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PubMedDate not supplied

Comprehensive evaluation of a community coalition: a case study of environmental tobacco smoke reduction.

Community coalitions have become an increasingly popular means for addressing community health issues, yet evaluating their effectiveness and performance has presented formidable challenges. To meet the community's need for health program evaluation, public health nurses will need to become better prepared to deal with the complexities of evaluating coalitions and their multifaceted organizational structures. This article presents the methodology and conceptual framework, Targeting Outcomes of Programs (TOP), used to evaluate the performance and impact of a local community coalition. The case study offered here focuses on a tobacco-prevention coalition composed of 15 public and private agencies and their 121 activities. The TOP evaluation model provided the coalition with formative evaluation, needed to improve the coalition's on-going program delivery, and summative evaluation, needed for annual reviews of the coalition's effectiveness and impact in the community. The methodological approach and instrument presented here provide the public health nurse with a solid conceptual framework for approaching such a task.

Community Health Planning↗
PubMed2003

Postgraduate training programs in veterinary clinical pathology in the United States and Canada (1998 to 2002).

BACKGROUND: Residency and graduate programs in veterinary clinical pathology provide specialized training for board certification and are important pathways to careers in clinical pathology diagnostics, teaching, and research. Information about training opportunities is useful for assessing disciplinary needs, outcomes, and changes, garnering program support, and providing objective data for program evaluation by faculty, trainees, and prospective applicants. OBJECTIVES: The goals of this study were to 1) compile detailed information on the number and types of postgraduate training programs in veterinary clinical pathology in the United States and Canada, 2) describe the goals, activities, strengths, and weaknesses of the programs, 3) assess the desirability of program accreditation and program standards, 4) identify supplemental training opportunities, and 5) evaluate changes in programs, trainees, and faculty 4 years later. METHODS: In July 1998, the American Society for Veterinary Clinical Pathology Education Committee sent a survey to representatives at the 31 schools and colleges of veterinary medicine in the United States and Canada and 31 diagnostic laboratories, private hospitals, and pharmaceutical companies. Survey data were compared with updated information obtained from training program coordinators in November 2002. RESULTS: Survey response rate was 94% for universities, 39% for nonuniversity institutions, and 66% overall. In 1998, there were 20 clinical pathology training programs, including residencies (n=10) and graduate programs combined with residency training (n=10), with 36 total training positions. In 2002, there were 25 training programs (14 residencies, 11 combined), with 52 total positions. The median faculty:trainee ratio was 2.0 in both years. Of 67 faculty members involved in training in 1998, 57 (85.1%) were board-certified in clinical pathology and 53 (79.1%) had DVM/PhD degrees. Net faculty numbers increased by 17 (25.4%) but the median per institution remained at 3.0. Primary program goals were 1) eligibility for and successful achievement of board certification in clinical pathology by the American College of Veterinary Pathologists, 2) proficiency in laboratory diagnostics, and 3) contemporary basic or applied research training. Many programs cited research opportunities, caseloads, and training in hematology and cytology as strengths. Program weaknesses included insufficient funding, too few faculty, and limited training in clinical chemistry and laboratory operations/quality assurance. Trainees completing programs within the past 5 years (n=70) were employed in academia (28.6%), diagnostic laboratories (32.9%), and industry (18.6%). For trainees completing programs between 1999 and 2002 (n=38), these percentages were 52.6%, 21.1%, and 7.9%, respectively. Most (62.5%) respondents supported program standards and accreditation, and 76% supported board review sessions for trainees. CONCLUSIONS: Opportunities for postgraduate training in veterinary clinical pathology increased between 1998 and 2002, with 5 new programs and 16 new training positions. These additions and the increased emphasis on diagnostic proficiency, efforts to strengthen training in clinical chemistry and quality assurance, and continuation of combined PhD-residency programs will help address the perceived need for increased numbers of qualified clinical pathologists in academia, diagnostic laboratories, and industry.

Accreditation↗
PubMed1999

A story/dialogue method for health promotion knowledge development and evaluation.

