Process evaluation of the ‘Singapore Physical Activity and Nutrition Study’

IntroductionThe Singapore Physical Activity and Nutrition Study (SPANS) aimed to improve the physical activity (PA) and nutrition behaviours of Singaporean women aged 50 years and over. The SPANS program consisted of PA classes, nutrition workshops, telephone dietary counselling, health booklets, a health calendar and program ambassadors. This study aimed to assess and understand the implementation of the program strategies and gain insight into process evaluation components to inform future programs.MethodsThe evaluation was guided by a process evaluation framework and collected data via questionnaires (n = 209), program ambassador documentation and exit interviews with program completers (n = 13) and non-completers (n = 12).ResultsIn total, 295 participants completed the program (response rate = 84 %). Participants reported high levels of satisfaction with the overall program (99.5 %) and program activities (96.7 %), and also rated program ambassadors highly. Participation rates were highest for telephone dietary counselling sessions. The main reason for not attending program activities was having a ‘busy schedule’ (n = 158). Participants cited a need for improved recreational centre facilities and increased flexibility around program delivery.ConclusionsThe process evaluation showed that the program strategies were implemented as planned and were deemed suitable for supporting behaviour change among Singaporean women aged 50 years and over. The program reached and involved the majority of participants throughout the six months. The combination of practical educational resources and supportive program ambassadors were key strategies that facilitated positive PA and dietary behaviours. However, there needs to be some flexibility in the delivery of programs. The findings of this research may inform other programs in the region.     

Looking Inside the “Black Box”

Abstract

The continued devolution of social welfare systems and services in the U.S. resultsin high stakes program evaluations in the field of family support and early intervention. Programs are expected to utilize evidence-based interventions and to demonstrate effectiveness. A look at implementation helps to differentiate between theories that do not work and programs that are not effective. Methods for identifying program implementation are needed. In a 17-site program evaluation, the author and her colleagues developed a methodology for measuring implementation and demonstrated the effects of differential implementation in understanding program outcomes.     

Investigating feasibility and fidelity of the Parenting Young Children program in Sweden

Specific aimsThis study explored feasibility and fidelity of an education program for parents with intellectual disability. The Australian Parenting Young Children intervention was translated and adapted for support workers in the Swedish social services.MethodFidelity was examined using implementation diaries tracking frequency of implementation of program activities and teaching approaches ((over 14 months, completed by 27 support workers from 15 municipalities). Eighteen of these support workers and their managers (n = 12) completed questionnaires examining feasibility using Roger’s concepts of program compatibility and complexity.FindingsResults showed that implementation of Parenting Young Children was feasible, with overall positive attitudes to Evidence Based Practice, good program compatibility, low perceived program complexity, and high satisfaction with implementation support. The fidelity measures suggest problems in how the program is used by some support workers: parents received less than the recommended number of sessions and activities such as observation of parents and follow up, were infrequently used by support workers.DiscussionThe findings raise questions about how program support and education should be provided. Difficulties in defining fidelity within the flexibility of the Parenting Young Children program are also discussed.     

Implementing an Early Intervention Program for Residential Students Who Present With Suicide Risk: A Case Study

Abstract

Objective: This case study examined the effects of an early intervention program designed to respond to residential college students demonstrating risk for suicide. Participants: Participants were 108 undergraduates at a large northeastern public university referred to an early intervention program subsequent to presenting with risk factors for suicide between Fall 2004 and Spring 2011. Methods: Data were collected from archival records to examine quality of early intervention services, student retention, and grade point average (GPA) during the semesters prior to, during, and subsequent to the referral incident. Results: Program implementation was timely and responsive to student needs; students successfully completing the early intervention program remained in school and demonstrated small but significant rebounds in GPA the semester subsequent to the incident. Conclusions: There are benefits associated with the implementation of early intervention programs designed to respond to students manifesting risk for suicide, such as connecting the student to vital services and support networks.     

Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities.This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed.     

Differential perceptions of a hypothetical sexual assault survivor based on race and ethnicity: Exploring victim responsibility,trauma, and need for social support

Objective: Explore the ways in which a sample of college women interpret racially/ethnically coded vignettes to understand their perceptions of responsibility and trauma experienced by a hypothetical female sexual assault survivor and her need for social support. Participants: Convenience sample of college women (N?=?51) attending a large, predominately white university in the Southeastern United States recruited between January and March 2013. Methods: Participants were randomly assigned one of three vignettes describing a hypothetical date rape scenario. Vignette scenarios were identical except for discrete statements coded to signify either an African American, Latina, or white female student. Participants responded to open-ended questions that gauged their interpretations of responsibility, trauma, and social support. Results: Qualitative analysis of open-ended responses revealed six overarching themes, including overt victim blaming/shaming, justification of the sexual assault, and perceived need for social support. Conclusions: Findings point to the significance of including race in discussions about and programs that address sexual assault on college campuses to ensure that all women who experience sexual violence receive the support that they need.     

