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This article represents an overview of the various types of evaluation research conducted in the fields of crisis intervention, suicide prevention, and mental health in general. An attempt is made to classify it according to its content and purpose, and to assess the relative merit of each. Emphasis is on goal attainment and outcome type of evaluation.
OBJECTIVE: To describe the profile of bio-psycho-social gravity in opiate-dependent patients in the Methadone Maintenance Programme. DESIGN: A descriptive crossover study. SETTING: Primary Care Centre. PATIENTS: 31 heroin-dependent patients on Methadone treatment at a drug-dependency care centre who attended the Health Centre for drug dispensing, between February and December 1996. MEASUREMENTS AND MAIN RESULTS: All patients were given the semi-structured clinical interview Opiate Treatment Index (OTI) and filled in the self-administered APGAR family questionnaire. 48.3% had little deterioration in their "General Health Status" section and 54.8% had low scores in "Conduct causing risk of HIV contagion". CONCLUSIONS: The observed data are consistent with the results to be expected in this kind of programme. The multidimensional evaluation instruments are a tool that can be used to tackle drug-dependent patients in Primary Care.
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Evaluation of health promotion interventions is essential in order to collect evidence about the efficacy of a program, identify ways to improve practice, justify the use of resources, and identify unexpected outcomes. This paper clarifies the role of evaluation as a crucial component of health promotion interventions. Moreover, it summarises the key elements of the most widely used planning/evaluation frameworks necessary for constructive evaluations of health promotion interventions and incorporates them into a single approach. It provides a methodical framework for the provision of evaluation guidance to health promotion practitioners and discusses the importance of including evaluation when planning any health promotion intervention. The focus of this paper is on the essential elements of the evaluation of health promotion programs.
The idea of program evaluation is both simple and appealing. Program outcomes are measured and compared to some minimum performance standard or threshold. In practice, however, evaluation is difficult. Two fundamental problems of outcome measurement must be addressed. The first, which we call the problem of auxiliary outcomes, is that we do not observe outcome of interest. The second, which we call the problem of counterfactual outcomes, is that we do not observe the threshold standard. This article examines how performance standard should be set and applied in the face of these problems in measuring outcomes. The central message is that the proper way to implement standards varies with the prior information an evaluator can credibly bring to bear to compensate for incomplete outcome data. By combining available data with credible assumptions on treatments and outcomes, the performance of a program may be deemed acceptable, unacceptable, or indeterminate.
OBJECTIVE: To describe how centers of amputee care in Canada evaluate program and patient outcome. DESIGN: National postal survey. SETTING: Amputee rehabilitation centers across Canada. PARTICIPANTS: Forty-four medical directors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Type and frequency of use of program evaluation, formal and informal patient outcome measures data, and how collected data was used. RESULTS: Forty-four clinics responded (response rate, 72%). Program evaluation was conducted in some format by at least 18 centers. Twelve centers conducted regular chart audits, whereas 15 indicated their intention to submit an annual program report. The majority of centers collected information on patient outcomes; however, most used informal measures. Thirty-nine clinics used part or all of a checklist of informal measures of skill attainment. The most common standardized outcome measure was the FIM instrument (18 centers). Eighteen centers used a form of mobility performance such as walking speed or timed walk test. Eighteen of 39 centers that responded to this section did not collect any formal patient outcome measures. The most frequently used outcome measures were the nonstandardized informal measures of independence. CONCLUSION: A diverse selection of program- and patient-related outcome measures were used by Canadian amputee centers. Outcomes could be better compared if all centers used similar outcome measures.
Evaluation of program implementation can help illuminate negative results of school-based smoking prevention programs. In three conventional quasiexperimental evaluations, no statistically significant impacts of smoking prevention programs on children's knowledge, attitudes, intentions, or behavior were detected. Complementary evaluations of program implementation along several dimensions using naturalistic methods suggested reasons for null effects were different at each site. These data were used to form hypotheses and recommendations for future interventions.
