citizen, consulting his opinion, or placating his desires, b) through a condition of partnership or delegated power in decision-maldng, and rarely, c) to effective citizen control. In concluding remarks she agreed with the OSTI conclusions that "in general, citizens are finding it impossible to have significant impact on the comprehensive plaming that is going on". Thus professionals have traditionally acted upon the assumption that only they possess sufficient expertise to plan and have continued to "benevolently" plan for the public. Unfortunately also, the laws requiring citizen participation have been a rather uncoordinated, undirected attempt to alleviate this marginal status. Consumers , there- fore, even after their forced entry into planning activities and their less than enthusiastic welcome have usually remained second-class citi- zens in real decision-making activities of the planning agencies (Bloarberg, 1969) . Fairweather (1967, p. 5) recamends that programs "... be deve10ped to change the status of those who only marginally participate. . . " . He further recommends that initially such programs be in the form of socially innovative experiments that ccmpare programs designed to improve such person's marginal status and that the first step be an Operational de- finition of the social position occupied by those in the marginal status. An Opportunity for an in-depth investigation of the position of the citizen participant in the decision-making process of planning has been afforded by a Comprehensive Health Planning "b" agency established in 1968 as a result of Federal legislation for "Partnership in Health". It is a regional agency planning and coordinating health delivery services in a tri-county area of lower Michigan with financial resources consisting of Federal H.E.W. funds matched 1 to l with local contributions. Its per- sonnel consists of a paid full-time professional planning staff and volun- teer part-time members of two types: providers of health services (any- one who earns his livlihood in teaching, delivery, or administration of health services), and consumer representatives (anyone who does not earn his livlihood in health teaching, delivery, or administration). Staff and providers are both therefore considered health professionals in this 393W . The internal organization of the agency is cmposed of the staff just mentioned, a Board of Trustees, an Executive Carmittee (acting between Board meetings), and five planning carmittees. The Board of Trustees, meeting quarterly, consists of 45 members and the Federal legislation re- quires that at least 51 percent of them be consumers. Planning camdttees, meeting monthly, range in size from 12 to 43 members, and generally re- flect the same consumer to provider ratio as the Board. Consumers should thus have more political power than providers in a "ore-man, one-vote" form of decision making. Marginal status of a participant in such an agency can be des— cribed by three general features: (1) behavioral or other objective measures of his integration into the decision-making process, (2) his ‘ attitude toward himself and other participants, (3) attitudes of other participants toward him. The most obvious feature of a person's marginal status is probably his om marginal behavior which can primarily be described by his lack of participation in actual decision-making meetings . His attitudes of marginality may be described by his internal self— perception of his situation: a sense of powerlessness, normlessness, and social isolation. Bloomberg (1969)e)q>lajred these to be some of the com- mtg of alienation. Bloorberg (p. 125) described powerlessness as a sense of "being at the mercy of a system which controls the individual for purposes other than his own .....". He described normlessness as a state "when goals and standard of conduct" do not "have that self-evident, convincing quality we usually take for granted but instead appear uncer- tain, capricious, and conflicting....". Relating it more closely to mar- ginal status, it means that no clear behavioral role exists for the mar- ginal participants. Finally he described social isolation as a percep- tion of separation from other members of the group. These definitions are in agreement with the more classical ones pr0posed by Seaman (1959) , and Dean (1961) . In addition to being self-perceived features , powerlessness, norm- lessness, and social isolation can also be described by the attitudes of the "in group" members toward the marginal merbers in which they ascribe the marginal member little power, an unclear role, and negligible accep- tance into the group. The present investigation will describe the social position of citi- zen consumers co'rpared to health providers in a health planning agency and will ascertain whether the consumers are, as they often appear to be, in a marginal status with respect to the activities and other merbers of the agency. HYPOI‘HESESANDMEI‘HODS eels All 144 participants in the agency were randomly divided into 2 groups, 1/2 being assigned to l interviewer (the author), and 1/2 being assigned to another interviewer (author's associate). For various rea— sons sore peeple were unable to be interviewed eg., no current address, on sabbatical leave, two refused. 111 peOple were individually inter- viewed for about 1 1/2 hours each, at the time and place of their choosing. Sections I and III were asked by the interviewers and Sec- tion II was self-administered (Appendix). The sample was made up of 5 staff (S) merbers (100 percent of pos- sible) , 52 consumers (C) (72 percent of possible), and 54 providers (P) (75 percent of possible). There was no significant difference on inter- viewers as to number, sex, or committee origin of respondents. There was no significant difference between the total number of Cs and P3 inter- viewed or between the number of Cs and P5 interviewed from each committee, except for mutate A. On this. committee significantly more Ps than Cs were interviewed, but since this ratio reflects the actual ratio of P3 to Cs existing on the committee, it is considered acceptable. Due to the small sample size of the staff (N = 5) , that group was not included in analysis where such a small sample would produce re- sults of very limited validity. 7 Hypotheses , Measurements and Analyses Overall marginal status was described by each of the four corporents tested by hypotheses: I. lack of behavioral participation, II. powerless- ness, III. normlessness, or lack of role clarity, and IV. social isolation. The hypothesis of participation was tested by a simple behavioral analysis. Since however, the most realistic view of most situations is usually com- prised of two facets (that of the person or persons involved as the object of the issue, and that of the person or persons involved in viewing or interacting with the issue object) the corporents of powerlessness, norm- lessness, and social isolation were examined from two perspectives, in- ternal and external. Internal perspective is the Cs viewpoint of his own situation aid the balancing perspective is one external to the Cs view- point, i.e- either that of the providers or sore more objective measure if possible. I. Participation - Ho: Corpared to P3, Cs have a lower record or parti- cipation in agency decision making meetings . A. Measurerent: Attendance records were examined for all committee meetings the agency held from August 1970 through July 1971. B. Analysis: Attendance was scored dichotomusly, 1 - non-attendance, 2 = attendance , X2 was run for frequency distribution into cate- gories for Cs vs. Ps for each of the committees individually aid the agency as a total. II. Powerlessness - General Ho: Cs have less power in agency decision- making activities than Ps. A. Internal - Ho: Cs see themselves as having less power than P5. 1) Measurement: a) Neal-Seeman (1964) Internal Ecternal Powerlessress Scale was taken from Bonjean (1967) and adapted to this study, b) (Appendix, Section II, Items 13-18). Powerlessness in this case is considered directly related to the percep- tion of external control and inversely related to the perception of internal control. Tannenbaum (1968) measure of influence was adapted to this study (Appendix, Section I, Items 7A, 8A, 9A, 10A). Tannenbaum asserted that the total power available in the organization is not a fixed quantity and therefore high power attributed to one participating group does not neces- sarily imply that low power must be attributed to other participating groups . 2) Analysis a) b) Neal and Seeman: Item response was scored dichotomously, 1 = power, 2 = powerlessness. X2 was corputed for indivi— dual items on the difference in distributions for Cs and P5. t test was corputed on the difference in means of Cs and P5 on the entire scale. Tannenbaum: Item response was scored 1-5 to correspond to "none" to "great deal". For measurerent of item 7A, the subjects perception of his influence, Cs and P3 were grouped separately and a t run on the difference in means for the two groups (7A,: vs. 7%). The responses from Cs only were grouped together for items 8A (8 influence), 9A (P influence), and 10A (C influence), and t tests run on the differences in means for SA vs. 10A, and 9A vs. 10A. B. External - Ho: Ps see Cs as having less power thanPs and S. 1) Measurement: Tannenbaum (1968) sare as in Alb above. (Appendix, Section I, Items 8A, 9A, 10A). 2) Analysis: Scored the same as in Alb above. Responses from P5 only were grouped together from items 8A, 9A, and 10A. t tests were run on the difference in means for influence of 8A vs. 10A and 9A vs. 10A. InteractionEbrternalandIntenal-CsarriPsseeCsashavinga small amunt of power or influence in agency decision making ac- tivities . l) Measurerent: a) b) C) Tannenbaum (1968) as in Alb above but item 10A only. Zero—sum: Tannenbaum (1968) in reviewing the reasoning behind this model reports that the amount of influence in an organization can be considered a fixed quantity. He explains that, in this viewpoint, for every gain in power one group gets, all other groups involved must lose power sothatthetotallossisequaltothetotalgain,and therefore the sum of the power exchange equals zero. In this study respondents were asked what percent of the total influence on a typical agency decision would they attribute to Cs, Ps, and S. (Appendix, Section I, Item 11). Arnstein (1969) ladder of participation adapted for this study. (Appendix, Section II, Item 30). From observa- tion of actual comunity participation in similar agencies Arnstein constructed a rating scale ranging from mere consultation to full citizen control. 2) 10 Analysis: a) Tamenbaum: Absolute level of influence accorded to Cs and P3 was described. A level at or below the median point (3) of the scale confirmed the Ho. b) Percent of total influence: percent accorded to Cs by P5 and Cs was described. Since by Federal law Cs must have 51 percent of the votes on agency decisions, and therefore have atleast 51 percent of the influence, any level below 51 percent confirmed the Ho. c) Arnstein: Absolute level of participation accorded to Cs was described. Since by Federal law Cs must have 51 per- cent of the vote on agency decisions, any level below F "control over decisions" confirmed the Ho. III . Normlessness A. Internal - Ho: Cs do not perceive themselves as having a clear role in the activities of the agency. 