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PubMed1996

Strengthening public health practice content in public health training.

U.S. schools of public health have recognized the imperative to strengthen the public health practice content of training for future public health practitioners. Five strategies to develop administrative and curriculum programs within schools of public health to address this need are described: (1) institution of centers for public health program evaluation; (2) creation of automated field placement and apprenticeship programs; (3) formalization of linkages with professional management training programs to create a track for future senior managers of community health agencies; (4) establishment of cross-departmental applied public health faculty tracks; and (5) offering applied public health evaluation scholarships for students. These initiatives may provide incentives for the institution of a public health practice focus within schools of public health.

Curriculum↗
PubMed1978

Applied anthropology and the concept of the underdog: implications for community mental health planning and evaluation.

Medical anthropologists have long been involved in health-program evaluation and have studied factors related to program acceptance in target communities. However, assessing the reasons for the success or failure of a program should not be an end in itself, but should be a process that generates guidelines for the development of similar programs elsewhere and more general suggestions about the appropriate roles that applied anthropologists can fulfill. This paper briefly summarizes the research of an anthropological team who investigated the apparent failure of a respite home facility for retarded children in a suburban neighborhood to generate requisite community support. The team was able to develop a series of recommendations in aid of a plan to establish such centers elsewhere in the county, and in the state of Florida as a whole. However, the paper is more broadly concerned with applied anthropological attempts to define the nature of target or client communities and at delineating the appropriate anthropological perspective on health care delivery transactions. New roles for the anthropologist as evaluator will be considered.

Anthropology, Cultural↗
PubMed1997

Primary prevention mental health programs: the future is exciting.

Current outcome research on primary prevention mental health programs is encouraging and the future is exciting. Data continue to accumulate regarding the efficacy of preventive intervention. Exemplary programs can prevent multiple problems across different outcome domains suggesting the need for collaboration among preventionists across disciplines and research areas. The commentators on our review (Durlak and Wells, 1997) offered many useful suggestions to improve the next generation of research. Most recommendations fall broadly under the rubric of increasing the precision of theory, design, and program evaluation. If current recommendations for improving future research are followed, the next reviewers of primary prevention mental health programs for children and adolescents will have a more complete and useful database for analysis.

Adolescent↗
PubMed1994

The measurement of community benefit: issues, options, and questions for further research.

Community benefit from a conceptual perspective can be traced to the philanthropic and humanitarian spirit that dominated the earliest foundations of the hospital as a social institution. However, the measurement of community benefit is a recent development and one rarely addressed in the literature in any detail. This article outlines the various concepts integral to community benefit measurement that must be taken into account for a program to demonstrate community accountability in an era where hospitals and health care institutions are increasingly required to evaluate and document their value to society. The perspective taken is that of a practicing health care executive. The use of the discussed concepts will assist health care executives and their staff in designing and evaluating programs, and will also assist academics in preparing students for this important professional responsibility.

Community Health Services↗
PubMed2003

Reaching managers at an industry association conference: evaluation of ergonomics training.

Managers rarely receive targeted safety and health training, despite the belief that management support is important for a successful workplace safety and health program. A program evaluation was performed on an ergonomics workshop for managers attending an industry association conference. The goals were to determine whether the conference was an effective setting for the training, to assess whether the training led to an increase in participants' knowledge and ability, and to determine whether participants could use what was taught in an applied exercise. The majority of participants (97%) believed the conference was an effective setting for the training. Participants' knowledge and ability to identify musculoskeletal risks increased significantly following the training. Additionally, participants were able to identify musculoskeletal risk factors and suggest solutions during the applied exercise. Occupational health nurses should consider trade association meetings as a venue for educational training sessions and for disseminating their research results.

Administrative Personnel↗
PubMedDate not supplied

Evaluating and improving VA substance abuse patients' care.

The VA has implemented a nationwide evaluation program to monitor process and outcome of care for substance abuse patients. This program focuses on the changing characteristics of VA substance abuse patients and treatment services and involves outcome-based evaluations of major VA substance abuse treatment modalities. Initial findings show that VA substance abuse patients, including patients with concomitant psychiatric disorders, improve substantially from treatment intake to a 1-year follow-up and that community residential facilities are an important part of the continuum of substance abuse care. Moreover, within broad limits, there is a dose-response relationship between the continuity of outpatient mental health care and better 1-year substance use and psychosocial outcomes. These findings are placed into context as part of an evidence-based initiative to improve the quality of VA mental health care.

