The Effectiveness of Religion-Affiliated Nonprofit Organizations in Social Services

266 Pages·2017·2.44 MB·English

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Theses and Dissertations Graduate School
2011
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Bulent Ucar
Virginia Commonwealth University
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The Effectiveness of Religion-Affiliated Nonprofit Organizations
in Social Services: A Survey Study of Nursing Homes in Virginia

A dissertation submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy at Virginia Commonwealth University.

by

Bulent Ucar
B.A., Marmara University, Turkey, 1996
M.P.A., Fatih University, Turkey, 2000

Director: Dr. Blue E. Wooldridge
L. Douglas Wilder School of Government and Public Affairs

Virginia Commonwealth University
Richmond, Virginia
December, 2011
ii

ACKNOWLEDGEMENTS

I would like to thank to those who have helped me during a long, and sometimes
frustrating process. First of all, I thank my dissertation committee chair Dr. Blue Wooldridge,
committee members, Dr. Robyn L Diehl, Dr. J. James Cotter and Dr. Nancy B Stutts. They
have guided me with their comments and insights despite their own busy schedules. They all
put fortward a genuine afford to make this study better.
I owe many thanks to previous and current administrators of the PhD program. To
mention just a few names here, Dr. Michael D. Pratt who was formerly director of the
program, Betty M. Moran who was the program's previous secretary and was like a good
mom for all of us, and Richard F. Huff who is the current graduate programs coordinator. As
busy he is, he has always helped me and other students to work through the administrative
process of education smoothly and easily.
I would like to thank those nursing home administrators who helped me to better
understand nursing home settings and fill out survey questionnaires in Virginia. Many
nursing home administrators did not only respond to the survey, but they also forwarded it to
some other nursing home administrators who they knew that would fill out the questionnaire.
I am really grateful for all the help.
I owe genuine thanks to my family, particularly my wife and my brother who
supported me in many ways. I also would like to thank my friends Bilgin Erdogan and Ozkan
Erenler (big brother) who supported me when I stumbled financially. Their help, at a time
when no one wanted to help, will never be forgotten. They showed how important friends are
for a man. Also, thanks to many friends whose names are not mentioned here.
iii

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ............................................................................... ii
TABLE OF CONTENTS .................................................................................. iii
LIST OF TABLES ........................................................................................... viii
LIST OF FIGURES ........................................................................................... xi
ABSTRACT ...................................................................................................... xii
CHAPTER I ........................................................................................................ 1
INTRODUCTION .............................................................................................. 1
Problem Statement and Purpose of the Study ……………………………………………….. 3
Theoretical Perspective ………………………………………………………………............ 4
Theory Borrowing Concept ………………………………………………………………... 18
Importance of the Study ……………………………………………………………………. 21
Data and Methods ……………………………………………………............. 24
Selection and Collection of the Data Set …………………………………………………... 24
The Secondary Data ………………………………………………………………………... 26
Research Design ………………………………………………………………………… 28
Research Questions and Hypotheses ……………………………………………………….. 28
Definition of Terms ………………………………………………………………………… 30
Outline of the Study ………………………………………………………………………... 33
CHAPTER II ……………………………………………………………………………….. 35
THE CHARITABLE CHOICE INITIATIVE ……………………………………………... 35
iv

What Is the Charitable Choice Initiative? ………………………………………………….. 36
Implementation of the Charitable Choice Initiative and Criticism ………………………… 41
Is Charitable Choice Initiative Unconstitutional? …………………………………………. 47
CHAPTER III ………………………………………………………………………………. 56
LITERATURE REVIEW ………………………………………………………………….. 56
What Is Organizational Effectiveness? ……………………………………………………. 59
What Is a Faith Based Organization? ..................................................................................... 62
Scope and Scale of Faith Based Organizations ...................................................................... 67
Role of Religion in Self Regulation and Social Service Provision ........................................ 74
The Effectiveness of Faith Based Programs in Healthcare Related Services ……................ 95
CHAPTER IV …………………………………………………………………………….. 100
RESEARCH DESIGN AND METHODOLOGY ............................................................... 100
The Research Questions and Hypotheses ............................................................................ 101
Variables .............................................................................................................................. 102
DATA SETS ........................................................................................................................ 108
The Secondary Data ............................................................................................................. 108
Making Conditions Equal .................................................................................................... 114
The Survey ........................................................................................................................... 115
Conducting the Survey ......................................................................................................... 115
Protection of Human Research Subjects and Ethical Issues ................................................ 118
DATA MEASUREMENT ................................................................................................... 119
Data Coding and Analysis .................................................................................................... 121
Reliability and Validity Issues ............................................................................................. 125
CHAPTER V ........................................................................................................................ 129
DATA ANALYSES AND FINDINGS ............................................................................... 129
v

