A Comparison of two analytic methods for the identification of neighborhoods as intervention and control sites for community-based programs

Study Objective: Interest in community as the focus of public health interventions is growing. However, choosing intervention and comparison neighborhoods when designing community based programs poses a challenge to program planners. Ideally, intervention neighborhoods should be chosen based upon risk profiles and demonstrated need for the program. Multiple sources of data that tap into neighborhood characteristics might be used to facilitate the selection of intervention and comparison neighborhoods for program implementation and evaluation.Design: We present and compare selected characteristics of two analytic methods that can be used to create perinatal risk profiles of neighborhoods within cities. For our example, we used information from several sources of routinely available data and used census tract level low birthweight as our intervention or outcome variable.Main Results: At the neighborhood level, we found average household wealth of the census tract, proportion of births to women with late or no prenatal care, proportion of teen births per census tract, per capita crime rates, proportion of housing violations, and number of community organizations as being important factors identifying neighborhoods at risk for high rates of low birthweight births. Advantages of both methods are discussed and risk profiles generated from either method can be used not only to identify high risk areas of the city for adverse perinatal outcomes but also for the identification of intervention and comparison neighborhoods for implementation of community based programs.     

An Empirically Based Framework for Content Selection and Management in Divorce Education Programs

Contemporary research has shown that divorce education programs are becoming mandated or recommended in numerous states throughout the nation. Cooccurring with the popularity of these programs is the variation in content of divorce education programs. The focus of this project was to systematically explore the research literature on factors related to divorce adjustment and identify findings to be used in content selection and development for divorce education programs. The divorce-stress-adjustment perspective was utilized to frame the divorce process affecting both children and adults. A systematic literature review resulted in identification of 103 published studies that fit the project criteria. Selected research findings identified in the literature review process were organized according to a conceptual framework designed to categorize content in a tiered approach useful for selecting and managing content in divorce education programs. Implications of the project findings for content identification in divorce education, program development, and program evaluation are explored.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

Applying national survey results for strategic planning and program improvement: The National Diabetes Education Program

Since the 1970s, the federal government has spearheaded major national education programs to reduce the burden of chronic diseases in the United States. These prevention and disease management programs communicate critical information to the public, those affected by the disease, and health care providers. The National Diabetes Education Program (NDEP), the leading federal program on diabetes sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), uses primary and secondary quantitative data and qualitative audience research to guide program planning and evaluation. Since 2006, the NDEP has filled the gaps in existing quantitative data sources by conducting its own population-based survey, the NDEP National Diabetes Survey (NNDS). The NNDS is conducted every 2–3 years and tracks changes in knowledge, attitudes and practice indicators in key target audiences. This article describes how the NDEP has used the NNDS as a key component of its evaluation framework and how it applies the survey results for strategic planning and program improvement. The NDEP's use of the NNDS illustrates how a program evaluation framework that includes periodic population-based surveys can serve as an evaluation model for similar national health education programs.     

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.     

Assessing local capacity for health intervention

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.     

Are the voices of parents heard? A scoping review of satisfaction in parenting programs

Parenting programs are an effective approach to promote positive parenting. In evidence-based practice, client’s values and preferences contribute to promoting quality, and are a crucial component of service evaluation. The current scoping review summarizes quantitative research that examines parental satisfaction with parent training for families with child conduct problems. We aimed to know how much research had been undertaken; what measures have been used; and what were the findings related to parental satisfaction. A scoping review was conducted to retrieve peer-reviewed original articles.Out of 420 papers 5.5 % obtained data on parental satisfaction. Seven different measures were used, mainly Therapy Attitude Inventory and Client Satisfaction Questionnaire. Out of 23 papers, ten studies reported Cronbach's alpha coefficients on the assessment that was used to evaluate parental satisfaction. All of the 23 included studies found that parents are very satisfied with the parenting program they have received.The findings indicate that only a few studies included parents’ values and preferences in quantitative evaluation studies on parental programs. In addition, there is a limited arsenal of assessment tools to measure what matters to parents. There is a need to develop measures with high psychometric quality, which will promote more quality in service evaluation.     

A Review of Multicomponent Interventions to Prevent and Control Tobacco Use Among College Students

Abstract

Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components.     

Addiction Social Work Fellowship Program in Canada

Substance use disorders (SUD) disproportionally contribute to the global social and economic cost of disease; however, their treatment has been inadequate in large part due to an enduring research to practice gap in which competencies for treating and preventing SUDs are often lacking from social work education curricula. Training social workers in managing SUDs has been separated from nurse and physician training, partly due to the long-standing divide between the behavioral health and medical care system. Recently, a new interdisciplinary fellowship in addiction social work, nursing and medicine has been established in Vancouver, Canada. We describe the novel fellowship program and outline initial impact of the training on knowledge and skills in addiction social work from our qualitative evaluation of the fellowship. We conclude that training social workers, and other allied health professionals alongside physicians and nurses may extend the reach of this type of training program even further.     

From pipeline to practice: Utilizing tracking mechanisms for longitudinal evaluation of physician recruitment across the health workforce continuum

PurposeArea Health Education Centers work with community partners to prepare a diverse, primary care workforce particularly among rural and underserved communities. We set out to assess our impact on the physician workforce across a multitude of short-term, intermediate, and long-term benchmarksMethodWe used a comprehensive evaluation scaffolding to assess benchmarks of success across the workforce pipeline including short-term (i.e. pre-medical intent to pursue a health career or medical students’ intent to practice in primary care), intermediate (college matriculation and primary care residency match rates) and longterm measures (licensure and medical practice location of program participants).ResultsWe identified significant findings in each part of the AHEC program continuum. Among our alumni, we found a significant increase in the pre-medical learner’s intent to pursue a health care career. Among medical students, we found a significant increase in intent to practice in primary care, rural areas, and medically underserved communities and a high rate of primary care residency match (compared to peers). Approximately one-third of licensed physicians are now practicing medicine serve in an underserved communityConclusionsOur findings confirm the value of longitudinal evaluation on confirming that participation in an AHEC supported program strengthen the physician workforce development.     