1) 2) Measurement: "Task Assignment": Respondents were asked to choose the one group (C, P, S) which most performed each of the tasks indicated. Options were also given for response of "no one" and "don't know". A variety of tasks supposedly being accorplished by the agency were listed. (Appendix, Sec- tion II, Items 35-49). Analysis: Responses from Cs were grouped together. For the category "don't know" frequency was recorded and the percent of assignment based on the total number of Cs. For the cate- gory "no one" frequency was recorded and the percent of assign- mentbasedonthetotalnumberoszwhoknewwhotoassign the task to. For C, P, and S categories the frequency was B. 11 recorded and the percent of assignment based on the total nmber of respondents assigning the task to one of these three groups. If not group clearly performed the task, a random split in responses would be expected 33 1/3 percent staff, 33 1/3 percent consumers, and 33 1/3 percent providers. A significantly different distribution from that expected by chance - an increase over random would indicate that chosen group to be clearly performing the task, i.e. included in the task assignment and vice versa for exclusion. A breakdown of inclusion, exclusion, or response within ran- dom expectation was obtained for each task. (+ = inclusion, - = exclusion, 0 = random expectation). Whatever group had the task assigned to it received a weighted score indicating the clarity of the role assignment. 4 = +, —, - /c1early chosen 3 = +, -, O/fairly clearly chosen 2 = +, 0, O/not too clearly chosen 1 = +, 0, +/shared assignment External-Ho: PsdonotperceiveCsashavingaclearrolein the agency . 1) 2) Measurement: Sate as internal measurerent Al above. Analysis: Sate as internal analysis A2 above except that P response will be grouped together. "u—w IV. 12 Isolation Corpoents : A. Grow Attraction-Acceptance B. Information 1) 2) Knowledge deficit Exclusion from information network C. Constituency Group Attraction and Acceptance 1) Internal - Ho: Cs are less attracted to the committee they belong to than are Ps. a) 13) Measurerent: Variables were drawn from the general concept of Jackson (1959) that a person's psychological membership in a grow is cmposed of two corporents: his attraction to the group, and the grow's acceptance of him. In this study attraction will be Operationally defined in two ways (a) a list of statements describing ways in which a person could show attraction to a committee as a whole, (Appendix, Section III Item 3), and (b) a list of iters describing attractive attri- butes of the people on the respondents committee which he uses to give ratings to each member of his committee, (Appen- dix, Section III, Item 1). Analysis 1) Attraction to the grow as a whole. Response on each item was scored from 1-5 to coincide with "strongly dis- agree" to "strongly agree". 2) Attraction to grow metbers. Responses were scored as aboveandratings fromeachmetberforeachotherperson on his committee were summed across items to give a 13 scale sum for each member. Means were obtained fromCs adPsasseparategropsandattestnmonthedif- ference . 2) External - Ho: The committee as a whole will be more accepting omeembersthanCmerbers. a) b) Measurement: Same items as internal measurement list (b) above, (Appendix, Section III, Item 1). Analysis: Item responses were scored 1-5 to coincide with "strongly disagree" to "strongly agree". Scores received by each merber were soured over all the respondents rating him. Growmeanswereobtairedadcorparedbyattest foers. P. B. Information 1) Knowledge deficit: a) b) Internal: Cs perceived their knowledge of health planning to be less adequate than Ps see their knowledge as being. 1) Measurement: Cs ad Ps were asked their perception of the adequacy of their health planning knowledge. (Apperdix, Section II, Item 7). 2) Analysis: Item responses were scored 1-5 to coincide with "very inadequa " to "more than adequa ". X2 was run on the difference in frequency distributions for Cs ad Ps. External-Ho: Csdonothaveasmuchknowledgeofmedical plaming matters as Ps do. 1) Measurement: Questions concerning sore of the general features of Cotprehensive Health Flaming, ad sore of the major activities of the local health planning agency. (Appendix, Section I, Iters 12—14, 15a, 16, 18, 19) Ill Items were placed in 4 categories: I = General health planning knowledge (Apperflix, Section I , Items 12-14). II Nares of Planning Committees, ad Planning Committee Chairmen. III = Names of staff members. IV = Items in Work Program 2) Analysis: Each item was scored dichotorously, 1 = no, 2 = yes, if the answer, person, or committee was "not known" or "mm". Means for Cs ad Ps were corpared for each scale by a t test. 2) Communication Network a) Internal Ho: Cs are not satisfied as P5 are, with the extent of their inclusion in the informal cormmication network. 1) Measurement: Cs were asked if they are satisfied with the amount of contact they have with agency staff, the amount of contact outside of committee meetings with people on their committee, and the arount of contact with peOple not on their committee. (Appendix, Section I, Item 150, 24d, 25d) 2) Analysis: Responses were scored from 1-5 to coincide with "much less often" to "much more of ". A sum and meanwas obtainedoverthethree items. ttestwas used on the difference in means between Cs and Ps levels. b) External-Ho: Csarenotincludedintheinformalcommmi— cation network of agency members to the'extent that P3 are. 15 1) Measurement: Each respondent was asked how often he talked with (a) staff members, (b) members of his com- mittee outside of committee meetings, ad (c) members of the agency who are not members of his committee. (Appendix, Section I, Items 15 a ad b, 24 a ard b, 25 a ad b). 2) Analysis: Frequency of contact with each recipient was scored 1-5 (1 = less than 1 contact/month, 2 = 1—2 con- tacts/month, 3 = 3-4 contacts/month, 4 = 5-8 ccntacts/ month, 5 = more than 8 contacts/month). Mean frequency of contacts given were calculated. (i.e. number of peOple in the agency the respondents said he knew) Mean frequency of contacts received was calculated (i.e. the number of respondents that knew a particular individual). Each re- sponse was also given a density weight to correspord to the 1-5 frequency of contact rating. Mean weighted aver- ages of contacts given and received were calculated. t tests were run on the difference in means for C5 ad Ps on the average number of peeple known ad the density of contacts. C. Constituency 1) Internal - Ho: Cs do not perceive themselves as having a consti- t11ency. a) Measurement: 1) Respondents are asked if they formally or informally re- present any group. (Appendix, Section I, Item 22a) 2) Respordents are also asked various questions to deter- mine if any group represented has any effect on the 16 respondents participation in health planning activities. (Appedix, Section I, Items 23 a - f) b) Analysis 1) Responses to item 22a regarding constituency existence were scored dichotomusly, l = No, 2 = Yes. Percentage of Cs indicating a constituency was described. X2 analy- sis cotpared the distribution into categories for P vs . C. 2) Responses to items 23 a - f, constituency expectation were coded 1-5, 1 = lowest category, 5 = highest. A sum admeanoveritemswasobtained foreachrespondent, Cs ad Ps were grouped separately ad t run on the difference in means. 2) External: Cs are perceived as having a constituency less often than Ps. a) Nbasurerent: All respordents were asked to indicate which members of their committee represent a group. (Appendix, Section III, Item 2) b) Analysis: Responses were scored dichotomusly, l = No, 2 = Yes. The percent of C received a "yes" response was described. Cs ad Ps were grouped separately ad a t test run on the difference in means. V. Consumers have a lower incore ad less formal education than Providers. A. Measurerent: Respondents were asked to irdicate their annual family income, their formal education level, ad their percep- tion of the amount of health knowledge they themselves had. (Appendix, Section II, Items 52, 53, 56) B. 17 Analysis: Educational level was scored from 1-7 to indicate grammar school through professional degree. Health education.was scored 1-5 to coincide to "none" through "great deal". Annual incore was scored 1-5 to irdicate 5 cate- gories ranging from "under $7,000" to "above $30,000". x2 analysis compared distribution into categories on each variable for Cs vs. Ps. RESULTS Hypothesis I Behavioral Participation Tables 1 a-g (Committee by Atterdance) shows the data relevant to hypothesis I. To stadardize attexdance ad alloy cmparison between CsandPs, thepercentof attedanceofeachgroupatcommitteemeetings was calculated. Each percentage is based on the total number of regu- lar committee meetings held for that committee. X2 values are based on the actual cell frequencies. Committee E met only once during the year ard was therefore not inclLded in the a1alysis because of the limited validity of attendance statistics. Examination of percent attendances shows that P atterdance exceeds C attendance on every committee. The X2 on overall attexdance (15.29, P (.001) , gives definite support to the primary hypothesis , that on the whole , Cs participate significantly less than Ps in decision-meldng meetings of the agency. Examination of irdividual committees shws that for the most power- ful decision making groups in the organization, i.e. Board of Trustees ad Ececutive Committee, C atterdance was significantly less than P (x2 = 13.31, p< .001; x2 = 5.17, 94.05). On the analysis of irdividual committees, X2 was significant at the .01 level for Committee C. X2 values were not significant at the .05 level for the other three com- mittees but percent of atterdance on each of these was higher for P3 than Cs. l8 19 TABLE 1a Committee by AtterdanceI Comm— W— OVERALL PEmtemshipz 75 Total Attendance Possible3 429 Attendance4 (N) 174 percent of those attendings 42.65 Percent of classification atterding 40.56 Non-attedance (N) 255 Percent of those not atteding 53.91 Percent of classification not atterding 59.44 'x2 = 15.29 6 *** (ldf) 77 452 234 57 . 35 51 . 