Sample Size and Ownership Characteristics ........................................................................ 130
Reliability Tests for the Level of Religiosity Variables ………………………………….. 136
Diognostic Tests for Determining the Internal
Consistency of Religiosity Categories ................................................................................. 137
Institutional Characteristics by the Ownership Type ……………………………………... 139
Reliability Tests for Dependent Variables ………………………………………………... 145
Reliability Test for Health Inspection Deficiency Variable ………………………………. 145
Health Inspection Deficiencies by Type of Ownership …………………………………... 147
Reliability Test for Long-Stay (Chronic Care) Variable ...................................................... 149
Testing Internal Consistency of Long-Stay (Chronic Care) and Short-Stay
(Post-Acute) Patient Quality Measures ................................................................................ 151
Exclusion Process of Sub-Variables for Internal Consistency of Long-Stay
(Chronic Care) Patient Quality Care Measure Variable ………………………………….. 151
Reliability Test for Short-Stay (Post-Acute) Patient Quality Care Measures …………….. 153
Descriptive Statistics for Two Patient Outcome Quality
Care Measure Variables ....................................................................................................... 155
BIVARIATE CORRELATIONS ......................................................................................... 159
Correlations Between Indepedent Variables ........................................................................ 159
MULTIVARIATE REGRESSION ANALYSES ................................................................ 164
Diognastic Tests for Three Regression Modals ................................................................... 164
Mean Independence ............................................................................................................. 164
Collinearity Assumption ………………………………………………………………….. 165
Homoscedasticity Assumption ……………………………………………………………. 167
Hypothesis Testing for Health Inspection Deficiencies …………………………………... 172
Hypothesis Testing for Long-Stay Patient Quality Care Measures …................................. 176
vi

Hypothesis Testing for Short-Stay Patient Quality Care Measures ………………………. 179
Comparing the Findings to the Similar Studies …………………………………………... 183
CHAPTER VI …………………………………………………………………………….. 185
SUMMARY, CONCLUSIONS, DISCUSSION
AND RECOMMENDATIONS ........................................................................................... 185
Summary and Discussion ..................................................................................................... 185
Research Questions and Hypotheses .................................................................................... 187
The Impact of Interacting Variables .................................................................................... 190
Approaches to the Analyses and Theory Testing ................................................................ 196
Policy Implications .............................................................................................................. 198
Limitations of the Study …………………………………………………………………... 203
Recommendations for Future Studies …………………………………………………….. 205
References ......................................................................................................................... 209
APPENDICES ..................................................................................................................... 239
APPENDICES A .................................................................................................................. 239
Survey questionnaire that was prepared for this study ………………………………….... 239
APPENDICES B .................................................................................................................. 242
Methodology for Constructing the Staring Ratings ……………………………………... 242
Health Inspection Domain ……………………………………………………………….. 242
Scoring Rules ……………………………………………………………………………. 242
APPENDICES C .................................................................................................................. 246
Calculation of Organizational Religiosity Scores Based on
Answers Given to the Related Survey Questions on Four Levels ....................................... 246
APPENDICES D .................................................................................................................. 247
APPENDICES E .................................................................................................................. 248
vii

APPENDICES F .................................................................................................................. 249
VITA .................................................................................................................................... 251
viii

LIST OF TABLES
Table 1: Dependent Variables, Their Definitions and Sources ............................................ 103
Table 2: Independent Variables, Their Definitions, Sources
and Level of Measurements …………………………………………………………......... 105
Table 3: Control Variables, Their Definitions, Sources and Level of Measurements …….. 103
Table 4: Independent Variables and Their Coding ……………………………………….. 123
Table 5: Control Variables and Their Coding …………………………………………….. 124
Table 6: Number and Percentage of Nursing Homes by Type of Ownership ……………. 131
Table 7: Responses Given to the Survey Questionnaire ...................................................... 134
Table 8: Case Processing Summary for Organizational Religiosity .................................... 137
Table 9: Reliability Statistics for Organizational Religiosity .............................................. 137
Table 10: Case Processing Summary for Staff Religiosity ………………………………. 138
Table 11: Reliability Statistics for Staff Religiosity ………………………………………. 138
Table 12: Case Processing Summary for Service Religiosity …………………………….. 138
Table 13: Reliability Statistics for Service Religiosity ………………………………….… 138
Table 14: Case Processing Summary for Overall Religiosity Score ……………….…….. 139
Table 15: Reliability Statistics …………………………………………………………….. 139
Table 16: Institutional Characteristics of Nursing Homes in
Virginia by the Ownership Type ………………………………………………………….. 143
Table 17: Health Inspection Deficiency Categories by Type of Ownership ……………... 146
Table 18: Case Processing Summary ……………………………………………………... 146
Table 19: Reliability Statistics …………………………………………………………….. 146