Arguments have been made in favour of a constructivist or postpositivist approach to health promotion knowledge development and program evaluation, but little has been articulated about what such an approach would look like. This article describes a 'story/dialogue method' that was created with and for practitioners in response to their concerns that much of their practice did not lend itself to a positivist, or conventional, methodology. Derived from constructivist, feminist and critical pedagogical theory, and with roots in qualitative methods, the method structures group dialogue around case stories addressing particular generative practice themes. While intended for practitioner training, organizational development and evaluation, the method to date has been used primarily for training purposes. This article describes the method, provides an example of its application, and discusses its strengths, weaknesses and relevance to health promotion.

Anecdotes as Topic↗
PubMedDate not supplied

HIV sexual risk reduction interventions for women: a review.

AIDS has emerged as a serious public health threat for women. Reducing the risk for HIV infection among sexually active women requires the adoption of preventive strategies that effectively inhibit viral transmission. However, there is a paucity of published literature describing interventions targeted toward women and even fewer published reports evaluating their effectiveness. We conducted a search of HIV prevention interventions for women using the MEDLINE, ERIC and PSYCHLIT on-line computer database for the years January 1984-May 1995 to assess the effectiveness of interventions in increasing condom use during sexual intercourse. Interventions efficacious at increasing condom use applied a social psychological model of behavior to guide the development and implementation of the intervention, used randomized controlled designs to evaluate program efficacy, emphasized gender-related influences, were peer-led, and used multiple intervention sessions. While these findings are promising, methodologic limitations preclude any definitive assessment of programmatic efficacy. One challenge for future studies is to corroborate and extend these findings using rigorous methodologic research designs to evaluate programmatic efficacy, in particular, longer follow-up to assess stability of treatment effects over time. Another challenge is to understand the implications of previous research for the development of more gender-relevant interventions. The urgency of the HIV epidemic demands that the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Medical Subject Headings (MeSH): women, HIV/AIDS, interventions, prevention.

Adolescent↗
PubMed2001

National standards for the long-term care ombudsman program and a tool to assess compliance: the Huber Badrak Borders Scales.

PURPOSE: We propose national standards previously recommended for the Long-Term Care Ombudsman Program by an Institute of Medicine program evaluation committee, and introduce a tool to measure the compliance of local ombudsman programs to those standards: the Huber Badrak Borders Scales. METHODS: The best practices for ombudsman programs detailed in the committee's report were adapted to 43 Likert-type scales that were then averaged into 10 infrastructure component scales: (a) program structure, (b) qualifications of local ombudsmen, (c) legal authority, (d) financial resources, (e) management information systems, (f) legal resources, (g) human resources, (h) resident advocacy services, (i) systemic advocacy, and (j) educational services. The scales were pilot-tested in 1996 and 1999 with Kentucky ombudsmen. RESULTS: The means of 9 of these 10 scales were higher in 1999 than in 1996, suggesting that local ombudsman programs were more in compliance with the proposed standards in 1999 than three years earlier. IMPLICATIONS: The development process consisted of 10 adopt-test-revise-retest steps that can be replicated by other types of programs to develop program compliance tools.

Guideline Adherence↗
PubMed1998

Dental public health for the 21st century: implications for specialty education and practice.

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

Certification↗
PubMed2000

Physical training as a substance abuse prevention intervention for youth.

Program evaluation data from school and community applications of a physical fitness drug prevention program is presented. A train-the-trainer methodology was applied to install the program in twenty-two settings within the state of Illinois. The physical training program consisted of exercise and educational modules delivered over a twelve-week time period that focused on learning values and life skills through exercise. Complete pre-post data were obtained on 329 participating youth at six school and community based sites. Significant increases were demonstrated in physical activity and physical fitness (cardiovascular endurance, strength, and flexibility). Youth self-report data indicated significant decreases in risk factors such as low self-concept, poor school attendance, anxiety, depression, and number of friends who use alcohol and drugs. There were significant reductions in the percentage of youth who used cigarettes, smokeless tobacco, and alcohol. It was concluded that a strong relationship was demonstrated for increased fitness leading to lowered risk factors and usage patterns. Likewise, the train-the-trainer model was shown to be an effective installation approach to expand fitness programming within prevention settings.

Absenteeism↗
PubMedDate not supplied

Family-centered care for the bereaved.