77 218 46.09 48.23 *** Attendance (August 1970 - July 1971) Committee E omitted Repeats members with membership on more than one cormittee Considered total number of atterda1ce opportunities Frequency of atterdance summed over all meetings Calculation based on the total atteding X2 based on frequency of atterdance (N) ad non-attedance (N) P< .001 20 TABLE lb Committee by Atterdancer BOARDOFTHJSTEES Consumers Providers Membership 27 16 Tota1 attendance possib1e2 108 64 Attendance3 (N) 38 41 percent of those attending4 48.10 51.90 Percent of classification attending 35.19 64.06 Non-atterdance (N) 70 23 Percent of those not atteding 75.27 24.73 Percent of classification not atterding 64.81 35.94 x2 = 13.31 5*** (ldf) 1 Attendance (August 1970 - July 1971) 2 Considered total number of attendance Opportunities Frequency of attedance summed over all meetings Calculation based on the total attending X2 based on frequency of attendaee (N) ad non-attendance (N) *** P < .001 21 TABLE 1C Committee by Attezdancel WW Consumers Providers Membership 8 6 Total attendance possible2 56 42 Attendarce3 (N) 23 27 Percent of those atterding4 46.00 54.00 Percent of classification atterding 41.07 64.29 Non-attedance (N) 33 15 Percent of those not atterding 68.75 31.25 Percent of classification not atterding 58.93 35.71 X2 = 5.17 5 (ldf) 1 Attendance (August 1970 - July 1971) 2 Considered total number of attedance opportunities 3 Frequencyofatterdance somedoverallmeetings 4 Calculation based on the total atterding 5 X2 based on frequency of attendance (N) ad non-attendance (N) P<.05 22 TABLEld Committee by AttendanceI CCI’MI'I'I‘EE A Consumers Providers Membership 12 25 Total atterdaee possible2 84 175 Attendance3 (N) 35 81 Percent of those atterding4 30.17 69.83 Percent of classification attending 41.67 46.29 Non-attedance (N) 49 94 Percent of those not attending 34.27 65.73 Percent of classification not atterding 58.33 53.71 x2 = 0.49 5, NS (1df) 1 Attendance (August 1970 - July 1971) 2 Considered total number of attendance opportunities 3 Frequency of attedance summed over all meetings 4 Calculation based on the total attending 5 X2 based on frequency of atterdance (N) ad non-attendance (N) 23 TABLE le Committee by Attendance1 CIIMI'ITEE B Consumers Providers Membership l3 7 Total atterdance possible2 78 42 Atterdaoe3 (N) 14 36 Percent of those atterding4 28.00 72.00 Percent of classification atterding 33.33 46.15 Non-attendance (N) 28 42 Percent of those not attending 40.00 60.00 Percent of classification not atterding 66.67 53.85 x2 = 1.85 5, NS (ldf) 1 Attendance (August 1970 - July 1971) 2 Considered total number of atterdaoe Opportunities 3 Frequencyofattexdance surmedoverallmeetings 4 Calculation based on the total attending 5 X2 based on frequency of atterdance (N) and non-attadance (N) 24 TABLE 1f Committee by AttendanceI CODNI'ITEE C Consumers Providers Merbership 11 5 Total attendance possible2 99 4s Attendance3 (N) 51 34 Percent of those attending4 60.00 40.00 Percent of classification attending 51.52 75.56 Noi-attendance (N) 48 11 Percent of those not attending 81.36 18.64 Percent of classification not atterding 48.48 24.44 2 5 X =7.39 ** (1df) Attendance (August 1970 - July 1971) 2 Considered total number of atterdance Opporumities Frequency of attadance summed over all meetings Calculation based on the total atteding ** P< .01 X2 based on frequency of atterdaxce (N) and non-attendance (N) 25 TABLE lg Crnmdtteelby.Attendancel (DMTI‘EE D Consumers Providers bhmbership 10 12 Total Attendance Possible2 50 60 Atterdance3 (N) 10 18 percent of those attending4 35.71 64.29 Percent of classification attending 20.00 30.00 Non-atterdance (N) 40 42 Percent of those not atterding 48.78 51.22 Percent of classification not attmding 80.00 70.00 x2 = 1.44 5, Ns (1df) 1 Attedance (August 1970 - July 1971) Considered total number of atterdaoe Opportunities Frequency of attendance sumed over all meetings Calculation based on the total attending X2 based on frequency of atterda1ce (N) ad non-attadance (N) 26 Hypothesis II Poverlessness Table 2 (Neal-Seeman Powerlessness Scale) and Table 3 (Neal-Seeman Powerlessness Items by Participant Classification) contain the infome- tion relative to hypothesis IIA: Internal Perception of Powerlessness. For the Neal-Seenan scale of Internal ad External Powerlessness, mean ad stadard deviation values are shovn for Cs and Ps. t test on the difference in these means ShOWS overwhelming support of the hypothesis (t = 3.65, P<.001). Eemination of Table 3 irdicates Cs to be higher on ponerlessness on each of the variables, ad to be significantly more powerless on 2 of the 6 individual items: #1, ability to protect in- terests vs. pressure groups, (X2 = 5.22, ldf); #2, ability to hold down medical costs, (X2 = 4.90, ldf). This series of X2 significaice tests was cotpared with Sakoda's (1954) graph indicating the chance probability of obtaining such significant statistics and fourd to be acceptable above the .05 level. TABLEZ Neal-Seeman Poverlessness Scale 7T 3 t C 1.28 0.24 3.65*** P 1.14 0.15 *** P < .001 Table 4 (Respordents Influence 7A by Participant Classification) ad Table 5 (Tannenbaum Influence Items by Consumer Response) shows the sta- tistics obtained from Cs perception of their own irdividual influence ad 27 add H868. finance ea; n Nx Sees a 5.3 8 80.2: e $8.5 3 seed $8208 m Amway mumoo Hmowooe some n ~x 12.03 3 sane mm Ewan mm 835 3 seamen cascaded m Amway mooono Add u ax 5.3 fl 5&8 mm and: em $25 2 gunned fies eammo a a z a z a z a z X mmgmmmHg g mmgmwmflhmgm g m mange @528 mean coaumOfimwmmsHU ucmoaofluumm an memuH mmmcmmmaumsom cmemwmldsmz mam. 28 mo.vm a at: 8088.0. 35 u ax 805 m 80.5 S amass m 3153 me 8089: engage e auto and c8 5 ncoanauut 8.0 u Nx Gene n 5.3 me 2548 a $313 me ascended 88838 m m8Emm and 8082 .46 emanates. 24 n mx 2.5.8 m 38.5 2 asses e Ends 3 Enacted 8889: e a z a z a z a z x unammwaumefim Hmsom mnemmmauwsom g m Hodge Hocfimcoo TQZEOOV m an. 29 the influence of other grows participating in agency decisions. It shows that on item 7A (Perception of Own Irdividual Influence) Cs per- ceived their own irdividual influence to be less than Ps see their's as being (t = 1.42, P (.10). Ebcamination of the mean values ‘shows that Cs perceive their influence (2‘ = 2.19) to be only slightly greater than the category "little" ad Ps perceived their influence (3? = 2.52) to be mid- way between "little" ad "sore". It shows also that Cs viewing other Cs as a group (Item 10A), perceived their influence tobemuch less than that of 3 (Item 8A) (t = 12.97, P<.001), ad much less than that of Ps (Item 9A) (t = 9.59, P< .001). Examination of the mean values shows that Cs perceive the influence of their grow (Y= 2.05) to be about equal to the category "little". They perceive the influence of PS (1? = 3.98) to be about equal to the category "quite a bit", ard s (Y = 4.43) to be almost midway between the category "quite a bit", ad the highest category "great deal". Thus , results from both Neal-Seenan ad Tannenbaum approaches to determining Cs perception of their relative power position strongly swport the hypothesis of a relatively powerless C position. TABLE 4 Respondents Influence 7A by Participant Classification SE 6 t c 2.19 1.20 1.42° P 2.52 1.07 30 TABLE 5 Tannenbaum Influence Items by Consumer Response Item 2 6 8A: Staff influence 4.43 0.7 t = 12.97*** 10A: Consumer influence 2.05 0.9:)1 = 9.59*** 9A: Provider influence 3.98 0.9 *** P< .001 Table 6 (Tannenbaum Influence Items by Provider Response) shows the data relevant to the hypothesis IIB: that Ps see Cs as having less power than Ps and S. The data swports the hypothesis by deronstrating that at the .05 level, Ps view Cs as having significantly less influence than either S (t = 13.42, P< .001), or Ps (t = 6.86, P<.001). Examina- tion of the means shows that Ps view C influence as only slightly above the "little" category (Y = 2.12) . 'Ihey view their own group as having "sore" influence (3- = 3.56) but place the staff midway between "quite a bit" ad "great deal" (Y = 4.50). TABLE 6 Tannenbaum Influence Items by Provider Response Item )7 G t 8A: Staff influence 4.50 0.79 3" 13.42*** 10A: Consumer influence 2.12 0.95 3.. 6.86m 9A: Provider influence 3.56 1.11 *** P< .001 31 Table 7 (Powerlessness Scales by Corbined Consumer ard Provider Response) gives the values relevant to hypothesis IIC: that Cs are accorded a powerless role in agency decision making activities. Cs ad Ps responses were combined for Tannenbaum Item 10A (Amotmt of Influence Consumer have in Agency Planning Decisions). The mean value resulting was 2.09, almost exactly equivalent to the category "little influence" which is also the closest category above "none". The overall mean for the zero-sum scale indicating how much influence Cs had in a typical agency decision was 12.90 percent out of a possible 100 percent. The overall mean for the Arnstein scale irdicating the amount of power ac- tually exercised by Cs was 2.38. This represents a position less than half-way between merely being "consulted before decisions are made" ad "voting on outcores which are modified by those controlling resources". Each of these values violates the acceptable cut-off limit. This hypothesis is then swportedadirdicates theCs positiontobeoneinwhich theCs are little more than consulted before decisions are made. In summary then, the hypothesis of Cs powerlessness is supported both fromtheCsviewthattheirownpoweris lessthanthatofPs, adfrom the Ps view that their own power is greater than that of the Cs. Finally, the Cs position is not only one of less power relative to other partici- pating grows, but also one in which the power possessed is very small in absolute amount. Hypothesis III Normlessness Table 8 (Tasks by Task Assignment-Consumer Response) shows the ini- tial values relevant to the Normlessness Internal hypothesis: Cs per- ceived no clear role for therselves. It shows that in being asked to _w 32 800m «.3 £03598 How m comm mom m mucosa? gmcoo "<3 Emu.“ Home 8513 N 85950 monsoomou o 98 0 .28 co comma sweater H «atmvfim m p 00.0 cod meta mm.~ 53mg 3;. wag. n m oo.o wooém omK om.~a Eswnoumw «at mm.m u n 00.0 oo.m mm. mo.~ «change some oodaoflacmam o magma toned o m demon Hmncomwmm Moog Em Hgncoo “58.580 3 modicum mmgmmmauoefim pg 33 TABLE 8 Tasks by Task Assignment-Consumer Responsel Task Response2 "don't know" Assigned to "no one"3 Frequency % of Total Frequency % of Unknown 01 18 34.62 3 8.82 02 15 28.85 1 2.70 03 23 44.23 3 10.34 04 18 34.62 4 11.75 05 15 28.85 3 8.11 06 21 40.38 5 16.13 07 13 25.00 6 15.38 08 13 25.00 4 10.26 09 12 23.08 1 2.50 10 16 30.77 4 11.11 11 16 30.77 7 19.44 12 17 32.69 7 20.00 13 13 25.00 2 5.13 14 15 28.85 3 8.11 15 16 30.77 5 13.89 2’ 30.90 10.91 6 5.64 5.19 TABLE 8 (cont'd.) 3” Assigned to a Group4 STAFF CONSUMERS PROVIDERS % of % of % of $995. Frequency Group Frequensy Gross. Freguencx. Group 01 13 41.93 0 0 + 18 49.42* 02 18 50.00* 7 19.44+ 11 30.56 03 14 53.84* 6 23.07 6 23.07 04 14 46.67* 1 3.33+ 15 50.00* 05 21 61.76* 1 2.94+ 12 35.29 06 12 46.15* 7 26.92 7 26.92 07 3 9.00+ 24 72.72* 6 18.18+ 08 17 48.57* 9 25.71 9 25.71 09 33 84.61* 2 5.12+ 4 7.69+ 10 18 56.25* 3 9.38+ 11 34.38 11 12 41.38 5 17.24+ 12 41.38 12 13 46.43* 6 21.43+ 9 32.14 13 34 91.89* 2 5.41+ 1 2.7o+ 14 15 44.12 0 0 + 19 55.88* 15 27 87.10* 0 0 + 4 12.90+ X' 53.98 15.51 29.75 a 20.30 18.06 15.01 Responses from co'xsurers only Percent based on total number of consumer responses Percent based on total number of consmer responses with "don't know" responses removed Percent based on nmber of consumer responses assigning the task to one of the participating grows Inclusion P < .05 Exclusion P < .05 35 assign the tasks 30.90 percent of Cs on the average did not even know who to assign ‘the task to. It shows that of those who did assign the task to one of the categories, 10.91 percent, on the average, resporded that "no one" in the agency was doing that task. Of the Cs who assigned the tasks to me of the grows participating in the decision making pro- cess, on the average 53.98 percent selected staff, 29.75 percent selected providers, ad only 15.51 percent selected consumers. For each task as- signed to a participating group, any score greater than 44.83 (33.33 + 11.51) irdicated that grow was selected significantly greater than ran- dom, ad thus included in assignment for that task. For each task as- signed to a particular participating grow, any score less than 21.82 (33.33 - 11.51) indicated that grow was selected significantly less than radon ad thus excltded from assignment for that task. Table 9 (Iters of Task Assignment by Participant Classification- Consurer Response) shows a breakdown by task according to inclusion of each of the three grows into task assignment or exclusion from it, plus a weighted score for each task, and the group whom the task was assigned by Cs. 