A review of literature: An examination of the correlation between attachment styles and adolescent girls’ sexual behaviors

ABSTRACT

This literature review examines eight studies of parental attachment styles, sexual behavior, and health outcomes among adolescent girls. The review focuses on studies that analyzed the perceived relationships between parents and their adolescent daughters and whether instabilities of life experiences correlated with risky sexual behaviors and if high-risk sexual behaviors were associated with an increase of sexually transmitted infections, unplanned pregnancies, and other poor health outcomes in adolescent girls. Findings show adolescent girls with insecure parental attachment styles were at a higher risk of sexual behaviors, early pregnancies, and transmission of sexually transmitted infections (STI’s). The most common finding in the studies reviewed was the significant association of how higher parental communication and monitoring may prevent risky sexual behaviors at an earlier age. Recommendations for mental and health care providers include the development of treatment programs to address the importance of parent-attachment relationships and multifaceted health needs of adolescents girls. Programs can be strengthened by involving other family members, improving parent-daughter communication and relationships and emphasizing system-level change (policy, procedure, practice). Adding these elements may ultimately lead to sustained improvements over time. Future research on other family social factors (e.g., divorce and separation of attachment figure, poverty, and single-parent homes) associated with attachment and high-risk behaviors is warranted. More research is needed to exam how secure attachments among adolescent girls may prevent earlier sexual encounters, unplanned pregnancies, and STI’s.     

Online Teaching in Social Work Education: Understanding the Challenges

There is a rapidly growing industry of online learning and distance education programs at the Master of Social Work and Bachelor of Social Work levels both within Australia and globally. A number of best practices have emerged from the literature that warrant consideration when delivering social work programs in online learning and distance education modes. Given the significant advancements in technology that are likely to continue into the next decades, social work academic leaders and accrediting bodies must be prepared to address the changing landscape of higher education, including limited financial resources. Social work academics need to become aware and implement best practices in online learning and distance education e-teaching environments to ensure positive student outcomes, student retention, and student engagement to meet the flexibility needs of students in higher education settings. The purpose of this paper is to identify and discuss the challenges and benefits of distance education and online learning for consideration when providing a social work program in these delivery models.

IMPLICATIONS

• Given the significant advancements in technology that are likely to continue into the next decades, social work academic leaders and accrediting bodies must be prepared to address the changing landscape of higher education.

• Social work academics need to become aware and implement best practices in the distance education and online teaching environment to ensure positive student outcomes, student retention, and student engagement to meet the flexibility needs of students in higher education settings.

     

Exploratory Evaluation of a School-Based Child Sexual Abuse Prevention Program

Internationally, efficacy studies of school-based child sexual abuse prevention programs display a series of methodological shortcomings. Few studies include adolescent participants, recording of disclosures has been inconsistent, and no studies to date have assessed presenter adherence to program protocols or summated the costs of program implementation. A pretest–posttest waitlist control design was used to evaluate the Tweenees program delivered to grade 6 (n?=?88) and grade 7/8 students (n?=?117) compared to a control (n?=?185). Outcome measures included a knowledge/skills questionnaire, systematic coding of disclosures, and video interaction analysis of lessons. Costs were calculated per student, class, and school. Adolescents made small knowledge and skills gains indicating a program ceiling effect. Implementation analysis suggests low levels of adult control facilitated disclosures. Program costs were relatively inexpensive. Recommendations are made for future research.     

What Pediatric Subspecialists Need to Know About Sexual and Reproductive Health: A Review of the American Board of Pediatrics Content Outlines for Subspecialty Certifying Examinations

ABSTRACT

Many adolescents with complex medical conditions regard their subspecialty providers as an important source of clinical information including sexual and reproductive health information related to their medical condition. Thus, training for pediatric subspecialty providers should include clinically relevant sexual and reproductive content. The purpose of this study is to understand what disease-relevant sexual and reproductive health information is currently included in content outlines for each of the available pediatric subspecialty certifying examinations. The American Board of Pediatrics (ABP) offers 17 subspecialty certifying examinations; 13 content outlines are available on the ABP website which defines the body of knowledge to be tested. Each available outline underwent content analysis for sexual and reproductive health information. A team of adolescent medicine physicians identified seven thematic areas including: 1) puberty; 2) sexual behavior and identity; 3) fertility; 4) contraception; 5) sexually transmitted infections; 6) other genital pathology; 7) pregnancy. Across disciplines, learning objectives related to sexual behavior, sexual identity, fertility, contraception and pregnancy were the most limited. However, content related to puberty, sexually transmitted infections and other genital pathology was better represented. Overall, disease-and treatment-specific sexual and reproductive health information was sparse. Most subspecialty content outlines contain very little disease-specific sexual and reproductive health information despite the growing adolescent and young adult population with complex medical conditions in the care of pediatric subspecialists. Further studies are needed to explore if lack of sexual and reproductive information on board exams relates to the knowledge base and skill set of pediatric subspecialists.     