The death of a child is a severe and profound loss to all family members. The many tasks of the grieving process can be supported and facilitated by a bereavement program. The Whispers of Hope Bereavement Program at Duke University is a comprehensive, family-centered program providing periodic telephone contacts with a bereaved family, a series of letters containing grief education and support materials, and an annual Day of Remembrance for families and staff. A bereaved parent, clinical nurse specialist, and chaplain share program coordination at a cost per year of less than $20.00 per family. Program evaluation efforts to date suggest a high level of family satisfaction with the program.

Aftercare↗
PubMed1992

Teaching community oriented primary care in a traditional medical school: a two year progress report.

Efforts are being made to extend the practice of Community Oriented Primary Care by reorienting existing health services or restructuring medical education curricula. Nevertheless, changes in education must be simultaneous to changes in health services so that health professionals trained in COPC will find areas to practice COPC. The experience described in this article presents an effort in these two directions. A teaching program was introduced in a traditional medical school curriculum and was extended to six health services by training the directors of the health service as teaching instructors of COPC or closely coordinating actions with the director of the health service. The results of the program show fulfillment of learning objectives and student satisfaction with the program. Evaluations of the development of COPC in the health services involved show modifications in health programs to meet community needs and stronger community leadership and organization.

Colombia↗
PubMed1987

Stress management for essential hypertension: comparison with a minimally effective treatment, predictors of response to treatment, and effects on reactivity.

Few studies of psychological interventions for essential hypertension have incorporated comprehensive coping skills treatment programs, evaluated the efficacy of such programs against credible, minimally effective controls, examined the effects of these interventions on pressor responses, or clarified the nature of person by treatment interactions. The present study examined the relative effectiveness of multimodal stress management training and a minimally effective treatment control (i.e. GSR biofeedback training) in the treatment of essential hypertensives' blood pressure at rest and in response to simulated stressful interpersonal situations. At the conclusion of an 8 week training period, stress management participants exhibited reliably lower resting diastolic blood pressure and tended to exhibit lower systolic pressure than controls. The former condition maintained their lower pressures through a 6-month follow-up period, but decreases in controls over follow-up rendered the conditions equivalent in blood pressure. No differences between conditions emerged in analyses on pressor responses. Stress management training was somewhat more effective for individuals scoring low rather than high on measures of trait anxiety and irritability.

Adult↗
PubMed1991

Getting together: administrative and clinical teamwork creates a geriatric care program for the hospital.

Sunnybrook Medical Centre, Toronto, has designed a written, multidisciplinary program of care for elderly patients in acute care. The program includes specific community outreach activities that support the in-hospital program and addresses the challenges presented by an increasingly aged population. Some of its objectives are to develop a measurement for length of stay patterns, a reduction in the number of patients waiting for relocation to a long-term care institution (commonly and derogatorily referred to as "placement problems") and an increase in patient, family and staff satisfaction. A method for program evaluation is being designed. The program takes a three-level approach to care: (1) the non-problematic elderly patient, (2) the more complex elderly patient and (3) the care of patients who have finished treatment for their acute illness but who require long-term care institutionalization.

Aged↗
PubMedDate not supplied

Evaluation of suicide intervention effectiveness.

Considering the prevalence of suicide and other forms of self-injurious behavior, it is ironic that relatively little attention has been paid to the training of mental health workers in suicide intervention. Still less effort has been spent in evaluating the effectiveness of such workers or the agencies in which they serve. We review the evaluation strategies that have been used to assess the process and outcome of suicide intervention, ranging from macroanalyses of the impact of crisis services on suicide rates in the community to microanalyses of the competence of individual suicide interventionists. Particular attention is paid to the Suicide Intervention Response Inventory, a self-administered test of suicide counseling skills whose validity, reliability, and practical utility suggest the benefit of its use in a broader range of research and applied settings. The advantages and disadvantages of each evaluation strategy are discussed, and guidelines are offered for the sophistication of future research and program evaluation efforts.

Community Mental Health Services↗
PubMedDate not supplied

Further psychometric evaluation and revision of the Mayo-Portland Adaptability Inventory in a national sample.

