Promoting sexual health and responsible sexual behavior: an introduction

Facing a myriad of sexual health problems today, health ministries are being compelled to develop comprehensive approaches to sexual health promotion. Recently, there have been several attempts to develop these strategies at national, regional, and global levels. One of the challenges of articulating strategies has been arriving at basic definitions of sex, sexuality, sexual health, and responsible sexual behavior. However, there is remarkable consistency throughout these recent documents. These documents call for leadership of the health sector to create better climates for discussion of sexuality, access to information and education about sexuality, prevention strategies, access to care, and more research in human sexuality and evaluation of programs designed to promote sexual health and responsible sexual behavior.     

The opportunities and challenges of multi-site evaluations: Lessons from the jail diversion and trauma recovery national cross-site evaluation

Multi-site evaluations, particularly of federally funded service programs, pose a special set of challenges for program evaluation. Not only are there contextual differences related to project location, there are often relatively few programmatic requirements, which results in variations in program models, target populations and services. The Jail Diversion and Trauma Recovery–Priority to Veterans (JDTR) National Cross-Site Evaluation was tasked with conducting a multi-site evaluation of thirteen grantee programs that varied along multiple domains. This article describes the use of a mixed methods evaluation design to understand the jail diversion programs and client outcomes for veterans with trauma, mental health and/or substance use problems. We discuss the challenges encountered in evaluating diverse programs, the benefits of the evaluation in the face of these challenges, and offer lessons learned for other evaluators undertaking this type of evaluation.     

Career Techniques and Interventions: Themes From an International Conversation

The need for appropriate, timely, and increasingly comprehensive career development and education programs continues to escalate. It is interesting that despite the differences in cultures, religions, economies, political systems, and education structures, many countries face similar challenges when designing and implementing career development programs. Sharing and adapting career development interventions and techniques cross‐culturally appear to be viable strategies for implementing or enhancing programs, provided the concepts and materials are tailored to the countries' unique requirements.     

Evolutionary Evaluation: Implications for evaluators,researchers, practitioners,funders and the evidence-based program mandate

Evolutionary theory, developmental systems theory, and evolutionary epistemology provide deep theoretical foundations for understanding programs, their development over time, and the role of evaluation. This paper relates core concepts from these powerful bodies of theory to program evaluation. Evolutionary Evaluation is operationalized in terms of program and evaluation evolutionary phases, which are in turn aligned with multiple types of validity. The model of Evolutionary Evaluation incorporates Chen's conceptualization of bottom-up versus top-down program development. The resulting framework has important implications for many program management and evaluation issues. The paper illustrates how an Evolutionary Evaluation perspective can illuminate important controversies in evaluation using the example of the appropriate role of randomized controlled trials that encourages a rethinking of “evidence-based programs”. From an Evolutionary Evaluation perspective, prevailing interpretations of rigor and mandates for evidence-based programs pose significant challenges to program evolution. This perspective also illuminates the consequences of misalignment between program and evaluation phases; the importance of supporting both researcher-derived and practitioner-derived programs; and the need for variation and evolutionary phase diversity within portfolios of programs.     

Coalition for a Healthier Community: Lessons learned and implications for future work

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic–community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.     

Student bodies, past and present

This article examines how the field of college health has evolved over time to address the needs of an increasingly diverse student population. The central argument is that college and university health programs developed in conjunction with shifting standards of medical care and public health practices in the United States. The author reviews the role of college health programs as public health agencies for campus communities, and describes contemporary public health challenges facing college campuses. She shows how the history of college health is intertwined with the history of diversity in higher education. In particular, the author outlines how the growth of health services made higher education accessible to women, racial minorities, veterans, and persons with disabilities.     

Parenting While Incarcerated: Tailoring the Strengthening Families Program for use with jailed mothers

Most incarcerated women are mothers. Parenting programs may benefit women, children and families, yet effectively intervening in correctional settings is a challenges. An evidence-based parenting intervention (the Strengthening Families Program) was tailored and implemented with women in a jail setting. Goals were to assess mothers' needs and interests regarding parenting while they were incarcerated, adapt the program to address those needs, and establish intervention delivery and evaluation methods in collaboration with a community-based agency. Women reported wanting to know more about effective communication; how children manage stress; finances; drug and alcohol use; self-care; and stress reduction. They reported high program satisfaction and reported reduced endorsement of corporal punishment after the intervention. Barriers to implementation included unpredictable attendance from session to session due to changing release dates, transfer to other facilities, and jail policies (e.g., lock-down; commissary hours). Implications for sustainable implementation of parenting programs in jail settings are discussed.     

