The aim of this study is to examine the predictors of effective performance measurement in the context of Turkish municipalities. In the study, mainly the theoretical guidance of context-design-performance model has been utilized to examine the contextual and design factors which have influenced the effective use of performance measurement systems in Turkish municipalities. The following research questions were examined in this study: To what extent do Turkish municipalities implement performance measurement systems effectively?, What are the predictors of effective performance measurement in Turkish municipalities?, and whether or to what extent do quality of performance measures, technical capacity of the municipality for performance measurement, organizational support, and external support for the use of performance measurement have influence on the effectiveness level of performance measurement systems in Turkish municipalities? In the study, the data were collected from Turkish municipalities by a self-administered online survey and were analyzed by using the structural equation modeling (SEM). It is hypothesized in the study that external support and organizational support for the use performance measurement, and technical capacity for the performance measurement are associated with quality of performance measures and effectiveness of performance measurement systems in general. The results of the study supported the hypotheses of the study regarding the relationships among organizational support, technical capacity, quality of performance measures, and effectiveness of performance measurement. Although the results confirmed that external support has an indirect effect on effectiveness of performance measurement via technical capacity and quality of performance measures, the hypothesis regarding the direct effect of it on effectiveness of performance measurement was not supported. Moreover, the study found that support of employees and citizens for the use of performance measurement in Turkish municipalities are relatively low, the municipalities have deficiencies both in the quantity and the quality of staff that are responsible for performance measurement activities, and the level of employee involvement in the development of performance measures is low.

A majority of diabetes self-management programs have been shown to improve knowledge, attitude, practice, and health care outcomes. However, in the literature the underlying causal mechanisms for the improvement attributable to health education have not been explored, especially, how diabetes educational intervention may affect diabetes care outcomes. The purpose of the present study was to identify the causal mechanisms responsible for improved knowledge, attitude, practice and outcomes, so that educational interventions can be tailored efficiently and effectively to patients who are most likely to benefit from self-care management. The study used the knowledge, attitude, practice and outcome (KAP-O) framework. The specific purpose of the study was to examine the causes of variation in the outcomes of glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDLC), functional capacity (FC), and poor perceived health (PPH). An experimental study with a randomized control trial design involving 141 participants was conducted. The experimental group (N = 87) and control group (N = 52) were comparable in terms of demographics and major diagnoses. The experimental group received diabetes education. The control and experimental groups received usual customary care. Knowledge, attitude, practice, functional capacity and poor perceived health were measured before and after intervention using reliable and valid instruments. The study used a tailored attitudinal instrument. Glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDLC) were measured before and after intervention. Multiple analytic strategies were applied to examine the experimental data. The four outcome variables of (A1C), (LDLC), (FC), and (PPH) did not constitute one common factor measurement model for outcome evaluation. Results of the Independent sample t-test showed that health educational intervention directly improves knowledge about diabetes. The path analysis of panel regression showed that health educational intervention directly lowers glycated hemoglobin (A1C). The causal modeling of {(Exp_Status)-(K-T2)-(A-T2)-(P-T2)} model showed that health educational intervention also indirectly improves preventive practice via knowledge. The effect of attitude (A-T2) was greater than the effect of knowledge on preventive practice of self-care. The difference-in-differences analysis showed that difference in practice (DP) statistically significantly affects the difference in glycated hemoglobin (DA1C). The greater the preventive practice, the greater the lowering of glycated hemoglobin (A1C), indicating a better control of diabetes. The data from this experiment do not support a strong causal path of experimental effects on outcomes via knowledge, attitude, and practice of self-care. The study should be replicated using the KAP-O model in research based on multi-centers, multiple providers, and a diverse population of Type 2 diabetes patients. The study should assess outcomes more than four times over a period of one to two years to elicit the trajectory of change in outcome variables. Knowledge and attitude should be assessed at baseline and continuously improved for the duration of the study.

