Abstract. The United States population is rapidly aging, and retaining direct care workers (DCWs) will continue to be a workforce concern for the industry in addressing the demand for long term care services. To date, scant literature exists that addresses the DCW perspective of leadership behaviors and their influence on organizational commitment. To respond to this deficiency, this research studied leadership behaviors of direct importance for DCWs at the immediate supervisor level, and provided empirical insight into organizational commitment among workers closest to patient care. Research on leader behaviors has focused on managerial and executive levels, with scant consideration in long term care at the lower hierarchical levels. Transformational leadership was hypothesized to have a significant positive relationship with organizational commitment, specifically affective and normative commitments, and a significant inverse relationship with continuance commitment. The quantitative correlational study explored the relationship between transformational leadership and organizational commitment among 322 direct care workers employed by nonprofit, multi-level long term care organizations located in the Midwest. Results revealed a statistically significant relationship between overall transformational leadership and organizational commitment as well as affective and normative commitment dimensions, with no significant relationship found between transformational leadership and continuance commitment. The study results are beneficial to industry leaders, researchers, and policymakers for addressing operational policies, leadership training, human resource practices, and workforce policy development. Operational policies should reflect the values of the organization and follow from a compelling, collective vision and mission. Human resources practices warrant review if not aligned with the vision, mission, and values. Leadership development training should be considered for continuing education for supervisors at all levels as well as for potential policy alternatives.

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Ghana is a developing sub-Saharan country in West Africa and it struggles with delivering health care within the universal health system. The primary barrier to medical care is the lack of access. The government of Ghana subsidizes universal health insurance for all of its citizens, but lacks technology, workforce, and more importantly access to sanitation and clean running water. Access to health care remains a challenge in Ghana, especially in rural areas. In this research, we studied opinion leadership for health care in Ghana using two surveys conducted in May, 2014. Student investigators administered a survey to explore who was identified as the health care opinion leaders by local community members. The respondents were asked to rank seven categories of health care providers by how often they spoke to the health care provider about their health, from most often to least often , including medical doctors, chemical sellers, herbalists, prayer camps, family members, midwives and shrines or voodoo priests. The study surveyed 157 respondents from local community members, including 51 people in cities, 65 people in rural villages and 41 people in Kpanla, a remote isolated island on Lake Volta. Student investigators also gave a self-designating survey to 61 health care providers to measure their health care opinion leadership. The results of these two surveys were consistent. Local community residents preferred to talk to medical doctors about their health care when medical doctors were accessible. Health care providers’ responses to the self-designating opinion leadership survey supported their strong opinion leadership for health care.

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