The Cosmetic, Toiletry and Fragrance Association (CTFA) Evaluation of Alternatives Program is an evaluation of the relationship between Draize ocular safety test data and comparable data from a selection of in vitro tests. In Phase II, 18 representative oil/water-based personal-care formulations were subjected to the Draize primary eye safety test and 30 in vitro assay protocols (14 different types of in vitro endpoints were evaluated; the remainder were protocol variations). Correlation of in vitro with in vivo data was evaluated using analysis of sensitivity/specificity and statistical analysis of the relationship between maximum average Draize score (MAS) and in vitro endpoint. Regression modelling is the primary approach adopted in the CTFA Program for evaluating in vitro assay performance. The objective of regression analysis is to predict MAS for a given test material (and to place upper and lower prediction interval bounds on the range in which the MAS is anticipated to fall with high probability) conditional on observing an in vitro assay score for that material. The degree of confidence in prediction is quantified in terms of the relative widths of prediction intervals constructed about the fitted regression curves: the narrower the prediction interval, the more predictive of the Draize score is the in vitro test result. 16 assays were shown to have the greatest agreement with the Draize procedure and were therefore selected for regression analysis. Based on the magnitude of the 95% prediction bounds of each of the 16 selected assays over the range of test data, it may be inferred that prediction of MAS values from experimentally determined in vitro scores is more accurate for oil/water-based formulations with lower rather than higher irritancy potential. The assays selected for modelling in Phase II generally exhibited weaker relationships with MAS than those selected in Phase I (evaluated using hydroalcoholic formulations), even though several assays were common to both Phases.
Because the reestablishment of coronary blood flow is believed to be central to the benefit of thrombolytic therapy, the U.S. evaluation program of anistreplase has focused on reperfusion, patency, and reocclusion comparisons with approved thrombolytic regimens, including (1) intracoronary streptokinase (completed) (TEAM-I), (2) intravenous streptokinase (completed) (TEAM-II), and (3) intravenous tissue plasminogen activator complex or alteplase (tPA, ongoing) (TEAM-III). The TEAM trials have established that anistreplase possesses similar reperfusion efficacy to intracoronary streptokinase, if given within 4 h, but is much easier to administer; comparisons with currently approved intravenous agents, streptokinase, and tissue plasminogen activator (tPA) have been completed and are being analyzed or are underway; reocclusion and reinfarction rates are low; safety is good, and similar to that of streptokinase; and mortality rates have been low with treatment, consistent with beneficial reports from randomized trials. Based on overall efficacy, ease of administration, and safety, anistreplase has been shown to be a promising agent for treatment of acute myocardial infarction.
The CTFA Evaluation of Alternatives Program is an evaluation of the relationship between data from the Draize primary eye irritation test and comparable data from a selection of promising in vitro eye irritation tests. In Phase III, data from the Draize test and 41 in vitro endpoints on 25 representative surfactant-based personal care formulations were compared. As in Phase I and Phase II, regression modelling of the relationship between maximum average Draize score (MAS) and in vitro endpoint was the primary approach adopted for evaluating in vitro assay performance. The degree of confidence in prediction of MAS for a given in vitro endpoint is quantified in terms of the relative widths of prediction intervals constructed about the fitted regression curve. Prediction intervals reflect not only the error attributed to the model but also the material-specific components of variation in both the Draize and the in vitro assays. Among the in vitro assays selected for regression modeling in Phase III, the relationship between MAS and in vitro score was relatively well defined. The prediction bounds on MAS were most narrow for materials at the lower or upper end of the effective irritation range (MAS = 0-45), where variability in MAS was smallest. This, the confidence with which the MAS of surfactant-based formulations is predicted is greatest when MAS approaches zero or when MAS approaches 45 (no comment is made on prediction of MAS > 45 since extrapolation beyond the range of observed data is not possible). No single in vitro endpoint was found to exhibit relative superiority with regard to prediction of MAS. Variability associated with Draize test outcome (e.g. in MAS values) must be considered in any future comparisons of in vivo and in vitro test results if the purpose is to predict in vivo response using in vitro data.