'Iwo interesting results shown here are that for Task 4 (Coordination of Medical Services) assignment is significant for two grows S ad Ps, ad that for Task 11 (Help PeOple be Aware of Health Needs) Cs are exchded ad there is not task assignment significantly above rardom. Table 10 (Summary Participant Classification by Task Assignment, Consmer Response) shows more clearly the results of task assignments in Table 9. It shows that staff received assignment for 11 out of 15 tasks, received a random response 3 times, ad was excluded only once. It shows that Cs assigned therselves only one task, gave random response 3 times, ad excluded themselves from 11 task assigments out of 15, 36 TABLE 9 l Iters of Task Assignment by Participant Classification-Consumer Response Weighted2 Task: Task Staff Cmsmrer Provider Score Assigned to 01 o - + 3 (P) 02 + - 0 3 (S) 03 + 0 0 2 (S) 04 + - + split (8 & P) 05 + - 0 3 (S) 06 + 0 0 2 (S) 07 - + - 4 (C) 08 + 0 0 2 (S) 09 ' + - .. 4 (S) 10 + — 0 3 (S) 11 0 - 0 split 9 12 + - 0 3 (S) 13 + — - 4 (S) 14 0 - + 3 (P) 15 + - - 4 (S) l + = task assigned significantly >radon - = task assigned significantlyradom task assigned significantly (radon task assigred within radom expectation 0 We' ghted Score HNth-P II II II II ++++ OOII +091 Task assigned to grow receiving the inclusion sign (+) 43 Table 14 (Summary Participant Classification by Task Assignment- Provider Response) shows a summary of P assigments given in Table 13. It shows that S received assignment for 10 out of 15 tasks, a response within random expectation twice, and was excltded from assignment 3 times. Cs were included in only one task, given response within random epecta- tion 2 times, ad were excluded 12 times. Ps assigned themselves the nearest to a normal distribution, with 3 tasks assigned, responses with- in radom expectation on 9 tasks, ad excluded from 3 tasks. This series of significant tests was compared with Sakoda's (1954) graph irdicating the chance probability of obtaining such significant statistics ad fourd to be acceptable above the .01 level. TABLE 14 Summary Participant Classification by Task Assignment-Provider Responsel'2 + 0 - N % N % N % S 10 (71.43) 2 (15.38) 3 (16.67) C l (7.14) 2 (15.38) 12 (66.67) P 3 (21.43) 9 (69.24) 3 (16.66) 2 Xp = 26.11*** (4df) 1 Values obtained from Table 13 2 + = task assignment significantly >random 0 = task assignment within radon expectation task assignment significantly< radon *** p<.001 41+ Table 15 (Participant Classification by Task Assignment Weighted Score-Provider Response) shows how clearly each group was chosen when being assigned tasks by Ps. Thus even though S was assigned a dispro- portionate number of times, it was clearly chosen (ws = 4) on only 2, fairly clearly chosen (ws = 3) on 6, ad not very clearly chosen (ws = 2) on 2. Ps gave no shared assignments , thus S received a weighted aver- age of 3.0, or fairly clearly chosen for their tasks. Cs, however, were very clearly chosen for one task assignment (ws = 4) , and therefore had a weighted average of 4.0. Ps assigned themselves 3 tasks, 2 clearly assigned (ws = 4) , ad 1 fairly clearly assigned (ws = 3), and thus them- selves a weighted average of 3.66, better than midway between ws = 3 (fairly clearly chosen) ad ws = 4 (clearly chosen). TABLE 15 Participant Classification by Task Assigment Weighted Score-Provider Response )2 Average 4 3 2 1 Weighted Score S 2 6 2 0 3.0 C 1 0 0 0 4.0 P 2 1 0 0 3.66 1 Values obtained from Table 13 2 4 = + - — 3 = + - 0 2 = + 0 0 1 = + 0 + Thus to summarize results from tables 12, 13, 14, ad 15, Ps who did assign the tasks to one of the participating grows, saw Cs as having a very clear role in the agency; thus not swporting the hypothesis. 1+5 . This firding should be tempered with the urderstading that this role was described by only 1 of 15 tasks, ad that Ps excluded Cs from task assignment on 12 of 15 tasks. Additionally it should be rerembered that on the average 19.50 percent of P5 did not know who performed the tasks described, ad 14.57 percent on the average of those assigning a task, thought that "no one" performed it. Hypothesis IV Social Isolation A. Committee Attraction-Acceptaxge Table 16 (Participant Classification by Attraction to Committee as a Whole) shows the results relevant to the first part of the Isolation- Grow attraction internal hypothesis: Cs are not as attracted to the committee to which they belong as are Ps. It shows that for attraction to the committee as a whole, the mean for P3 is higher than that for Cs (t = 1.83, P< .10). Thus, the hypothesis is only weakly swported. TABLE 16 Participant Classification by Attraction to Committee as a Whole i 6 t c 3.33 1.00 1.83° p 3.68 0.79 ° pc .10 Table 17 (Jackson Attraction-Acceptance by Participant Classification) shows the attraction-acceptance scores for Cs ad Ps , when the committee evaluation is considered to be the sum of the evaluation of individual me1bers. The values do not swport the hypothesis that with this 1+6 interpretation Cs are less attracted to their commuttees than P5 are (t = 0.77, NS). It shows both means (i c = 3.74, if p = 3.83) to be close to the category "moderately agree" thus both indicating a moderate attraction to the members of their commuttee. Thus if attraction is int terpreted as being directed toward the commdttee as a unit, then Cs are slightly less attracted than Ps, but if it is interpreted as the sumiof attraction to individuals in the group, Cs and P3 are about equal. Table 17 (Acceptance) does shows strong support for the hypothesis that C members are less accepted by their committees than P members are (t.= 2.58, P’<.025). It shows that the mean acceptance value was 3.53 for Cs, about.midway between "neutral" and "moderately agree", i.e. moderately accepted. Mean value for P = 3.72 near the moderately ac- cepted standard. It also shows that.while the mean fer P stayed fairly constant between attraction (3.83) and acceptance items (3.72), the mean for C dropped (3.74 to 3.53). Thus in summary, Cs are only slightly less attracted to their CD“? muttees than P3 are, but are significantly less accepted.by their com— mittees than P3 are. TABLE 17 Jackson.AttractionrAcceptance by Participant Classification "X- G 1? C t Attraction 3.74 0.44 3.83 0.55 0.77, NS Acceptance 3.53 0.45 3.72 0.36 2.58* * P(.05 97 B . Information (1) Knowledge Deficit Table 18 (Participant Classification by Information Satisfaction Category) shows the values relevant to this hypothesis. It shows over- whelming swport (X2 = 19.67, P< .001) , of the internal hypothesis that Cs perceived their knowledge of health plaming to be less than P per- ceived their knowledge as being. It shows that 100 percent of those having "very inadequa " knowledge were Cs, ad 81.82 percent of the "fairly adequate" responses were Cs, or to summarize, 88.25 percent of those who had less than "barely adequate" knowledge were Cs. Looking at the results across categories, 52.94 percent of Cs thought their health planning information was "barely adequate" or less corpared to 86.00 percent of Ps who thought their's was "fairly adequate" or "more than adequate". Table 19 (Information Category by Participant Classification) shows the results relevant to the social isolation - Information External hy- pothesis: Cs do not have as much knowledge of medical plaming matters as Ps do. It does not generally shows significant swport for the hypo- thesis. It does show that for each of the information categories, P mean were above the C mean, but that none of these differences were significant at the .05 level, and only the Information I was significant at the .10 level. It shows that on the categories I - III (general information, staff ad committee names) only abo1t 45 percent of either grow correctly identified the responses ad for category IV (Work Pro- gram Itets) only 18 percent did so. Thus while Cs perceive their health planning knowledge to be significantly less than that of Ps, their know- ledge of sore furdamental iters in the planing agency was equal to that of Ps. Hoo. v m «at 98 $63 «tavhwda u Nx mums oo.oo diam 3.3 00.0 boomumo mo w oo.~m ooém 00.3 ooé o m m0 w 2.. 36 8.3 00.3 m m o z 8.8 8.8 8.2. 9.3 . 0053 Commune no a 3.: mm.mm mm.mm no.5 2...: u no 1.1 Rd 36 m we NH m m z 0 M outmoded Tum—50nd conceded 3% 3% ans menace douse menace has m e m m H W833 coflomwmwusm £03950? mo coaumoflwmmmao unmeaoflhmm ma an. 1+9 TABLE 19 Informaticm Category by Participant Classification Consumer Provider if C if G t Information I 1.41 0.40 1.53 0.32 l.72° Information II 1.46 0.28 1.49 0.27 0.46, NS Information III 1.41 0.33 1.45 0.30 0.64, NS Information IV 1.18 0.25 1.18 0.22 0.05, NS ° P< .10 (2) Information - Caummication Network Table 20 (Participant Classification by Satisfaction with Carmunica— tion Network Inclusion) shows the results relevant to the social isolation Carmunication Network internal hypothesis that Cs are not satisfied with the extent of their inclusion in the informal camunication network. It shows that while mean satisfaction for P (3? = 3.82) is higher than that of Cs (3.84), the difference is not significant (t = 1.25, NS). TABLE 20 Participant Classification by Satisfaction with Cmmmication Network Inclusion 2 G t C 3.61 0.87 1.24, NS P 3.82 0.70 50 Table 21 (Informal Ccnmunication Network by Participant Classifica- tion) shows the statistics relevant to the Isolation - Cammnication Net- work - external hypothesis that Cs are not included in the informal catmunication network of agency menbers to the extent that P5 are. There were not significant differences for the average nurrber of peOple known (1: = 1.12, NS) or known (t = 0.93, NS) by either group. It shows that on the average, Cs reported that they knew 17.37 members in the agency and were krmn on the average by 16.17 other numbers. Ps on the other hand, knew on the average 20.76 members, and were known on the average by 18.98 menbers. The weighted averages of contact given, indicated a mean contact density of 1.58 for Cs or about an average contact of 1/ mnth for the peOple that Cs knew. It also indicated a mean contact den- sity of 1.77 for Ps, or an average contact close to Z/mnth for the nerbers that Ps identified. The difference in these means is signifi- cant (t = 2.13, P<.05) . The weighted average of contacts received in- dicates a mean for C of 1.69, and for P3 of 1.77, which are both near the 2/nonth range and not significantly different (t = 0.54, NS). C. Constituency Table 22 (Participant Classification by Formal Representation) shows the values relevant to the constituency internal hypothesis that Cs do not perceive themselves as having a constituency as often as Ps do. Even though the X2 value (1.70) is not significant, the table slows that when asked if they formally represented sane group, four times as many Ps said "yes" as said "no". When asked the same question, only twice as many Cs said "yes" as said "no". 51 fine—.5035 a vu H fiogfioBoB NA u m fioooxflofio8 T... u m fio8\flofio8 mum u o fiogxfioflo8 m A u m “83m 3&0: H mo. v o. .4. 82.809” 303:8 Mo gum $5 3.0 EA 8.0 $4 “mango oooomnoz mm C392 3.0 8.3 m3: 222 2.2 0362 no 0852 Egg 303:8 mo gum .43.... $5 2.4 2.5 $4 Moog 3.332 24 2.2 2.8 22% 2.2 :59 mg U m o m u among mHmoBmcoo 83033330 “330%.