Using multiple regression analysis, this study analyzes the impact of state-level adolescent reproductive health statutes on rates of teenage pregnancy, birth and abortion rates. This study also analyzes the impact that adolescent reproductive health policy outputs have had on teenage pregnancy outcomes between 1992 and 2008, and the disparate impact of policies on minority teens. While some preventive adolescent reproductive health policies are found to impact teen pregnancy outcomes, most research findings pertain to the impact of abortion policy. Restrictions on minors' access to confidential prenatal care are associated with reduced rates of teen abortion while restricting access to contraceptive services is associated with increases in teen abortion. Surprisingly, states with more family planning program spending are found to have been less effective in reducing rates of teen pregnancy and births between 1992 and 2008. Abortion restrictions are found to decrease rates of teen abortion and increase rates of teen birth. Mandated parental involvement in minors' abortions is found to increase rates of teen birth and contributed to a slower rate of decline in teen abortion between 1992 and 2008. This study indicates disparate impact of both preventive adolescent reproductive health policies and restrictive abortion policies. Restrictive abortion statutes were found to have an exceptionally strong positive effect on rates of Black teen birth, with a moderate impact on Hispanic teen birth and no impact on White teen birth.

Conflict between managers and employees is inevitable in any organization, whether public or private. Often, the source of the conflict is employee non-compliance. Managers are responsible for disciplining those employees whose performance or conduct is sub-standard or inappropriate. Therefore, the ability to effectively address employee non-compliance is an essential skill for all managers. Most employee discipline systems fall into one of three categories: traditional, progressive, and affirmative. Traditional systems were prevalent in the late-nineteenth and early twentieth centuries. An autocratic, demanding manager would mete out punishment to non-compliant employees both as an action against the employee and as a warning to other employees. Employees were often terminated for their first offense. With the advent of labor unionism and fair labor practices in the first half of the twentieth century, organizational leaders were required to develop more progressive employee discipline systems which protected employee "due process" and which allowed time and opportunity for improvement by the non-compliant employee. Progressive employee discipline systems are the most prevalent discipline systems in America's workforce today. These systems entail three or four steps, with each successive step usually resulting in more severe penalties for the same offense or more severe offenses. Progressive employee discipline allows the employee an opportunity to respond to non-compliance issues and to try to improve it to the extent required to maintain their position. A new employee discipline system, affirmative discipline, has gained adherents in the private sector primarily. Affirmative employee discipline systems do not use punishment to correct employee non-compliance but instead, ask managers to "coach" and "counsel" the non-compliant employee to better behavior and performance. Rehabilitating the employee's non-compliance is the primary goal of affirmative systems. The emphasis is not only upon the non-compliant employee, but on rehabilitating the "marriage" of non-compliant employee and direct supervisor. Little evidence exists to determine the extent to which progressive and affirmative employee discipline systems are being utilized in the modern organization. No evidence exists that indicates the prevalence of these systems in Florida's healthcare institutions. A survey-based analysis of the use of progressive and affirmative employee discipline systems in Florida's hospitals resulted in respondents indicating frequent utilization of formal progressive employee discipline systems. Designed in three or four steps, these progressive systems allow the employee to improve his/her behavior. Two common tools in progressive systems, the verbal warning and the performance counseling statement, are utilized frequently based upon those respondents surveyed. The use of affirmative employee discipline systems, on the other hand, is relatively rare. The use of written behavior contracts to elicit improved employee compliance is also quite rare. The vast majority of respondents appear to be unfamiliar with the use of written behavior contracts to elicit improved employee compliance.

The purpose of this research was to evaluate the causal relationships between job strain, the practice environment and the use of coping skills in order to assist in the prediction of nurses who are at risk for voluntary turnover. It was conducted at the level of the individual nurse employee in order to better understand the health consequences associated with job strain, the factors in the professional practice environment which may contribute to the propensity to leave and the influence of coping behaviors in response to workplace stressors. It was undertaken with the intention of identifying intervention strategies which will promote a healthy workforce and the retention of nurses in the workplace. An exploratory cross-sectional survey of 1235 staff nurses employed on the intensive, progressive and general medical-surgical nursing units of seven hospitals associated with a major Central Florida healthcare network tested a client-centered model in an effort to identify nurses vulnerable to the health consequences of job strain using structural equation modeling. Human subject protection was assured. An 82 item questionnaire was used to collect demographic data and measure responses to items associated with the constructs of health status, autonomy, collaboration, decentralization, coping, satisfaction, absenteeism and intent to leave. A variety instruments that were previously demonstrated as valid and reliable were used in the construction of the instrument. Subjects were also given the option of including additional written comments. A total of 325 surveys were returned, of which 308 met inclusion criteria, for a response rate of 25%. Data analysis determined that the measurement of job strain as a function of self-assessed generic health status was predictive of propensity to leave (ã = -.21). The experience of job strain shared a strong association with indicators of mental health status. Job strain was significantly influenced by coping behavior (ã = .56) which targeted activities associated with sustaining and balancing. Anecdotal remarks suggested that the need for balance influenced perceptions regarding stressors in the workplace. The professional practice environment was associated negatively with the propensity to leave (ã = -.58). Those staff nurses who experienced higher levels of autonomy expressed a greater degree of satisfaction and lower intent to leave. The variables of collaboration and decentralization contributed minimally to the construct of professional practice. Anecdotal remarks suggested that the low contribution of collaboration and decentralization contributed to a sense of powerlessness and frustration with work related circumstances. The influence of job strain, coping and the professional practice environment upon staff nurses suggests that health promotion strategies, efforts to enhance coping behavior and promotion of a professional practice environment will increase employee satisfaction and reduce intent to leave. Adoption of policies and procedures which support the health and well-being of individual staff members will benefit employees, strengthen the organizations in which they practice and promote the overall retention of nurses in the face of looming nurse shortages.

