ADMINISTRATOR AND PROVIDER PERCEPTIONS OF PROBLEM TRACTABILITY AND PROGRAM DELIVERY IN PRENATAL CARE SERVICES IN MISSOURI'S COMMUNITY HEALTH CENTERS.

Description

A non-experimental case study design was utilized to explore the perceptions and understandings of those working as administrators and providers in prenatal care programs in community health centers in Missouri concerning the tractability of the problem of infant mortality, and to assess how those perceptions and understandings influence the delivery of prenatal care in their respective programs. The data were obtained from interviews, administrative documentation, archival records, and direct observation with 20 persons working as administrators and providers in prenatal care programs in 10 of the 12 community health centers in Missouri. Key themes which emerged from the data are the major role that values/biases play in the development and implementation of programs; the differences seen in the methods of problem solving and decision making between those from urban and rural areas; an actual contradiction between policy mandate and perspective in the philosophy of community health centers; and, the current socio-political climate which favors incremental versus fundamental change. Mazmanian and Sabatier's (1981) framework provided a useful but limited guide to analyze the implementation process. Data collected through interviews and observation for this study offered many insights into the notion of problem tractability and its effect on policy outputs. Further investigation is needed about the potential implications that values/biases and differences in urban and rural organizational cultures can have on program implementation.

Subjects