“ .3 xuofiwz 838g H9503 HN ah. 52 TABIEZZ Participant Classification by Formal Representation No Yes N % N % Consumer 16 (59.25) 33 (44.59) Provider 11 (40.75) 41 (55.41) x2 = 1.71, NS (1df) Table 23 (Participant Classification by Constituency Effect) also shows the results relevant to the internal hypothesis of consumer con- stituency. It shows that of those who indicated they did represent a group, P5 felt the group affected their participation in the agency satewlnt less than a moderate amount (3?= 3.60 on a 5 point scale). Cs on the other hand were much nearer to a "neutr " effect. 'Ihe difference between these means is significant (t = 2.35, P< .05) indicating that even though consumers report a constituency only slightly less often than providers, the effect that constituency has on Cs is much less than the effect that Ps constituencies have on them. TABLE 23 Participant Classificaticn by Constituency Effect i 5 t Consumer 3.31 1.46 2.35* Provider 3.60 1.30 * P<.05 53 Table 24 (Participant Classification by Constituency) shows the sta- tistics relevant to the constituency external hypothesis that Cs are not perceived as representing a constituency. It stuns that on the average 16.24 Cs were identified as having a constituency while 40.58 Ps were so identified. Unfortunately the standard deviation values (C = 16.72, P = 31.03) were so high that t = 1.23 fell slightly short of the .10 signifi- cant level . TABLE 24 Participant Classification by Constituency 3? C t C 16.24 16.72 1.23, NS P 40.58 31.03 Hypothesis V Socio-Econcmic Status Table 25 (Participant Classification by Health Education Category) shows the data relevant to the internal hypothesis: Cs perceive them- selves to have less formal health education that Ps see themselves as having. The hypothesis is overwhelmingly supported (X2 = 57.16, P< .001) . It shows that the average value for Cs is 2.08, almst exactly equiva- lent to the category of "little" formal education and the P average is 4.26, which falls between "quite a bit" and "great deal". It shows that 91.30 percent of those falling in the "none" category were Cs and 100 per— cent of those falling in the "little" category were Cs. It shows on the middle value equal distribution between Cs and P3. On the category 51+ .30. v m t: $63 «tag—”Km u NX 8.03 8.8 8.8 8.0 8.x E888 mo 1. 8.8 8.8 8.2 8.0 8.4 a mo 1. m. 84 8.4 8.8 8.: 8.8 88 8.~ z 88 3.8 8.8 8.03 8.8 @838 co 8 8.0 8.3 8.3 8.8 2.2. o co m w 34 8.~ 8.8 88 85 8.2 8.3 z u m 38 £95 in a 3nd 2.8 333 802 n v m m H E838 838:8 5.8% an 83633330 ufifloflfia mm EB 55 "quite a.bit" 57.89 percent were Cs and on the highest category "great deal" 100 percent were Ps. Thus the results show a classic distribution reversal. Table 26 (Participant Classification by Formal Education Category) shows the results relevant to the external or Objectives hypothesis of formal education. The data overwhelmingly supports the hypothesis that Cs have less formal education than Ps (x2 = 29.17, H.001). ‘Ihe mean value for C = 3.77, roughly equivalent to a little less than a college Bachelors degree, while the mean value for P = 5.26, a little above a Graduate degree at the Master's level. This table also demonstrates a classic reversal in.distributicn of responses between P and C. Table 27 (Participant Classification by Family Income Category) shows values relevant to the hypothesis regarding fandly inconen The values support (x2 = 12.27, P< .025) that Cs have significantly less family inccme than Ps. It shows Cs mean equal to 3.20, slightly above the $12,000 - $20,000 category, and P3 mean equal to 3.81, slightly below the $20,000 - $30,000 range. Similar to the other tables on socio~economic factors, the C distribution into categories was the re- verse of P, with C constituting 100 percent.of the lowest category, and P constituting 70.59 percent of the highest. 56 H8. V m «at 38v «ash—”5N u ax Hm.~m oo.oo om.no sm.m~ om.sm oo.o oo.o myoomaoo no a mo.v~ o~.~H ma.mm mm.oa ~H.o oo.~ oo.o o no m sm.H o~.m oo.~H oo.o oo.oa oo.m oo.m oo.H oo.o .z mo.a oo.oo Hm.m me.as om.~o Hm.~m oo.ooH snooopoo «0 m ~o.a mo.» Hm.sa oo.mm mo.m mo.m~ ~a.~ o no a om.a ss.m oo.H oo.o oo.o oo.o~ oo.m oo.~H oo.H .2 In .m .ouo ..m.o.o ago «muons mousse .mono Hoocom Hoocom .o.o ..o.:_ nanomnzr uoaonoom sumo swam massage a o m o m m H suommuoo cosponsom ensues sn_ooauooamannoao_u:oaaoauuom mug 57 mo.vm Got .884 u .mx 8.8 8.8 8.8 8.8 85 E838 mo w 8.8 8.8 8.2. 8.8 88 o no a m ~a.o Hm.m oo.~H oo.mH oo.ma oo.o oo.o z #8 8.8 8.8 8.8 888 E838 80 a 88 8.8 8.8 8.» 8;. o no a m 84 88 8.8 8.2 8.8 86 8.3 2 u m 898? 828-88 8o.o~-~$ 28.8-8 8o§nv m o m N H @0538 9605“ 3 gm an 8.383330 unmmflogm 5N an”. DISCUSSION The following chart summarizes the main tests of significance can- puted on data related to each of the hypotheses tested and presents the basic framework for the discussion which follows. SUMMAIW: Tests of Significance Related to Hypotheses I . PARTICIPATION Hypothesis: Compared to P5, Cs have a lower record of participation in aLency decision—making meetings . Method Overall attendance Board of Trustees Ehcecutive Committee Ommittee A Camdttee B Committee C Committee D II . POWERIESSNESS A. Internal Hypothesis: Significance Test Significance Level x2 = 15.29 p <.001 x2 = 13.31 p<.001 x2 = 5.17 P <.05 x2 = 0.49 NS x2 = 1.85 NS x2 = 7.39 p <.01 x2 = 1.44 ms Consumers see themselves as having less power than Providers . 58 Method Neal-Seeman Scale Item 1 Item 2 Itan 3 Item 4 Item 5 Item 6 Tannenbaum Item 7a, C vs. P Item 8a vs. 10a Item 9a vs. 10a 59 Significance Test Significance Level t = 3.65 p <.001 x2 = 5.22 p <.05 x2 = 4.90 p (.05 1.96 NS 1.10 NS 0.80 NS 0.54 NS t = 1.42 P (.10 t = 12.97 p <.001 = 9.59 P <.001 B. External Hypothesis: Ps see Cs as having less power than Ps. Method Tannenbaum 8a vs . 10a 9a vs. 10a C. Interaction Hypothesis: Method Tannenbaun Zero-Sum Arnstein Significance Test Sigificance Level t = 13.42 P (.001 t = 6.86 P <.001 CsarxiPsseeCsashavingasmallanount of power or influence in agency decision- makinLactivities. Significance Test Significance Level t = 9.89 P (.001 Z = 7.84 P<.001 t = 35.49 P<.001 III . NONELSSI‘JESS A. Internal Hypothesis: 60 Cs do not perceive themselves as having a Method Task Assignment B. External Hypothesis: clear role in the activities in the ggency. Significance Test Significance Level x2 = 24.54 p< .001 P5 do not perceive Cs as having a clear role Method Task Assignment IV. ISOLATION in the agency. Significance Test 2 Significance Level X = 26.11 P<.001 A. Group Attraction-Acceptance 1. Internal Hypothesis: Method Attraction to cmmittee as a whole Attraction to members 2. External Hypothesis: Cs are less attracted to the committee they belong to than are Ps. Significance Test Significance Level t = 1.83 NS t = 0.77 NS The committee as a whole will be more accepting Method Acceptance of members B. Information oanembersthanCnembers. Significance Test Significance Level t = 2.58 P<.005 l . Knowledge Deficit a. Internal Hypothesis: 61 Cs perceive their knowledge of health plan- Method Adequacy Question b. Ebcternal Mothesis: ning to be less adequate than Ps see their lmowledge as being. Significance Test Significance Level x2 = 19.57 P <.001 Cs do not have as much lmowledge of medical Method Information I Information II Information II I Information IV 2 . Communication Network a. Internal Hypothesis: alarming matters as Ps do. Siflficance Test Significance Level t = 1.72 P<.10 t = 0.46 NS t = 0.64 NS t = 0.05 NS Cs are not as satisfied as P5 are with the Method Satisfaction Question b . Ebctenlal Hypothesis: extent of their inclusion in the informal communication network. Significance Test Significance Level t = 1.24 NS Cs are not included in the informal carmunica— tion network of agency members to the extent that P5 are. .Method Mmberslcnwn Weighted average of contacts given Number of members kncwn by Weighted average of contacts received c. Constituency 1. Internal Hypothesis: Method Reported constituency 2. External Hypothesis: thhod Perceived constituency V. SGIIO-EIJODDMIC STATUS 62 Significance Test Significance Level t = 1.12 NS t = 2.13 P< .05 t = 0.93 NS t = 0.54 NS Cs do not perceive themselves as having a constituency as often as Fe do. Significance Test Significance mvel x:2 = 1.70 ms Cs are perceived as having a constituency less often than Ps. Significance Test Significance Level t = 1.23 NS Hypothesis: Cs have a lower incane and less formal education than Ps. Method Health Education Formal Education Income Significance Test Significance Level x2 =. 57.16 p<.001 2 U x = 29.17 P<.001 x2 = 12.27 P< .001 63 I . Participation The most basic feature of effective input into the decision-making process is participation in those meetings where binding decisions are made. Even if a structure is created to give recipients of such deci- sions 51 percent of the voting power in determining the decision, the right to vote must be exercised for the potential to becate reality. Unfortunately the results revealed that such participation by consumers has been sadly lacking, leaving the voting as well as persuasion Oppor- tunities in meetings in the hands of the professionals. If only 41 per- cent of 51 percent attend, then at maximum only about 20 percent of the votes can be consumers. It is particularly noticeable that the most powerful groups, Board of Trustees and Ececutive Committee are the ones where consumer participation is most lacking so that effective input is removed not only from review and comment decisions , but policy decisions as well. Thus consumers are clearly marginal to this basic process of decision making. II. Powerlessness The results on powerlessness were expected. They demonstrate a very acute power imbalance in the agency. This is most vividly demonstrated by the fact that there was general agreement between Cs and P3 on the significant differences between the influence of S and P (t = 2.33, P<.05) and that of Ps and Cs (t = 5.09, P<.001). This relationship is very well described by the overall description of the mean percent of influence ac- corded each group: S = 52.6 percent, P = 34.50 percent, C = 12.90 percent. The results on Arnsteins (1969) scale of participation confirmed that the Cs position is one that is not only powerless relative to other groups but 61+ also exists in an absolute sense when more operationally defined. A good overall description of the Cs powerless position can be obtained using Arnstein's terminology. The consumer is usually consulted before deci- sions are made, but at best, and even then not often, votes on decisions which may be reversed by those controlling necessary resources. Some interesting results within and between tables are also worthy of discussion. In the results on Table 3 (Neal-Seemin Powerlessness Items by Participant Classification) there was a significant difference between C and P on the first two iters: "OOping with pressure groups" and "preventing rising medical costs". It is most interesting to note that the powerlessness means on these two items are much higher for both C and P, than the means on any of the other items. About 36 percent of P, and 60 percent of C marked the powerlessness Option for these items. The high value on "caping with pressure groups" could be explained by the idea that the pressure group involved is not specified so that, for example, Cs could feel powerless against the health professional, and