Student Participation in Study Abroad Programs: Social Justice Implications for Tertiary Education

ABSTRACT

Short-term study abroad programs are increasingly embraced by Australian schools of social work. These programs improve access to international experiences and have a demonstrable impact on academic outcomes. However, little is known about the factors that influence students who decide to participate in such programs. Using a qualitative semistructured design, eight Australian social work students were interviewed about their perspectives on the pre-application phase of a short-term study abroad program to Ireland that was advertised in early 2018. The findings reveal a number of multilevel structural, institutional, and personal enablers and barriers that impacted their decision to participate. Implications for future research, the tertiary education sector, and social work educators are identified, especially in terms of broader economic and political issues that contradict social justice and render the future of these programs precarious.

IMPLICATIONS

• Short-term study abroad programs offer important learning opportunities for students, but there is a need to understand the dimensions that can impact the decisions of students to participate in these programs.

• The qualitative findings indicate that various factors impact on the participation of students, especially financial and caring responsibilities.

• Further research that is underpinned by a social justice lens is needed to address inequities in student participation.

     

Toward a Horizontal Participatory Implementation Approach for Community Health Programs Serving Vulnerable Populations

Participatory implementation in three community health programs is examined using a 17 point assessment tool organized within a participatory framework made up of three conceptual elements: stakeholder participation in the program, cultural and structural relationships, and partnership synergy. The study results suggest that horizontal cultural relationships between frontline program implementers and beneficiaries, could lead to beneficiary satisfaction and empowerment even when structural relationships are vertical and beneficiary participation is not as robust as in complete participatory programs. The study's findings also suggest that partnership synergy can affect the success of program implementation and the growth of community social capital.     

Providing context to the implementation of health promoting schools: A case study

PurposeIssues related to program context are important components of population health interventions and particularly among complex, adaptive initiatives in schools. Health Promoting Schools (HPS) is a global approach to support early development of healthy behaviors among children and youth. The purpose of this study was to explicate the practical and contextual processes that influenced implementation of HPS in schools in Nova Scotia (Canada).MethodsUsing a case-study approach, data was collected using interviews (n = 14) with principals, teachers and parents, observations collected during school visits and document review in five diverse schools.ResultsCase study schools reported a variety of HPS practices and three key themes emerged that provided context to the processes that facilitated their implementation. The results suggest that although school characteristics (theme 1), like staff allocation, physical location and resources, are important, these barriers can be mitigated by building organizational capacity (theme 2) and establishing a supportive school community culture (theme 3).ConclusionsThe study provided insight to the variability in implementation by describing how contextual barriers were experienced and mitigated by schools. Establishing a broad system to support HPS, with collaboration across health and education sectors, could help to progress adoption, implementation and sustainability of HPS.     

Cultivating Compassion for Self and Others: A School-Based Pilot Study for Peer-Nominated Caring Adolescents

Many have called for school-based student programs that teach skills related to self-care and caring for others. Here, such a program for peer-nominated adolescents was developed and piloted virtually at one high school during the COVID-19 pandemic. Results of a longitudinal, quasi-experimental evaluation of the program showed high-quality program implementation and promising program impacts. Effect sizes indicated moderate to large program impacts on improvements in adolescents' self-compassion, sense of interdependence, and perspective-taking, and female adolescents' interoceptive awareness, compared to controls. No group differences in compassion for others were found. The need for more research on programs that help adolescents balance compassion for the self and for others is discussed.     

Understanding innovation in health program planning and development

IntroductionA need for innovative public health programs is evident as the field adapts to address changes in health priorities and target populations. The Innovative Teen Pregnancy Prevention Program (iTP₃) was created to support and enable innovation in teenage pregnancy prevention, developing programs to reach the most at risk youth.MethodsA formative evaluation was conducted to understand what innovation means in the context of program development, and examine the process of innovation. Qualitative data was collected through baseline interviews with program development teams, referred to as Innovators, prior to the start of the project period and follow-up interviews conducted at the end of a 12-month funding period. Additional open-ended written responses were collected in the middle of the funding cycle. A thematic analysis with an open-coding scheme was used to identify emergent themes.ResultsInnovators considered programs innovative because of the target population of focus, program delivery mechanism, and/or program development approach. They specifically identified that a “culture” of innovation must be present if new programs are to be developed. Over time, Innovators began to shift their definition of innovation toward unique design processes and ecological approaches.DiscussionThrough creating a culture of innovation and utilizing systems thinking, this project provides important insights in how to develop innovations in public health.     