Student Bodies,Past and Present

Abstract

This article examines how the field of college health has evolved over time to address the needs of an increasingly diverse student population. The central argument is that college and university health programs developed in conjunction with shifting standards of medical care and public health practices in the United States. The author reviews the role of college health programs as public health agencies for campus communities, and describes contemporary public health challenges facing college campuses. She shows how the history of college health is intertwined with the history of diversity in higher education. In particular, the author outlines how the growth of health services made higher education accessible to women, racial minorities, veterans, and persons with disabilities.     

Using formative research to tailor a community intervention focused on the prevention of chronic disease

This case study attempts to illustrate and address in-depth the issues surrounding the collection, analysis, and application of formative research findings to program development and implementation. We provide an in-depth case study of tailoring a program for the residents of Berkshire County, Massachusetts. The formative research process includes collection and analysis of secondary data sources, extensive in-person interviews with community leaders, and in-depth focus groups with members of the population of interest. Findings from the formative research are then applied to tailoring the program materials and presentations and the training of the integrative team of health professionals that offer the program. Distinct components of program are tailored to the realities of the social, cultural, historical, and health and medical contexts in each community while other components of the program are tailored to individual participants. Overall, we believe this case study fully illustrates the utility of formative research in tailoring evidenced-based programs to increase program relevance and positive outcomes while maintaining fidelity to a program’s learning objectives and evaluation. We hope this in-depth account with specific examples proves useful as a guide to others when designing and conducting formative research to tailor health and medical interventions to the audience.     

Striking a Balance between Program-Specific and Portfolio-Level Evaluation: Lessons Learned from a Multi-Site Evaluation on the Texas-Mexico Border

Funders are increasingly making strategic investments across multiple grantees, aiming for their portfolio to improve targeted outcomes in a specific issue area. To this end, funders might use multi-site evaluation (MSE) approaches to examine the impact of their collective investments. However, it is important to recognize that each program—and its own program evaluation—must be tailored to its setting, population, and local context to best meet the needs of its target population. Therefore, multi-site evaluations need to account for this complexity. This paper describes the Sí Texas project, a large initiative of eight grantees implementing different integrated behavioral health models to improve physical and mental health outcomes along the Texas-Mexico border. With over 4,200 MSE study participants, the evaluation for Sí Texas used a partnership-centered approach to both enhance the evidence base and build local organizational capacity. This paper describes this approach, the process of tailoring evaluation practices to the grantees’ context, and the challenge of balancing consistency at the grantee-level for the portfolio multi-site evaluation. Successes, challenges, and lessons learned related to study design, data collection, grantee partnership, and capacity building are discussed.     

Qualitative cost–benefit evaluation of complex,emergent programs

This paper discusses a methodology used for a qualitative cost–benefit evaluation of a complex, emergent program. Complex, emergent programs, where implementation varies considerably over time and across sites to respond to local needs and opportunities, present challenges to conventional methods for cost–benefit evaluation. Such programs are characterized by: ill-defined boundaries of what constitutes the intervention, and hence the resources used; non-standardized procedures; differing short-term outcomes across projects, even within the same long-term goals; and outcomes that are the result of multiple factors and co-production, making counter-factual approaches to attribution inadequate and the use of standardized outcome measures problematic. The paper discusses the advantages and limitations of this method and its implications for cost–benefit evaluation of complex programs.     

The American Stop Smoking Intervention Study. Conceptual framework and evaluation design.

Reducing tobacco use, especially cigarette smoking, is a public health priority. The American Stop Smoking Intervention Study (ASSIST) was initiated in 1991 to prevent and reduce tobacco use primarily through policy-based approaches to alter the social-political environment. This article describes the conceptual design, research framework, evaluation components, and analytic strategies that are guiding the evaluation of this demonstration research endeavor. The ASSIST evaluation is a unique analysis of the complex relationships between the social context, public health activity at the state level, tobacco use, and individual behavior. The measures of tobacco control activity developed for this evaluation may be useful in ongoing national cancer control surveillance efforts, and the lessons learned will enhance the development of tobacco control programs.     