Ps could feel powerless against the Federal government. It is also interes- ting that while many felt unable to "cOpe with pressure groups" most felt able to "affect important decisions in his own life“. They seered to have indicated that they participate in the decision-making process but determine its outcomes only when little Opposition exists from others. The high powerlessness values on ability to prevent rising medical costs (P = 40 percent, and C = 64 percent) may be a demonstration of the feeling that "this is bigger than all of us". Indeed the inflation trend is often beyond the power of any group, and consumers who are marginal to the decision-making may be all but totally powerless. On the whole, however, the extent of powerlessness indicated by in- dividuals on the Neal-Seeman scale was not that high (P = 14 percent, 65 C = 28 percent indicating powerlessness). Tannenbaum's item on "subjects own influence" (Table 4) , however, asked much the same question and the results indicated a large degree of powerlessness for both (sorewhat less than midway between little and none). An explanation can be drawn by considering the focus of these two scales. Neal-Seeman has items of a general nature pertaining to health issues, and control in general. Tannenbaum, however, relates specifically to the agency under sbldy. It should also be noted that the Neal-Seeman items generally refer to potential control while Tannenbaum items refer more to utilized power. Thus while members do not feel potentially powerless with regard to con- trol of general health issues, they do believe they exercise little power in this particular agency. It is also worthwhile to cmpare responses across Tannenbaum items (Table 5 and 6) for C vs. P. Consumers described their individual in- fluence position as low and described the influence of Cs as a grow to be about the same (t = 1.11, NS). Ps on the otherhand, described their individual influence position to be fairly low but described that of Ps as a grow to be quite a bit more (t = 4.72, P< .001). This deronstrates that Ps see control being exercised by members of their grow even if they personally do not do so, while Cs see neither themselves nor other Cs as exercising any real power in the agency. Finally in considering the powerlessness results, it is interesting to colpare the geleral pattern of results for C vs. P, on the Tannelbaum items. There was general agreerent between C and P of the influence position of S and Cs high and low respectively. Cs however, described Ps as being higher in influence than Ps described themselves (t = 1.95, P almost .05) . Thus either P3 are underestimating the influence they exercise or Cs see them as having a lot more influence than they really do. The truth is probably somewhere in between. 66 III . Normlessness The results shown on the tables of normlessness (Tables 8-15) were both unexpected and interesting. The hypothesis was not swported by the data. Cs are in fact viewed as having a clear role, that is one for which both S and P were excluded in assignment. This should be examined more clearly before the tetptation to say, "they only do one thing, but they do it well". The task they were assigned read: "they represent commmity problems and Opinions". The word "represen " can unfortunately be exercised both as an active and passive role. If the respondent viewed it as a "passive" expression of "who stands for what", most would indeed be likely to designate Cs for representing "commlnity problers and Opinions ". If on the other hand Cs were viewed as actively repre- senting community Opinions in agency actions, it seems most Lmusual that they were assigned no other roles, in fact excluded from almost all roles which would indicate that they had Operationalized this Objective. Some interesting features of the breakdown of response categories (Tables 8 and 12) also exist in and "don't know" and "no one" categories. 31 per- celt of Cs indicated they "didn't know" who performed the tasks compared toonly leercentOfPs. It is perhaps notbadwhenl/Sofagrowdo not know "who is doing what", but when l/3 of a grow falls in this cate- gory there is strong suggestion that such a grow is isolated from the proceedings and thus marginal to the process. It is interesting to note that when the taskwas assigned there was agreement between C and P on who the task should be assigned to. Cs were assigned the task to "represent community problems and Opinions". Ps assigned the tasks Of "helping in planning medical facilities" and "providing expert Opinion" to themselves. Staff was assigned all the rest. It is noteworthy that Cs were excluded from task 2 "fulfill legal 67 requirerents" when by Federal law at least 51 percent of the governing Board must be consumers for the agency to receive funding. It is also worth noting that while Cs "represent community problems and Opinions" they are some how able to do it without task 8"dea1ing with other or— ganizations in the community", task 9, "gathering and reporting infor- mation", task 11, "helping pecple be aware of health needs", and task 12 "infonming the cammunity about health problems and needs". This pattern strongly suggests that while the philOSOphical ideal is for C8 to repre- sent cmmunity problems and Opinions, they are excluded in the Operational tasks that would be necessary to actually do this. Task assignment for P3 was much clearer when Ps responded rather than Cs. 'Ihus Ps perceived therselves as doing much more than Cs see themasdoingbutashavinglesspaverthanCsseethemashaving. Finally, in looking at the summary of inclusion and exclusion fran task assignment (Tables 10 and 14) one is impressed with the almost clas- sic textbook picture of role reversal and heirarchy of operational invol— vement in agency activities, (Xcz: = 27.20, P<.001; X123 = 26.11, P<.001). Itvmldaqapearflatthestaffdoesalnosteveryflfing,theccnsmnersdo almost nothing, and the providers fluctmte almost randanly sanewhere in the middle. It is entirely possible that the tasks chosen for analysis were not representative of the entire domain of comprehensive health planning activities and indeed sampled primarily staff activities . The tasks were constructed however, to cover the full range of activities as suggested by the literattme and members of the agency. It is diffi- cult to believe that another set of items would alter significantly such 68 a dramatic response pattern. Considering the basic philosophy of equal sharing of rights and responsibilities in the program, it would appear that to the meters, the "Partnership for Health" is almost non-existent for consumers and only weakly so for providers. IV. Social Isolation A. Committee Attraction—Acceptance Jackson (1959) tried to explain the difference between "formal mem- bership" and "psychological merbership" in an organizatim. He stated thattobeanythingmoretl'ananameonametbership list, aperson must be both attracted to the group and accepted by it. Attraction is consideredtobearelationshipofapersonandgrwpstrwturein whichthepersonwants tobelongmorethanhewantsmtbebelong. Acceptance is defined as being more than socianetric liking and includes theexpectations ofcertainbehavior forthegroupmerbersardtheaccep- tanceofhimperfonmingsareroleorroles inthegroup. ‘Iheitemsonattractiontomerbersofthegrowaxdacceptanceby themwere based onJackson's research. The items on attraction to the group as a whole were based on Jackson's concept although the referent wasthegroupratherthantheindividual. ‘I‘herewassarediscrepancy betweenattractiontothegrowasawitarfitothemetbershipwith the latter being higher and the difference being smevhat greater for Cs, (tc = 2.41, P<.Ol; tp = 1.56, NS). This difference could be attributed totleideathatconsmersaremoreattractedtothepeopleinthegroup than the group itself, particularly if the function the grow is per- forming does not seem particularly desirable or because it does not seen to be performing a desirable ftmction very well. 69 The most interesting feature here however , are the carparisions of attraction and acceptance, for Cs and Ps. They indicate that both Cs and P5 are attracted to their committee and that there is no significant difference between them in this respect. The results indicate simultaneously that Ps are accepted to the same extent that they are attracted but Cs considerably less so. The results would, in Jackson's terminology, re- present a position of "psychological merbership" for Ps and a "preference group relationship" for Cs. To quote Jackson (p. 17): A "preference group relationship is found in a situation where a person wants to be- long to a grow but is not assigned a merbership role", or as an example, a group in which veterans and new members were both formally merbers, but the veterans constituted an "elite in group" to which the rev members desired to belong. Considering also the previous evidence on task assigment this des- cription would appear to be a good fit for the situation which exists in the planning agency: professionals constituting the "elite in group" andconsumersbeing fonralmerbersofthegmip, buttryingtobelong to the "in group" of decision makers. Jackson also describes a "marginal group" relationship in which the person has positive acceptance but little attraction, this \mfortmiately does not coincide with the present more general terminology of members who are peripheral to meaningful grow process for many reasons. B. Information 1. Knowledge deficit 'Iheresultswithregardtothekmvledge thatthegroips hadwas mixed. The overwhelming swport of the hypothesis the Cs perceive their health planning knowledge to be inadequate swported the general 70 sentiments conveyed in conversations with agency consumers . It is intriguing however, that Cs did as well as Ps on the objective questions. The content of these items should then be examined carefully. Informa- tion category I , on very general and obvious features should be simple enough for most meters to answer. Information II and III involved sim- ple name recall. Information IV involved more specific information on the Operating programs Of the agency and accuracy for both Cs and P3 dropped dramatically. IIhis would result if such items were not salient in the cognitive Operating structure Of the membership. Indeed no pro- gress reports are regularly presented to members about the progress of these itemsontheoverall agencyprogramonceannualfurdinghasbeen reached. Thus it would appear that the hmledge deficit perceived by Cshadnotbeenadequately sampledorthatCsinfactknewmorethan they actually had given themselves credit for. 2 . Carmmication Network The mixed findings on knovledge deficit are satewhat clarified when thecammmicaticnnemork is examined. 