OBJECTIVES: To evaluate the internal consistency of the Mayo-Portland Adaptability Inventory (MPAI), further refine the instrument, and provide reference data based on a large, geographically diverse sample of persons with acquired brain injury (ABI). SUBJECTS: 386 persons, most with moderate to severe ABI. SETTINGS: Outpatient, community-based, and residential rehabilitation facilities for persons with ABI located in the United States: West, Midwest, and Southeast. METHODS: Rasch, item cluster, principal components, and traditional psychometric analyses for internal consistency of MPAI data and subscales. RESULTS: With rescoring of rating scales for 4 items, a 29-item version of the MPAI showed satisfactory internal consistency by Rasch (Person Reliability=.88; Item Reliability=.99) and traditional psychometric indicators (Cronbach's alpha=.89). Three rationally derived subscales for Ability, Activity, and Participation demonstrated psychometric properties that were equivalent to subscales derived empirically through item cluster and factor analyses. For the 3 subscales, Person Reliability ranged from.78 to.79; Item Reliability, from.98 to.99; and Cronbach's alpha, from.76 to.83. Subscales correlated moderately (Pearson r =.49-.65) with each other and strongly with the overall scale (Pearson r=.82-.86). CONCLUSIONS: Outcome after ABI is represented by the unitary dimension described by the MPAI. MPAI subscales further define regions of this dimension that may be useful for evaluation of clinical cases and program evaluation.

Adaptation, Psychological↗
PubMed1983

Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.

The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

Activities of Daily Living↗
PubMed1996

Conducting a comprehensive school health program.

Since the late 1980s, the eight-component model of the comprehensive school health program (CSHP), has been adopted widely in the United States and internationally. While it is acknowledged that the eight program elements should be delivered in a coordinated, interactive manner, numerous issues regarding how this integration best can be achieved, including who at the school level should have this responsibility and how the eight components relate conceptually and logistically, have not been addressed adequately. In essence, a CSHP transforms several solo performers into an orchestra. This article proposes the school health coordinator as an essential element in the eight-component model of the CSHP--the maestro, without whom there can be no symphony. The coordinator's principal responsibilities include administration, integration of personnel and programs, evaluation, and direct intervention. Three program elements--staff wellness, healthy environment, and community/family involvement--are subsumed within the coordinator's role, effectively reducing the number of program elements from eight to five. Potential benefits in addition to issues regarding feasibility of the SHC, are discussed and studies examining the effectiveness of the SHC model are recommended.

Administrative Personnel↗
PubMedDate not supplied

The AcCell series 2000 as a support system for training and evaluation in educational and clinical settings.

Providing effective training, retraining and evaluation programs, including proficiency testing programs, for cytoprofessionals is a challenge shared by many academic and clinical educators internationally. In cytopathology the quality of training has immediately transferable and critically important impacts on satisfactory performance in the clinical setting. Well-designed interactive computer-assisted instruction and testing programs have been shown to enhance initial learning and to reinforce factual and conceptual knowledge. Computer systems designed not only to promote diagnostic accuracy but to integrate and streamline work flow in clinical service settings are candidates for educational adaptation. The AcCell 2000 system, designed as a diagnostic screening support system, offers technology that is adaptable to educational needs during basic and in-service training as well as testing of screening proficiency in both locator and identification skills. We describe the considerations, approaches and applications of the AcCell 2000 system in education programs for both training and evaluation of gynecologic diagnostic screening proficiency.

Automation↗
PubMed1979

Human services workers: a study of perceptions of their role.

Human services workers at the Veterans Administration Hospital, Brentwood, are involved with patients from the time they are admitted to the hospital until they are discharged and adjust to the community. As part of an evaluation of their role, a study was done of their tasks as perceived by themselves, by their supervisors, by other paraprofessionals, and by patients. In general, human services workers were perceived to be most involved in assisting patients in the hospital, followed by involvement in treatment planning; discharge; therapy; assisting patients in the community; support activities; community activities; patient admission and evaluation; and research, education, and program evaluation.

Allied Health Personnel↗
PubMed1979

Comprehensive evaluation model for nursing education.

The proposed model provides structure for determining decisions to be made, questions to be answered, and sources of information about evaluation. A sample of the kinds of decisions that can be made for the various matrix elements of the evaluation model is reflected. Examples of questions that could be asked (why) in order to evaluate various aspects of a program (what) and of whom these questions could be asked (who) are provided. The model as described is useful in comprehensively delineating all aspects of the system. The flexibility of the system allows for the unique needs and aspects of the individual school to emerge. The model also provides a framework for organizing and implementing a plan for total program evaluation.

Data Collection↗