Matthew E. Archibald

An Organizational Ecology of National Self-Help / Mutual-Aid Organizations

Although a considerable amount of research on modern self-help/mutual aid has been undertaken during the past several decades, studies have yet to address the question What are the organizational dynamics underlying the institutionalization of self-help/mutual aid? As a partial answer to this question, the author describes the central patterns of growth, decline, and persistence of national self-help/mutual-aid organizations, their formal diversification, and the extent to which subpopulations gain market share. In addition to using an organizational—ecological focus to map the trajectory of voluntary organizations, this article builds on resource partitioning theory by applying its central insights to subtypes of organizations. Expansion of self-help/mutual aid is remarkably similar to the trajectories of commercial and bureaucratic populations, but expectations that generalist concentration fosters growth of specialist organizations are not supported. Specialists dominate generalists except among medical self-help/ mutual aid. Implications for future research are discussed.

An Extended Model of Reasoned Action to Understand the Influence of Individual- and Network-Level Factors on African Americans’ Participation in HIV Vaccine Research

In the United States, the number and proportion of HIV/AIDS cases among black/African Americans continue to highlight the need for new biomedical prevention interventions, including an HIV vaccine, microbicide, or new antiretroviral (ARV) prevention strategies such as pre-exposure prophylaxis (PrEP) to complement existing condom usage, harm reduction methods, and behavioral change strategies to stem the HIV epidemic. Although black/African Americans are disproportionately impacted by HIV/AIDS, their participation in HIV clinical research continues to have unique challenges. We theorize that interaction among multilevel factors creates ideal alignment for minority participation in HIV clinical studies. Thus, we initially set out to test an extended model of reasoned action with 362 participants to understand the interplay of sociopsychological and network-level considerations influencing minority participation in HIV prevention research efforts. In this study, we linked the intrapersonal dimensions of attitudes, beliefs, and normative concerns to community-level components, appraisal of involvement with the clinical research organization, an entity which operates within a networked structure of community partner agencies, and identification with coalition advocacy aims. Various participatory outcomes were explored including involvement in future HIV vaccine community functions, participation in community promotion of HIV vaccine research, and community mobilization. Three-stage least squares estimates indicated similar findings across three models. Significant effects demonstrate the importance of positive attitudes toward HIV vaccine research, favorable health research beliefs, perceived social support for participation, HIV/AIDS issue engagement, and perceived relevance of the clinical research site’s mission and values. Identification of these nuanced pathway effects provides implications for tailored community program development.

BETWEEN ISOMORPHISM AND MARKET PARTITIONING: HOW ORGANIZATIONAL COMPETENCIES AND RESOURCES FOSTER CULTURAL AND SOCIOPOLITICAL LEGITIMACY, AND PROMOTE ORGANIZATIONAL SURVIVAL

This paper analyzes a multidimensional model of organizational legitimacy, competencies, and resources in order to develop the linkage between institutional and resource-based perspectives by systematically detailing relationships among these factors and organizational viability. The underlying mechanisms of isomorphism and market partitioning serve as a point of departure by which the effects on organizational persistence of two sociocultural processes, cultural (constitutive) legitimation and sociopolitical (regulative) legitimation, are distinguished. Using data on 589 national self-help/mutual-aid organizations, this chapter explores how isomorphism and market partitioning foster legitimacy and promote organizational viability. Results show that the more differentiated an organization’s core competencies and resources, the greater the sociopolitical legitimacy; the more isomorphic an organization’s competencies and resources, the greater the cultural legitimacy. The latter isomorphic processes, however, do not promote greater organizational viability. In fact, while isomorphism legitimates with respect to cultural recognition, it is heterogeneity, not homogeneity, that promotes organizational survival.