'IheresultsshowthatCandP both want slightly more communication with other agency participants staff included, and that there was no significant difference between C and P means. Alsointerestinginthissamegeneraldirectionis thatonthemea- sure of contacts given and received, Ps indicated they gave contacts as frequently as they received them. Cs however, received more contacts than they thought they gave. Both the unusual results of satisfaction with the cammnication network and inclusion into it could be explained if personal communication contacts in the health area were more salient 7l andimportanttoPs thantoCs. Thenitwould follovthatPswouldbe likely to desire more contacts and remember all of them. Indeed it would appear that Cs place far too much erphasis on the amount of knonledge they do not have, rather than viewing contacts with other interested Cs and P3 as a way of learning information about ongoing agency activities . C. Constituency The results on constituency follow some of the general trend of the information results. Even tholgh Ps perceived thetselves as formally re- presentingsoregrowtwiceasoftenthanCs, thelargevalues ofthe standard deviations did not allow the difference to be statistically significant. As constructed, "yes" responses could have ranged from 0 to 45 on the largest committee. Thus a large standard deviation was pos- sible. Further investigation therefore is necessary before Obtaining more conclusive results . V. Socio-E‘conomic Status Sore factors of socio-economic status were examined not so much because they were causes or products of anything specific to the agency's present Operations , but because they describe built-in handicaps .that Cs bring with them when entering into an agency whose decision-making is in the health area. The results confirm the expectations that consumers report significantly less health education, less formal education, ard less incore than providers . Conclusion Consumers began with sore basic features of marginal status and even after formal and majority inclusion in the decision-making process 72 of the agency still occwied a marginal status, which was Operationally defined in terms of attendance and features Of powerlessness, normless- ness, and social isolation. It appears as Fairweather (1967, p. 7) puts it that "margiral status Often results in effective social isolation Of the persons from meaningful participation", and that consumers may have attempted to "solve their problem or marginality by becoming apathetic and assuming no responsibility at all". But as Blomberg (1969, p. 126) points out "there may be a self-confirming circularity" in the perceptions of powerlessness, normlessness, and social isolation, which often produce behaviors which ultimately reinforce the marginality of the status. Thus is may well be the responsibility Of those seeking meaningful participation for these recipients Of the decision making process to stOp these processes Of non-involvement and reverse them if possible so that meaningful participation in a derocratic society can occur and a position Of power, task assignment, and social inclusion can be accorded to the consumers. It became necessary then to do as Fairweather recormends, to develop a program which will "change the status of those who only marginally participate". Indeed if these processes can be viewed as a system it might look like this: External to Consumers: Power Task Assigment Social Inclusion PARI'ICIPATIQI T Internal to Consumers: Poverlessness Normlessness Social Isolation 73 To provide a program which aims at increasing participation, the mechanism apparently involves reducing the powerlessness, normlessness , and social isolation perceived by consumers. It seems obvious that 5018 program should be created which allovs the consumer the social swport of a constituency and not only helps him overcore the perceived hmledge deficit by presenting him with sore facts utilizable in actual partici- pation, but also introduces him into the functional communication network so that he becores informed Of political as well as factual information. Jackson (1966) believes greater inclusion in the comunication network would allow consumers to perceive their role more accurately and clarify it to themselves so that the lack of definiteness in role would not pro- duce what Jackson (1966) calls "discontinuity in expectation" of persons in the actual decision-making meeting. Finally the program should offer new Opportunities so that the self-confirming circularity of powerlessness can be broken, and Cs can, with some degree Of confidence, enter into participation in the decision process with the expectation that their input will be both meaningful and effective. Such a program will perhaps not be easy to create, nor accorplish all Of these objectives successfully, but such a program sholld be created and evaluated or society will once again atterpt to wash its hands in diagnosis and rhetoric rather than putting them to work in producing change. BIBLICBRAPHY BIBLICXSRAPHY b Altshuler, A. Community Control. New York: Pegasus, 1970. Arnstein, S.R., "A Ladder of Citizen Participation," American Institute of; Planners Journal, §_5_, #4, July 1969, 216-244. Bloorberg, W., "Community Organization," in R. Kramer and H. Specht (eds.) , Readin in Community Organization. Englewood Cliffs, N.J.: Prentice- Hall, $69. _ Bonjean, C., R.J. Hill, and S.D. McIerore. Sociological Measurerent: ;, u+ An Invento Of Scales and Indices. San Francisco: Chardler ‘1‘ 1313b 5, 1967. ‘ Dubey, S.N. , "Cormmity Action Programs and Citizen Participation: Dean, D., "Alienation: Its Meaning and Measuremen ," American Socio- logical Review, 26, (Oct., 1961), pp. 753-758. Fairweather, G.W. , Methods for Ewerimental Social Innovation. New York: John Wiley, 1967. Gilmer, B. , Industrial Psychology. New York: McGraw—Hill, 1966. Jackson, J. , "A Space for Conceptualizing Person-Grow Relations , " Human RBIatiODS, 1.3, 1959’ 3-150 Jackson, J. , "A Conceptual and Measurerent Model for Norm and Roles," Pacific Sociological Review, 9, #1, Spring, 1966. Krarer, R., Participation of_ £13 Poor. Inglewood Cliffs, N.J.: Prentice- Hall, 1969. Moynihan, D. , Maximum Feasible Misunderstanding. New York: The Free Press, 1970. Sakoda, J.M., Cohen, B.H., Beall, G. "Test of Significance for a series of Statistical Tests," Psychological Bulletin, 51, #2, 1954. Seeran, M. , "m the Meaning Of Alienation," American Sociological Review, 24, (Dec., 1959), 783-791. Tannenbaum, A. Control in Organizations. New York: McGraw-Hill, 1968. 7’4 APPENDIX 75 APPENDIX QUESTIONNAIRE USED BY RESPONDENTS This questionnaire is one part of a longitudinal study designed to survey the services, attitudes, and activities at the agency. It is being conducted with the lmowledge ard approval of the Board Of Trustees and agency staff. However, these questionraires retain the prOperty Of the surveyors, and no information pertaining to particular individuals shall be available to anyone else. The survey will be divided into three sections. First, there will be a brief section Of general questions asked by the interviewer, followed by a section which should be easier to answer by yourself. Finally, we will ask sore questions Of a more specific nature. In all, thetimeinvolvedshouldnotexceedonehour. Name Date Interviewer Time SECTION I: These questions will be asked by the interviewer. For your: convenience, however, we encourage you to follow along on this copyofthequestions. Fromtimetotime,weshallrefertooeof thesecardswhichgivecategorieswewillaskyoutouseinyourre- sponse. 'E _—m-_ -9‘L17‘13_ 1- ___ __ . . E 76 Which committee (5) do you serve on at the agency? Do you consider yourself a health consumer (l) or a health provider (2) at the agency? Why did you join the agency? Whichaspectsoftheagencydoyolthinkaremostworthwhileard which are in need Of improvement? What would you suggest to improve health planning at the agency? What do you see as the benefits and disadvantages Of consumer participation? Novwewolldliketomovemtosoremorestructuredquestions. We askyoltoanswerthefollowingquestimsusingtheresponsesmCard #1. (See the following page for Card #1) 7. A. Howmnhinfluencedoyouthinkyolhaveonplamlingdecisions intheagency? Would you like it to be different? Howmuchinfluencewolldyouliketohare? Ingeleral,howmuchinfluencedoesflle§_t§_f_fhaveonplaming decisionsintheagency? Would you like it to be different? InyourOpinion, howmuch influence Mthe staff have? In general, howmuch influence do health providers have on planning decisions in the agency? Would you like it to be different? In your Opinion, In»: much influence should health providers have? 5:! f 1542:” -2. -n’ ‘1 —M .5 NW 77 10. 11. B. C. 78 In general, how much influence do consumers have on planning decisions in the agency? Would you like it to be different? In your Opinion, how much influence _s__h_o_u_l_d_consmrers have? In summary, then, how much is a typical decision influenced by the staff, how much by the providers, and how much by the con- sumers? In other words, given 100% of the influence in the agency, what percent (to the nearest 10%) is exerted by each of these three groups respectively? Staff influence % Provider influence % Consumer influence % Would you like it to be different? What percent of infltelce would you prefer for each grow? Next,wewolldliketofirdouthowmuchinfomationabo1tmedicalser- vices ad health planning the members Of the agency have. We do not expect you to be able to answer all Of these questions corpletely. 12. 13. 14. Please tell me what major department in the Federal government finances the agency's annual budget? Please tell me what a Health Maintenance Organization (H.M.O.) is? Please tell me the difference between an "a" agency ad a "b" agency in Corprehensive Health Planning? A. Wymgivemthenamsofasmayofthestaffmmbersas you know? Using the categories on Card #2, would you tell me approximately howmanytimes amonth youspeakwitheachoneyoumentioned? (See the following page for Card #2) 79 CARD#2 5=Morethan8times .5 ll 5t08times 3=3to4times 2=lt02times 1=lessthanltime E fig-3'1} _ _J 15. 16. 17. 18. 19. A. B. 80 Compared to the amount of contact you now have, how Often would you like the staff to talk with you? Wouldyounareasmanyof the FlamingCommitteesasyoulcm? Woild you male the chairmen of these committees? Have you ever been to the agency's office? Please tell me the budget for the work program next year? Vbuldyolnameasmanyitersofnextyear'smrkprogramasyou canrererber? Next,wemolldliketodiscusssoreaspectsofyolrbackgromdinthe commmity. 20. 21. 22. A. E. F. DO you belong to any other organizations or grows in the commmity besides your place Of erployment? Which orgalizations are these? Do yo: regularly attend meetings at any of these organizations? Do yol make financial contributions to any Of these organiza- tions? Doyouserveonanycommittees fortheseorgalizations? Have you ever held Office in any Of these organizations? Using the categories on Card #3, approximately how many peOple outside the agency do you talk to abort Corprehensive Health Planning? (See the following page for Card #3) A. Were you selected specifically to represent axy grow at agency meetings? If so, which grow were you selected to represent? Quite Often people do not formally represent any organization but still reflect the Opinions ad needs Of a greater nmber of peOple than just therselves. Do you think yo: reflect the needs ad Opinions Of any larger grow Of peOple? 81 CARD#3 5=Agreatmany .5 ll miteafew Afew d 22. 23. 24. 25. D. A. 82 If so, which grows Of people are these? Using the categories on Card #4, how likely is it that the people yol mentioned would fird out what you do at the agency? (See the following page for Card #4) Doyoufeel that the people youmentionedexpectyoltodo anything in particular at the agency? How much do these people influence what yo: do? How important is it that you have these people to back yo: w? Areyoumore likelytospeakwatmeetingswiththesepewle backing you up? DO you feel that yolr contribution will carry more weight with these peOple backing you w? Coildyounarethepeopleyolknowattheagencyotherthan those on the cormittee(s) you belong to? Using the categories on Card #5, approximately how many times amonthdoyou speakwith eachpersonyoumentioned? (Seethe following page for Card #5) What prOportion of your discussions with each one are health- related? Corparedtotleamomtofcontactyoumwhave, howoften would yol like these peOple to talk with yol? Could yol nave the people you know on the committee(s) you belong to who you speak with outside those meetings? C, D. Same as #24 above. 