Workforce reentry for people with HIV/AIDS: intervention effects and predictors of success

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.     

Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma

IntroductionGlaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma.MethodsThe RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions.DiscussionBy targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17–19%) – a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive.ConclusionsEvaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.     

Reframing the benefits and beneficiaries of public benefits programs

This article uses current research to demonstrate that in addition to the direct benefits received by recipients of four main types of public benefit programs—cash assistance, public health insurance, food assistance, and public housing—non-recipients receive a variety of indirect economic and noneconomic benefits. Non-recipients include individuals, families, organizations, businesses, neighborhoods, and the general public. The review indicates that public benefits programs can indirectly benefit non-recipients economically by increasing economic security; stimulating local, state, and national economies; increasing employment and other measures of economic well-being; generating tax revenues; and providing cost savings. In addition, we determined two main types of indirect noneconomic benefits: enhancing neighborhood quality and the intrinsic rewards gained from fulfilling humanitarian and related values. We then summarize the results of these studies and make suggestions for future research. Finally, based on the reviewed research, we identify methods to reframe negative perceptions of government spending on public benefits programs. By reframing the benefits and beneficiaries of these programs, social workers, professional organizations, lobbyists, politicians, and elected officials can increase societal and political support for public benefits programs.     

Implementing the ecological approach in tobacco control programs: results of a case study

The ‘new public health’ has stimulated calls to adopt an ecological approach for action aimed at improving population health. However, the implementation of ecological programs has often remained a challenge. The objective of this study was to identify factors facilitating the implementation of ecological tobacco control programming in two Public Health Departments in Québec (Canada) using Scheirer's model of program implementation as a conceptual framework and an exemplary case study design. Analysis revealed two distinct configurations of environmental, organizational and professional characteristics that were related to equally successful implementations of the framework. Key roles for factors such as provincial ministerial guidelines and financial resources, human resources, and relationships and alliances with other organizations, were highlighted. These results replicate findings from quantitative surveys and allow better understanding of the conditions required for planning ecological programming.     

Safe patient handling curriculum in occupational therapy and occupational therapy assistant programs: A descriptive study of school curriculum within the United States of America

The purpose of this study was to identify safe patient handling (SPH) curricular content in accredited occupational therapy and occupational therapy assistant programs in the United States of America. A survey was emailed to 155 accredited occupational therapy and 137 accredited occupational therapy assistant programs. With a 39% response rate, most programs addressed SPH curricula by including lectures and lab-based experiences with gait belts, slide boards, and manual transfers while stressing ‘safe’ body mechanics. There were limited responses regarding curricular-based hands-on experience, evaluation of sit-to-stand lifts, how to safely transfer bariatric persons, and information on “no-lift” policies. While occupational therapists have a central role in teaching SPH to caregivers, it is important to enhance SPH curricula to reduce exposure to musculoskeletal risk, thereby, increasing the health and safety of the occupational therapy workforce as well those whom the profession serves.     

Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations.     

Outcomes Measurement

SUMMARY

Outcomes measurement in health and mental health should be of vital concern to social workers since public support and financing will follow evidence of effectiveness. Social work in health and mental health requires a framework for conceptualizing outcomes measurement so that the profession can focus clearly on the work to be done in outcomes measurement. This framework should distinguish among the various ways that outcomes measurement can be used to advance policy, program and practice. This article discusses two applications of outcomes measurement, namely for improving policies and programs, and, second, for conducting outcomes research. Other dimensions that could be included in an outcomes measurement framework for social work in health and mental health are identified but not elaborated. The author's objective is to make a strong case for the role that outcomes measurement can play in both the improvement of social work policies and programs in health care, through performance measurement, as well as in advancing the healthcare knowledge base, through outcomes research.     

Narrative review of strategies by organizations for building evaluation capacity

Program evaluation is an important source of information to assist organizations to make “evidence-informed” decisions about program planning and development. The objectives of this study were to identify evaluated strategies used by organizations and program developers to build the program evaluation capacity of their workforce, and to describe success factors and lessons learned. Common elements for successful evaluation capacity building (ECB) include: a tailored strategy based on needs assessment, an organizational commitment to evaluation and ECB, experiential learning, training with a practical element, and some form of ongoing technical support within the workplace. ECB is a relatively new field of endeavor, and, while existing studies in ECB are characterized by lower levels of evidence, they suggest the most successful approaches to ECB are likely to be multifaceted. To build the level of evidence in this field, more rigorous study designs need to be implemented in the future.     

The current state of truancy reduction programs and opportunities for enhancement in Los Angeles County

School truancy, defined as any intentional unauthorized or illegal absence from school, influences, and is influenced by, multiple academic, health, and social factors. This project sought to describe how truancy-reduction systems are operating in Los Angeles County and identify the highest priority policy and program options to effectively address truancy. The Department of Public Health convened an expert panel and collected data through literature review, key informant interviews, focus groups, and surveys. Results describe the interconnected players that are working to address truancy. Recommendations focus on increasing school-based efforts, identifying innovative ways to address students' and families' physical and mental health needs, enhancing coordination across partners and elevating their commitment, expanding evidence-based programs, and enhancing data collection efforts to better identify additional effective strategies. Other jurisdictions can build off our prioritization framework to describe the current state of their systems and identify promising programs to augment system functioning.