Adult↗
PubMed1987

The importance of considering alternative structural equation models in evaluation research.

The availability of the LISREL computer program and similar software (for example, COSAN, EQS) have made structural equation modeling accessible to researchers interested in program evaluation. An article was published in the December 1985 issue of this journal that used LISREL to investigate the relationship between family medicine residents' moral reasoning and their clinical performance with patients (Sheehan et al., 1985). We present a reanalysis of the data from that study to illustrate the importance of considering alternative structural equation models in evaluation research.

Ethics, Medical↗
PubMed1997

Multiplying health gains: the critical role of capacity-building within health promotion programs.

Health outcomes in populations are the product of three factors: (1) the size of effect of the intervention; (2) the reach or penetration of an intervention into a population and (3) the sustainability of the effect. The last factor is crucial. In recent years, many health promotion workers have moved the focus of their efforts away from the immediate population group or environment of interest towards making other health workers and other organisations responsible for, and more capable of, conducting health promotion programs, maintaining those programs and initiating others. 'Capacity-building' by health promotion workers to enhance the capacity of the system to prolong and multiply health effects thus represents a 'value added' dimension to the health outcomes offered by any particular health promotion program. The value of this activity will become apparent in the long term, with methods to detect multiple types of health outcomes. But in the short term its value will be difficult to assess unless we devise specific measures to detect it. At present the term 'capacity-building' is conceptualised and assessed in different ways in the health promotion literature. Development of reliable indicators of capacity-building which could be used both in program planning and in program evaluation will need to take this into account. Such work will provide health-decision makers with information about program potential at the conclusion of the funding period, which could be factored into resource allocation decisions, in addition to the usual information about a program's impact on health outcomes. By program potential, we mean ability to reap greater and wider health gains.

Australia↗
PubMed2000

Using focus groups to design a community health program: what roles should volunteers play?

This volunteer-based community health advisory program illustrated the benefits of using focus groups to monitor and guide program development. Three focus groups, conducted by program evaluators, obtained input regarding the role of community volunteers. Focus group findings confirmed some of the assumptions held by program developers but refuted others. For example, prospective community participants and program developers were found to view the role of "volunteer" in the neighborhood health advisory program differently. As a result, adjustments were made in recruitment strategies and other procedural aspects to accommodate the residents' perspectives and values. This experience illustrated how preliminary focus group research can enhance linkage between program developers and community members.

Attitude of Health Personnel↗
PubMed1988

Menstrual regulation in Bangladesh: an evaluation of training and service programs.

This article evaluates the performance of three urban menstrual regulation (MR) training and service programs in Bangladesh. Virtually all of the MR providers including physicians and paramedics in the three centers received training in various MR procedures by means of demonstration or class lectures. However, a significant proportion of the trained MR providers were unable to render proper MR services due to the lack of clinical facilities and lack of equipment. Analysis of follow-up data for MR clients revealed that those women who utilized MR procedures offered through the centers had an average of about three live births. Physician providers were more likely to serve clients from a higher socioeconomic strata, while paramedical providers were more likely to serve MR clients from lower socioeconomic strata or agricultural background. Most of the clients receiving MR services were ever and current users of contraceptives and developed fewer complications from MR procedures than those served by untrained traditional herbalists, healers or birth attendants.

Adult↗
PubMed1979

Evaluation of extramural programs.

Extramural programs may be evaluated in terms of effectiveness in achieving their particular goals. The components of structure, process, and outcome are examined as related sets of program elements. Goals influence appropriate structure in organization, facilities, and manpower. Structure in turn influences process or activities which result in outcome. Outcome is considered in terms of goals. Each set of elements is examined by institutional faculty and administration, extramural faculty, and students. Where all agree that desired outcome variables are relevant to the goal(s) and are achieved, the program is "effective." Where outcome and goal are not compatible, process and then structure must be examined for appropriateness of each. When there is disagreement between groups about any element, a problem area in the program is specifically identified. The procedure for cyclic assessment may be used by a school or program for self-study or for periodic internal monitoring of problem areas. Use of this method has shown some characteristics common to different types of extramural programs.