83 CARD#4 5 = Very Likely 4 = Probably 3 = Maybe 2 = Unlikely l = Very Unlikely CARD#5 5=Morethan8times 4 5t08times 3=3to4times 2=lt02times 1=lessthanltime 81} SECTION II: Each of the following questions may be answered in one Of sev- eral ways. Please check the answer following each question which best describes yon answer. 1. How long have you been attending meetings at the agency? 2. Doyouplanoncontinuingasamerberoftheagencynextyear? Yes N0 7 3. Sllppose that as a result of strong Opposition to the agency from within the commmity, the agency was in real danger Of folding w. f ' Pm much effort would yo: be willing to sped in order to prevent this? A great deal Quite a bit Sore Little None 4. Swmse that as a result Of general merber disinterest, the agency wasinrealdangerof foldingw. Howmucheffortwouldyoube willingtospendinordertOpreventthis? Agreatdeal Quite a bit 85 5. How well do yo: think the agency is doing in the field of Cotpre- hensive Health Planning? ___ Very well __ Fairly well __ All right Poorly Very poorly 6. Consumer participation is a necessary part Of Colprehensive Health Planning? __ Strongly agree __ Moderately agree __ Neutral __ Moderately disagree __ Strongly disagree 7. Corpared to what yol think a person needs to participate effectively in health planning, how adequate do you think yon erowledge of health and health planning is? __ More than adequate __ Fairly adequate __ Barely adequate __ Inadequate __ Very inadequate 8. Considering health delivery in general, how important a part is Corprehensive Health Flaming? __ Very important __ Fairly important Somewhat important Not too important Not important at all 86 9. How long do you think it will take before such planning will have significant effects on the quality of health services? __ More than 10 years _ 6 to 10 years __ 3 to 5 years __ l to 2 years Less than 1 year In The following staterents are growed into pairs. Would you check one statement from each pair which best describes yon feelings? 10. __ A. Better coordination of existing services should be given first priority in meeting today's health problems. i; B. Flaming new programs should be given first priority in meeting today's health problers. 11. A. Consumers ad providers in the agency sholld formally speak for sore grow of peOple. B. Consumers ad providers in the agency sholld express only their own personal Opinion. 12. A. This community reeds Corprehensive Health Planning. B. The people already providing health services can take care of health planning therselves. 13. A. Persons like myself have little chance Of protecting on personal interests when they conflict with those Of strong pressure grows. B. I feel that we have adequate ways Of OOping with pressure groups. 14. A. I think we have adequate means for preventing run-away medical costs. B. There's very little we can do to keep medical expenses from going higher. 87 15. A. High quality medical care can be achieved by those of us who work toward it. B. There's very little we can do to bring about high quality medical care. 16. A. There's very little persons like myself can do to im- prove the comunity's knowledge abolt medical services. B. Ithinkeachofuscandoagreatdealtoimprovethe community's knowledge of medical services. 17. A. This world is run by the few peOple in power, ad there isnotmuchthe littleguycandoaboutit. B. The average citizen can have an influence on important decisions affecting his life. 18. A. It is only wishful thinking to believe that one can really influence what happens in medical services today. B. People like me can change the conse of medical services if we make ourselves heard. The followingare sore ofthegrowswhowork togethertomakehealth services what they are today. Please indicate how much influence or "fl" eachgrophasindeterminingthetypeofhealthservices that will be Offered. 19. Medical Professional Associations: A great deal Quite a bit Sore Little 20. 21. 22. 23. 24. 88 Cknmunity Opinion: Physicians: Cknpmehensive Health Planning Agencies: HOspital Administration: State government: A great deal Quite a bit Little A.great deal Quite a.bit Little A great deal Quite a bit Little A great deal Quite a.bit little A.great.dea1 Quite a bit Little 25. 26. 27. 28. 29. 89 City government: Other Flaming Agencies: Voluntary (Charitable) Organizations : Federal Government: Medical SChools : Agreat deal Quite a bit Little A great deal Quite a bit Little Agreatdeal Quite a bit Little A greatdeal (mite a bit Little A great deal Quite a bit Little 90 The following staterents describe various types Of participation consurers could have in Corprehensive Health Planning. 30. 31. 32. 33. A. They are infomed Of decisions. B. They are consulted before decisions are made. C. 'Ihey vote on decisions, but outcomes can be modified by those controlling necessary resources. D. They share in making final decisions Of resource allocation. E. They have delegated power to make decisions. F. They have control over the decisions. Which statement best describes the way in which consumers are now actually participating in the agency? A. B. C. D. E. F. DO yo: think this is the type of participation they should have? No Yes (go to question 33) which staterent best describes the way in which consumers sholld be participating in the agency? A. B. C. D. E. F. The following are potentially critical problems in the health field. Please check the ones which you feel are actually problems in the tri-county area. A. Notenoughadequatecareforthepoor. B. Not enough citizen participation in planning ad delivery Of services. C. Not enough hospital beds. D. Too much government intervention. E. Not enough adequate care for the elderly. F. Too many hospital beds. G. Not enolgh para-professional manpower. 91 33. (continued) H. Rising medical costs. I. Inadequate training of medical personnel. J. Not enough power in Cotprehensive Health Planning. K. Not enough government intervention. L. Too many physicians . M. Lack of COOperation in medical services. N. Not enolgh planning for medical facilities ad services. 0. Not enough adequate transportation to medical facilities. P. Not enough physicians. Q. TOO much planning for medical facilities ard services. R. Enviornmental pollution. __ S. Duplication of medical services. 34. Would you like any other problems you think are critical in the tri-county area? The following is a list of tasks which could be performed in a health planning agency. Please irdicate which grow performs each task the most. Sore tasks can be shared by two or more grons, but please select that grow which does it more than the others. 35. They help in planning medical facilities. Staff Consmers Providers No one Don' t 36. They fulfill legal requirements for Operation. Staff Consumers Providers No one Don't 37. They search olt ways to serve the needy. Staff Consumers Providers No one Don' t 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 92 They coordinate medical services. Staff Consumers Providers No one Don't They give information about resources available. Staff Consumers Providers NO one Don't They give a balance of Opinion. Staff Consumers Providers NO one Don't They represent.commmmdty problems and opinions. Staff Consumers Providers No one Don't They deal.with other organizations in the community. Staff Consumers Providers No one Don't They gather and report information. Staff Consumers Providers No one Don't They evaluate the feasibility of programs. Staff COnsumers Providers ‘No one Don't They help people to be aware of health needs. Staff Consumers Providers No one Don't They inform.the community about health problems and services. Staff Consumers Providers No one Don't Know They provide the time and effort necessary fOr compiling reports and distributing notices. Staff Consumers Providers No one Don't They provide expert Opinion. Staff COnsumers Providers NO one Don't 93 49. They see to it that planning proceeds smoothly. Staff Consumers Providers No one Don' t Know The following questions relate to yon own backgromd. Please answer by checking the category most appropriate . 50. What is your occwation? 51. What is yon age? 52. Of these educational categories, which one best describes yon educational background? A. Gramar School B. High School C. Bachelor's Degree D. Para-professional Degree E. Master's Degree __ F. Ph.D. Degree G. Professional Degree 53. A. lbw much formal educational training have yo: had in any health related field? A great deal Quite a bit B. Have you participated in the Urban league's Consumer Health Training Program? Yes No 54. Are you, orhave yoleverbeenmarried? Yes No (go to question 56) 55. 56. 57. 58. 59. 9a How many children do you have? Of these categories of annual family incote, please irdicate which category yon family falls into? __ Urder $7,000 __ $7,000 to $12,000 __ $12,000 to $20,000 __ $20,000 to $30,000 __ Over $30,000 Howmanyyearshaveyollivedinthe tri-comty area? How many times have you or a merber of yon immediate family visited a physician in the last year? ___MorethanlOtimes ___6tolOtimes ___3toStimes ltoZtimes None Howmanytimeshaveyouoramemberofyonimmediatefamilybeen hospitalized in the last 5 years? __MorethanlOtimes ___6tolOtimes _3toStimes ___ltoZtimes None 95 SEXITION III: l. The following staterents are ways in which a person could describe other people on a committee. For each person that you know on this list Of committee members, please indicate, using the following choices, how much you agree that each staterent describes that person: 5. Strongly agree 4. Moderately agree 3. Neutral 2. Moderately disagree 1. Strongly disagree A. He makes a valuable contribution to the tasks of the cormittee. B. When you are urdecided on an issue, he can usually persuade you to accept his viewpoint. C. Yol enjoy working with him on the committee. D. Ingeneral, he is the satekindofpersonyolare. E. In general, he is interested in the sate things yol are. F. You benefit from his associatio': with the committee. Quite often people do not formally represent any orgalization but they still reflect the Opinions ad needs of a greater number of peOple than just themselves. Do yol think that any of the peOple you lcnow on this list reflect the needs ad Opinions of any larger grow of peOple? The following staterents are ways in which a person could describe his relation to his committee. Using the categories above, please irdicate how much you agree that each statment applies to yon. A. Yol enjoy atteding meetings of the committee. B. The committee makes a valuable contribution to planning in the field of health services. C. 96 In general, you try to do what the committee expects a member to do. The committee is dealing with the same things you are interested in. You benefit from working with the committee. You usually go along with the committee's decision on issues. HICHIGQN STQT 312931 E UNIV. LIBRARIES WWIWIWIIIWIKI’1HH 01647364