The evolution of self-help

The Demography of Self-Help Defining Self-Help: How Does a Movement become an Institution? From Small Beginnings: Growth and Diversification Legitimation: The Paradox of Public Recognition of Self-Help The Evolution of Public Recognition and Its Consequences Resources: How Competition Selects Only the Fittest Organizations Conclusion and Future Directions

The Impact of Density Dependence, Sociopolitical Legitimation and Competitive Intensity on Self-Help/Mutual-Aid Formation

Density-dependent and density-independent legitimation and competition are used to explain the evolution of self-help/mutual-aid (1955—2000), a long-lived population of health movement organizations. While previous research suggests the importance of both kinds of measures, this paper shows that better specification of density-independent sociopolitical legitimation and competitive intensity improves understanding of organizational and institutional factors affecting organizational formation. Sociopolitical legitimation, for instance, has a beneficial impact on self-help/mutual-aid formation, but later depresses founding rates because identity enclosure hinders new entries. Implications for further studies of identity, legitimation and competition are discussed.

Delivering a "dose of hope": a faith-based program to increase older african americans' participation in clinical trials.

Background Underrepresentation of older-age racial and ethnic minorities in clinical research is a significant barrier to health in the United States, as it impedes medical research advancement of effective preventive and therapeutic strategies. Objective The objective of the study was to develop and test the feasibility of a community-developed faith-based intervention and evaluate its potential to increase the number of older African Americans in clinical research. Methods Using a cluster-randomized design, we worked with six matched churches to enroll at least 210 persons. We provided those in the intervention group churches with three educational sessions on the role of clinical trials in addressing health disparity topics, and those in the comparison group completed surveys at the same timepoints. All persons enrolled in the study received ongoing information via newsletters and direct outreach on an array of clinical studies seeking participants. We evaluated the short-, mid-, and longer-term effects of the interventional program on clinical trial-related outcomes (ie, screening and enrollment). Results From 2012 to 2013, we enrolled a balanced cohort of 221 persons in the program. At a 3-month follow-up, mean intention to seek information about clinical trials was higher than baseline in both treatment (mu=7.5/10; sigma=3.1) and control arms (mu=6.6/10; sigma=3.3), with the difference more pronounced in the treatment arm. The program demonstrated strong retention at 3-month (95.4%, 211/221) and 6-month timepoints (94.1%, 208/221). Conclusions The “Dose of Hope” program addressed an unmet need to reach an often overlooked audience of older African Americans who are members of churches and stimulate their interest in clinical trial participation. The program demonstrated its appeal in the delivery of effective messages and information about health disparities, and the role of clinical research in addressing these challenges.

An Integrated Service Delivery Model to Identify Persons Living with HIV and to Provide Linkage to HIV Treatment and Care in Prioritized Neighborhoods: A Geotargeted, Program Outcome Study.

Background Recent studies have demonstrated that high human immunodeficiency virus (HIV) prevalence (2.1%) rates exist in “high-risk areas” of US cities that are comparable to rates in developing nations. Community-based interventions (CBIs) have demonstrated potential for improving HIV testing in these areas, thereby facilitating early entry and engagement in the HIV continuum of care. By encouraging neighborhood-based community participation through an organized community coalition, Project LINK sought to demonstrate the potential of the CBI concept to improve widespread HIV testing and referral in an area characterized by high poverty and HIV prevalence with few existing HIV-related services. Objective This study examines the influence of Project LINK to improve linkage-to-care and HIV engagement among residents of its target neighborhoods. Methods Using a venue-based sampling strategy, survey participants were selected from among all adult participants aged 18 years or more at Project LINK community events (n=547). We explored multilevel factors influencing continuum-of-care outcomes (linkage to HIV testing and CBI network referral) through combined geospatial-survey analyses utilizing hierarchical linear model methodologies and random-intercept models that adjusted for baseline effect differences among zip codes. The study specifically examined participant CBI utilization and engagement in relation to individual and psychosocial factors, as well as neighborhood characteristics including the availability of HIV testing services, and the extent of local prevention, education, and clinical support services. Results Study participants indicated strong mean intention to test for HIV using CBI agencies (mean 8.66 on 10-point scale [SD 2.51]) and to facilitate referrals to the program (mean 8.81 on 10-point scale [SD 1.86]). Individual-level effects were consistent across simple multiple regression and random-effects models, as well as multilevel models. Participants with lower income expressed greater intentions to obtain HIV tests through LINK (P<.01 across models). HIV testing and CBI referral intention were associated with neighborhood-level factors, including reduced availability of support services (testing P<.001), greater proportion of black/African Americans (testing and referral P<.001), and reduced socioeconomic capital (testing P=.017 and referral P<.001). Across models, participants expressing positive attitudes toward the CBI exhibited greater likelihood of engaging in routine HIV testing (P<.01) and referring others to HIV care (P<.01). Transgender individuals indicated greater intent to refer others to the CBI (P<.05). These outcomes were broadly influenced by distal community-level factors including availability of neighborhood HIV support organizations, population composition socioeconomic status, and high HIV prevalence. Conclusions Project LINK demonstrated its potential as a geotargeted CBI by evidencing greater individual intention to engage in HIV testing, care, and personal referrals to its coalition partner organizations. This study highlights important socioecological effects of US-based CBIs to improve HIV testing and initiate acceptable mechanisms for prompt referral to care among a vulnerable population.