Building evaluation capacity: definitional and practical implications from an Australian case study

Internationally, evaluation capacity-building activities have mushroomed as demands have increased for government-funded programs to demonstrate that they are effective and efficient. Despite this, there is a lack of clarity in the way in which evaluation capacity-building is defined and conceptualized. The current paper presents a case study of a national evaluation capacity building exercise that we are in the midst of conducting in Australia, and discusses the findings in relation to definitional, conceptual and practical issues. Specifically, we describe an evaluation capacity building exercise involving over 100 mental health projects, detailing the methods that we employ, some of the challenges that we have faced, and the benefits we feel we are achieving. Our key message is that definitions of evaluation capacity-building should not only make reference to equipping organizations to routinely conduct evaluations, but should also stress the varied uses to which evaluation findings can be put. In addition, such definitions should acknowledge some of the valuable by-products of evaluation capacity building activities, such as the development of shared understandings of the program or project being evaluated.     

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.     

Experiments in evaluation capacity building: Enhancing brain disorders research impact in Ontario

This paper is the introductory paper on a forum on evaluation capacity building for enhancing impacts of research on brain disorders. It describes challenges and opportunities of building evaluation capacity among community-based organizations in Ontario involved in enhancing brain health and supporting people living with a brain disorder. Using an example of a capacity building program called the “Evaluation Support Program”, which is run by the Ontario Brain Institute, this forum discusses multiple themes including evaluation capacity building, evaluation culture and evaluation methodologies appropriate for evaluating complex community interventions. The goal of the Evaluation Support Program is to help community-based organizations build the capacity to demonstrate the value that they offer in order to improve, sustain, and spread their programs and activities. One of the features of this forum is that perspectives on the Evaluation Support Program are provided by multiple stakeholders, including the community-based organizations, evaluation team members involved in capacity building, thought leaders in the fields of evaluation capacity building and evaluation culture, and the funders.     

A framework of operating models for interdisciplinary research programs in clinical service organizations

A framework of operating models for interdisciplinary research programs in clinical service organizations is presented, consisting of a "clinician-researcher" skill development model, a program evaluation model, a researcher-led knowledge generation model, and a knowledge conduit model. Together, these models comprise a tailored, collaborative approach to enhancing research-informed practice in community-based clinical service organizations. The models place different degrees of emphasis on the development of research-related skills in practitioners, the generation of knowledge tailored to clinical practice, and knowledge sharing. The nature, philosophical basis, roles of research staff members, outputs and impacts, and strengths and limitations of each model are described, in the context of a long-standing, interdisciplinary research program in a children's rehabilitation service organization. The use of the model framework as a tool for the design of interdisciplinary, community-based research programs is discussed.     

How and why are Theory of Change and Realist Evaluation used in food security contexts? A scoping review

The complex ways in which food security actions lead to nutrition and other health outcomes make it important to clarify what programs work and how, with theory-driven evaluation emerging as a promising approach to evaluate complex programs. However, it is unclear how and why theory-driven evaluation is applied in food security contexts. Our objective is to examine the development and use of Theory of Change and Realist Evaluation to support food security programs globally. Using a systematic search and screening process, we included studies that described a food security program, used a Theory of Change or Realist Evaluation, and presented original research or evaluations. We found a total of 59 relevant Theory of Change studies and eight Realist Evaluation studies. Based on our analysis, Theories of Change arose in response to three main problems: 1) the need to evaluate under complexity; 2) challenges with evaluation; and, 3) information gaps surrounding a program. In contrast, Realist Evaluation was reported to be developed primarily to understand a program’s outcomes. Reflecting on the problem to be addressed in the evaluation would help improve understandings of the evaluation context, which would then inform the choice and design of an evaluation approach.     

Examining the macroergonomics and safety factors among teleworkers: development of a conceptual model

With the rising number of teleworkers who are working in non-traditional work locations, health and safety issues are even more critical. While telework offers attractive alternatives to traditional work locations, it is not without challenges for employers and workers. A macroergonomics approach or work system design for telework programs is proposed to address these new challenges. This approach explains the impact of organizational, psychosocial and workplace risk factors on teleworker's health and safety. A process for managing the health and safety of teleworkers is presented along with preventive strategies to provide an injury-free working environment.