Nonprofit organizations rely heavily on their governing board of directors to provide leadership, strategic guidance, and financial oversight. The nonprofit community continues to grow, and the services provided by these organizations have become a critical part of our society, providing a wide variety of services targeting a diverse population. In this context, how the role of the board of directors impacts the financial position of the nonprofit organization is of great interest to both the academic community and the practitioner. This study examined three areas of interest: board effectiveness, funding source, and financial vulnerability. First, the association between board effectiveness and financial vulnerability was tested. Second, specific board behaviors associated with strategic planning and stakeholder management were tested to determine if they were greater predictors of financial vulnerability. Finally, the role of funding source (specifically privately funded organizations) as a moderating variable for board effectiveness and financial vulnerability was explored. The sample was composed of 112 participants, consisting of board member/executive director survey responses and financial information for the participating organizations. The sample was drawn from six counties in the Central Florida area. Data were collected from a series of mailings, and surveys were distributed at nonprofit lecture series. The Financial Vulnerability Index (FVI) was used as a measure of the financial condition of the nonprofit organization and represented the dependent variable in this study. The Board Self-Assessment Questionnaire (BSAQ) was used to assess board effectiveness and represented the independent variable in this study. Primary funding source was identified as a moderating variable, while board size, age of the organization, CEO tenure, service area, United Way affiliation, national affiliation were included as control variables. Board effectiveness as measured by the BSAQ was a significant predictor of financial vulnerability as measured by the FVI. The strategic and stakeholder behaviors associated with board effectiveness were not found to be significant predictors of financial vulnerability, beyond other behaviors associated with board effectiveness. Funding source was shown to moderate the observed relationship between board effectiveness and financial vulnerability, as the association between effectiveness and financial condition was significant in privately funded nonprofit organizations (no such significance was identified in government funded or commercially funded organizations).

Prosecutors have enormous discretion in the criminal justice system. Their decisions can ultimately impact and shape the course of the lives of the offenders whom they prosecute. This is certainly true for juvenile offenders considered for transfer to the adult court. Previous research indicates that serious, violent offenders are the most likely to be transferred to the adult court. However, very little is known on prosecutors' views of the role of the juvenile court, the process of transfer or the facts that influence their decision to transfer a juvenile to the adult court. A statewide survey of 800 Florida prosecutors was implemented using factorial vignettes. The results indicate that prosecutors support the idea of transfer generally, particularly when they are making the final determination to transfer to the adult court. Further, prosecutors indicate that juvenile transfer should be used sparingly, in extreme cases that are not appropriate to the resources of the juvenile court. The data were also examined to determine the effect of juvenile offender and juvenile offense characteristics on the decision to transfer a juvenile to the adult court. Analysis revealed several significant predictors of preference for transfer: age, threat to society, presence of a violent offense, ethnicity of juvenile, presence of prior adjudications, and amenability to treatment.