Exploring the Reciprocal Effects of Substance Abuse Treatment Provision and Area Substance Abuse

This study examines the relationship between substance abuse treatment provision and substance abuse. Several questions serve as the basis for testing substance abuse reduction, treatment need-demand, and diffusion hypotheses: Does treatment provision reduce area rates of substance abuse; do area rates of substance abuse (i.e., treatment need-demand) foster increases in treatment provision; and, does spatial and temporal diffusion drive changes in both substance abuse and treatment provision? Analyses of spatial and panel data from 159 counties in Georgia revealed that provision of treatment services did not reduce area rates of substance abuse, in fact, greater density of service providers was related to increases in prevalence. Moreover, demand did not foster changes in service provision; only greater service provision at an earlier period. While temporal diffusion of substance abuse and treatment provision took place, there was little evidence of spatial clustering. Strategies to uncover mechanisms underlying these relationships and their implications for treatment policy are discussed.

Professional and political alliances, legitimating authority and the longevity of health movement organizations

This paper examines whether affiliation strategies used by social movement organizations to establish institutional linkages assure survival. Several streams within both social movement and organization theories suggest contrasting expectations. Two core research questions are proposed: how does strategic affiliation, as well as increasing legitimation, alter social movement organizations’ longevity, and how does the evolution of the movement condition these dynamics? Our answer focuses on the self-help/mutual-aid movement and the institutionalization of national self-help/mutual-aid organizations. Analyses comparing economic, political and symbolic means of survival at the population-of-organizations level and organizational level, and across the history of the movement, show that professional and political alliances and legitimation impact the longevity of self-help/mutual-aid organizations in unexpected ways. For instance, as the number of political alliances at the population level increases, the likelihood of organizational survival declines, although political alliances at the individual organizational level are beneficial for an organization. These relationships change dramatically as the movement matures. Implications for integrating social movement and organizations theories are discussed.

Socioeconomic and racial/ethnic disparities in substance abuse treatment provision, treatment needs and utilization

Despite continuing socioeconomic and racial/ethnic gaps in many health care services, the National Healthcare Disparities Report (2004) documents parity in substance abuse treatment provision among individuals of varying socioeconomic and racial/ethnic backgrounds. This study investigates that achievement by analyzing the relationship between community socioeconomic and racial/ethnic disadvantage and organizational provision of substance abuse treatment, treatment need and utilization across United States counties, 2000, 2002 and 2003. Results confirm equity in service provision in poorer communities and those with higher concentrations of African Americans. Significant disparities remain, however, in communities with higher concentrations of Hispanics, youth and female-headed households. Limitations and implications for future studies of health care provision are discussed.