The Adolescent Family Life Program and Adoption Research

Abstract

The Office of Population Affairs administers the Adolescent Family Life Program. Authorized in 1981, the Adolescent Family Life Act funds adolescent pregnancy prevention programs as well as care programs for pregnant and parenting teens. It also funds research into related issues, including adoption. A primary purpose of the Adolescent Family Life Program is to develop and test approaches that encourage adoption as an alternative to abortion. However, both abortion and adoption rates have dropped since the program was instituted. While existing research has answered some of the questions surrounding adoption, there is need for additional research into the factors associated with adoption. The Office of Population Affairs is actively seeking creative, well-conceived proposals that address some of the as yet unanswered questions.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.     

Collaborative Treatment for Sexual Behavior Problems in an Adolescent Residential Center

Abstract

Many residential treatment and sex offender programs for adolescents historically have used coercion-based interventions. Treatment programs employing coercive techniques often replicate the same destructive and intrusive behaviors they seek to eliminate. Tension between departments coupled with poor communication and discomfort around sexual behavior issues within the staff of residential treatment centers are more likely to inhibit the progress of the youths they serve.

Collaboration among residential, educational, and clinical components enables staff to work in a direct, genuine, and respectful fashion with students who have histories of sexually abusive behavior. It further assists in maintaining a safe and predictable environment for these students. Finally, it helps students eliminate destructive behaviors by directly and consistently addressing four key areas: sexually abusive behavior, antisocial attitudes, social/emotional functioning, and overall self-care. It is not the author's intention to hold Bennington School, Inc.up as a model residential treatment program or to criticize other residential facilities. Rather, it is hoped that what is working in Bennington may be helpful to others.

Many who have worked on the front lines of residential treatment with sexually abusive adolescents have received training in elements specific to sexually abusive behavior. The origins of treatment for youth who have sexually abused were noteworthy for their lack of offense-specific interventions (National Adolescent Perpetration Network, 1993). However, a wealth of literature soon emerged addressing the need for assessment and treatment techniques specific to this population (Perry & Orchard, 1992; Barbaree, Marshall & Hudson, 1993). Much of this literature made assumptions regarding high levels of chronicity (Perry & Orchard,1992) while other contributions stressed the role of denial and minimization (Barbaree & Cortoni, 1993). As a result, while many issue-specific forms of assessment and treatment were developed, they often did not take into account other developmental needs and issues in the lives of sexually abusive youths (Lane, 1997).

Concurrent with this emerging research was a substantial increase in the number of treatment programs for juvenile sex offenders (National Adolescent Perpetration Network, 1993). In this context, it is not surprising that many treatment programs relied heavily on treatment targeting denial, minimization, and perceived sexual deviance without taking into account other treatment needs of youths. Although a recent literature review of adolescent residential programs (Curwen, 2000) notes a trend away from shame-based approaches, there appears to be less clarity on specific criteria on which to base residential treatment of adolescents who have sexually abused (Curwen, 2000).

Finally, recent research shows that among adult populations, accepting responsibility for abusive behavior in treatment is more likely to result from a warm, genuine, and empathic treatment style (Marshall, Fernandez, & Anderson, 1999). Group therapy participation, similarly, results from encouragement, open questions, and nonconfrontational challenge. The emerging themes of recent trends and research should inspire those at the front lines of residential treatment to reconsider not just basic treatment approaches, but the most minute elements of their interactions with youths.     

Lapses,infidelities, and creative adaptations: Lessons from evaluation of a participatory market development approach in the Andes

Participatory approaches are frequently recommended for international development programs, but few have been evaluated. From 2007 to 2010 the Andean Change Alliance evaluated an agricultural research and development approach known as the “Participatory Market Chain Approach” (PMCA). Based on a study of four cases, this paper examines the fidelity of implementation, the factors that influenced implementation and results, and the PMCA change model. We identify three types of deviation from the intervention protocol (lapses, creative adaptations, and true infidelities) and five groups of variables that influenced PMCA implementation and results (attributes of the macro context, the market chain, the key actors, rules in use, and the capacity development strategy). There was insufficient information to test the validity of the PMCA change model, but results were greatest where the PMCA was implemented with highest fidelity. Our analysis suggests that the single most critical component of the PMCA is engagement of market agents – not just farmers – throughout the exercise. We present four lessons for planning and evaluating participatory approaches related to the use of action and change models, the importance of monitoring implementation fidelity, the limits of baseline survey data for outcome evaluation, and the importance of capacity development for implementers.     

Predictors of Clinical Outcomes in Sexually Abused Adolescents

ABSTRACT

This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.