The goal of this exploratory study is to examine the effects of public service motivation (PSM) in predicting decision-making of criminal justice personnel (reentry managers) in the management of former prisoners. The overarching research question seeks to answer if, and in what way, PSM score influences reentry managers' approach to their work with the formerly incarcerated, who are in transition from prison back into the community. The main assumption of this study is that those reentry managers with a higher PSM score will be more inclined to take an assistance oriented approach with former prisoners and be more likely to make rehabilitative decisions than those with lower PSM scores, who will be more inclined to assume a punitive role. This study utilized binomial logistic regression and chi-square analysis to test hypotheses. Survey data was collected over a period of three months in the summer and fall of 2014, and was based upon a national sample of 108 reentry managers whose agencies had received funding from a federal reentry grant. Follow-up interviews were also conducted with nine participants to provide deeper understanding of responses and explain some of the quantitative findings. Overall findings supported the key assumption with the overall sample possessing medium to high PSM scores and a greater frequency of making rehabilitative decisions.

Poor pregnancy outcomes such as prematurity, low birth weight and infant mortality are societal indicators of a nation’s health status. These indicators have remained at exceptionally high rates in the United States despite the levels of resources and technology. In the quest to understand that discrepancy, among the ranges of theories and models for explaining poor pregnancy outcomes an emerging concept is coming to attention: social capital. In order to test whether maternal social capital has an impact on pregnancy outcome, women in a Healthy Start program were surveyed over a 13-month period to assess their social capital levels and then their pregnancy outcomes. What emerged was that maternal social capital can predict up to 47% of the variance in pregnancy outcome. That is a powerful research result considering that previously there has been no literature tracing a link between maternal social capital and pregnancy outcome. In this study, maternal risk factors adversely affect up to 30% of the variance in pregnancy outcomes. Previous research has focused on maternal risk factors as the primary reason for high rates of preterm delivery, low birth weight, and infant mortality in the United States. However, this research found that in the sample of women at risk for adverse pregnancy outcomes, maternal risk factors had a very strong influence on maternal social capital (R-square=65%) while their effects on pregnancy outcomes were about half of their effects on social capital. This result suggests that social capital mediates the effects of maternal risk factors on pregnancy outcomes. It appears that one of the reasons that the high rates of adverse pregnancy outcomes in the United States have remained a mystery is that maternal social capital has not been taken into account.

In 1998, Florida voters approved Article V, Revision 7, which changed the funding mechanism of the state circuit court system from a county/state mix to state responsibility. The change was implemented as planned in the 2004/05 fiscal year. Although increased efficiency was a key goal of Revision 7, to date no published studies exist on the impacts of Revision 7 on circuit or system efficiency and/or productivity. This work analyzes Revision 7, integrating the larger debate of increasing judgeships or improving efficiency. The study is a full performance analysis of the Florida circuit courts from 1993 through 2008 that can benchmark the system‟s future efficiency and productivity. In that respect, top performers are identified. The study follows the evolution of court studies from their rational origins to the more recent orientation of open-natural systems. Resource dependency and institutional theory, two open-natural system frameworks, are utilized to predict that Florida‟s circuit courts have become more efficient over the period since the implementation of Revision 7. The efficiency outcomes are expected to be unequal across circuit sizes. Integrating a Florida debate to a larger one that transcends time and culture, productivity changes are expected to be a function of the number of judges that a circuit adds within a given year, controlling for other factors. The results of the study methodologies—data envelopment analysis, Malmquist Productivity Index, hierarchal regression analysis and analysis of covariance—reveal that only 3 of 300 DMU‟s in Florida are technically efficient; the mean IOTA score is .76. The Florida circuits did not improve efficiency and productivity as expected, in fact becoming significantly less efficient over time as a function of Revision 7. Small and medium-sized circuits lost iii efficiency, large circuits showed no change and there was a significant interaction between circuit size and Revision 7 period. Within the system overall, productivity fell by 2.7%, most noticeably in the small and medium-sized circuits. The number of judges a circuit added explained 32.2% of the variance in total factor productivity change. The largest system productivity losses followed both Revision 7 intervention years and the addition of the most judges in a single year. Analysis of covariance revealed that productivity increased only when no judges were added to a circuit, regardless of circuit size or time period (+2.6%). The addition of a single judge reduced average productivity by 8.6%; adding two judges reduced productivity by 10.5% and adding 3 or more judges reduced productivity by 16.2%. As judges were added, productivity declined in circuits of all sizes, but the drop was more pronounced in the small and medium-sized circuits. None of the circuits showed an increase in productivity from 1993 to 2008. Revision 7 has not increased circuit court efficiency or productivity in Florida. It is recommended that efficiency and productivity analyses be included in resource allocation decisions such as adding judgeships. More data on court structures and process are needed. Efficiency and productivity measures show that the current level of circuit court judgeships is sufficient.