A reduction in clinical nursing educator positions resulted in the need for the Department of Nursing to continue to facilitate the professional development of nursing staff members with limited resources. In this article, the author describes a program, developed by the central Nursing Education Department at The Toronto Hospital, that was offered to clinical resource nurses, nurse managers, patient care coordinators, and preceptors. These individuals could use the information to promote the development of nursing staff members at the unit level. Several topics were presented: self-directed learning, needs assessment, behavioral objectives, lesson plans, teaching strategies, educational program evaluation, and clinical evaluation. Program evaluations were positive, and 45% of the respondents indicated they had the opportunity to apply what they learned.
The purpose of continuing education is to build upon nurses' educational and experiential basis for the enhancement of their practice, administration, education or research, to the end of maintaining and improving the public's health. Continuing education evaluations traditionally have been formative and summative, determining the participants' perceptions and opinions about continuing education offerings or immediate assessment of changes in knowledge and attitudes. The purpose of this study was to determine whether nurses who attended a management development continuing education program had greater cognitive knowledge and were able to implement management models and theories into their practice following the program. The program was three to four days, depending on the size of the facility. Ten different Veterans Administration medical centers participated in the programs. The investigator sent questionnaires to 191 nurse managers who had attended a Southwestern Regional Medical Education Center continuing education program. Responses from 111 managers were received. The data analysis indicates a high correlation between theories presented and theories/models implemented in management practice. In addition, data indicate that nurse managers who were able to apply theory in a practical manner felt this was due primarily to the continuing education program. A model for the development of the new nurse manager (Sheridan, Bronstein, & Walker, 1984) was used in planning the program, and the Stake countenance model (Stake, 1973) was used in evaluating the program.
Evaluation of educational programs not only determines their effectiveness, but also yields helpful information for planners and participants in both past and future programs. In this article, the authors describe how evaluation of an inservice venipuncture program provided valuable information without undue effort.
The evaluation of programs with multiple, and potentially conflicting, goals requires the integration of measures of goal achievement that often are not easily combined. One approach is the development of analytical themes which span the various goals of a particular program. The themes provide a mechanism by which the policy concerns of individuals with varying perspectives can be integrated into the evaluation framework. As well, the themes allow for flexibility in the development of new analysis as the program matures and environments change. This paper describes the application of the thematic approach to the evaluation of a complex, community-oriented cancer research program.
When faced with the task of program evaluation, many directors of medical education may find themselves overwhelmed. This article presents suggestions for conducting an evaluation, including the six basic elements to consider before embarking on such an undertaking. With an emphasis on selecting a model framework as a guide for conducting a program evaluation, this article examines one model--Stufflebeam's CIPP model--in depth.
OBJECTIVE: To review and synethize the research material on focus groups with children and adolescents and to provide guidelines for future development. METHODS: Psychlit, Medline, and Cinahl electronic databases, as well as the reference lists of those articles consulted, were reviewed for information regarding focus groups with participants under the age of 18 years. Both empirical and methodological articles were part of this review. RESULTS: We review the utility of focus groups for exploratory research, program evaluation, program development, and questionnaire construction or adaptation. Based on previous research, we provide guidelines for focus groups with children and adolescents and outline suggestions for future development. CONCLUSIONS: There is evidence to suggest that focus groups are a valuable means of eliciting children's views on health-related matters, given an appropriate research question. However, empirical research is required in order to investigate systematically the effect of different processes and variables on the final outcome of focus group interviews.
Evaluation of health care programs is a complex process which presents many challenges. A case study of a small-scale adult day care program evaluation is presented to illustrate these issues. The rationale for developing the program and the findings from the evaluation study are discussed. Several evaluation issues including the use of multiple methods, levels of analysis, characteristics of the sponsoring agency, political influences, methodological issues and influences on utilization of findings are addressed.
Although many volunteer programs have been called "successful" and the use of paraprofessionals urged, few program evaluations with a benefit-cost analysis have been reported. Several major studies of volunteer utilization are reviewed, and particular needs with reference to program evaluation are discussed. Three alternative evaluation methodologies are proposed. The importance of utilizing a comprehensive evaluation incorporating all three methodologies is discussed. An ongoing volunteer program in a community mental health center is used as an illustration.