Education, Medical↗
PubMed2005

A meta-analysis of parent training: moderators and follow-up effects.

A meta-analysis of 63 peer-reviewed studies evaluated the ability of parent training programs to modify disruptive child behaviors and parental behavior and perceptions. This analysis extends previous work by directly comparing behavioral and nonbehavioral programs, evaluating follow-up effects, isolating dependent variables expressly targeted by parent training, and examining moderators. Effects immediately following treatment for behavioral and nonbehavioral programs were small to moderate. For nonbehavioral programs, insufficient studies precluded examining follow-up effects. For behavioral programs, follow-up effects were small in magnitude. Parent training was least effective for economically disadvantaged families; importantly, such families benefited significantly more from individually delivered parent training compared to group delivery. Including children in their own therapy, separate from parent training, did not enhance outcomes.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience.

BACKGROUND: Advances in the diagnosis and treatment of breast carcinoma have led to a multidisciplinary approach to management for patients with breast carcinoma. To assess the effect of this approach, the authors performed an evaluation for a cohort of patients examined in a multidisciplinary breast cancer center. METHODS: An analysis was performed for the records of 75 consecutive women with 77 breast lesions examined in consultation in a multidisciplinary breast cancer center between January and June 1998. Each patient's case was evaluated by a panel consisting of a medical oncologist, surgical oncologist, radiation oncologist, pathologist, diagnostic radiologist, and, when indicated, plastic surgeon. A comprehensive history and physical examination was performed, and the relevant mammograms, pathology slides, and medical records were reviewed. Treatment recommendations made before this evaluation were compared with the consensus recommendations made by the panel. RESULTS: For the 75 patients, the multidisciplinary panel disagreed with the treatment recommendations from the outside physicians in 32 cases (43%), and agreed in 41 cases (55%). Two patients (3%) had no treatment recommendation before consultation. For the 32 patients with a disagreement, the treatment recommendations were breast-conservation treatment instead of mastectomy (n = 13; 41%) or reexcision (n = 2; 6%); further workup instead of immediate definitive treatment (n = 10; 31%); treatment based on major change in diagnosis on pathology review (n = 3; 9%); addition of postmastectomy radiation treatment (n = 3; 9%); or addition of hormonal therapy (n = 1; 3%). CONCLUSIONS: The multidisciplinary breast cancer evaluation program provided an integrated program in which individual patients were evaluated by a team of physicians and led to a change in treatment recommendation for 43% (32 of 75) of the patients examined. This multidisciplinary program provided important second opinions for many patients with breast carcinoma.

Adult↗
PubMed1990

Improving the use of evaluation in health settings: do data support and order of recommendation make a difference?

This study examined two variables associated with nurse decision makers' perceptions of the usefulness of program evaluation. The first variable represented amount of data support for recommendations; the second represented the order of presentation of supporting and nonsupporting recommendations. The sample of New York state nurses reflected two levels of decision makers: Supervised (staff nurses) and supervising (head nurses, supervisors, and directors). Results indicated that experience with decision making and order of presentation affected perceptions of recommendations and sufficiency of information.

Administrative Personnel↗
PubMedDate not supplied

Organizing and presenting program outcome data.

This article focuses on the challenging process of collecting, organizing, and presenting outcome data for systematic program evaluation. Critical thinking is used as an example of outcome criteria. The article indicates how a baccalaureate and master's program benefited from the development of a systematic, creative method of data collection, analysis, and reporting.

Accreditation↗
PubMedDate not supplied

An international physician education program to support the recent introduction of family medicine in Egypt.

BACKGROUND AND OBJECTIVES: There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI). METHODS: Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation. RESULTS: Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before. CONCLUSIONS: Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

Clinical Competence↗
PubMed1992

Quantifying handicap: a new measure of long-term rehabilitation outcomes.

According to the World Health Organization (WHO), handicaps exist when individuals are unable to fulfill expected social roles. Although ameliorating handicaps is one of the prime goals of rehabilitation, its effectiveness in this area is poorly measured and has not been documented empirically. Therefore, the Craig Handicap Assessment and Reporting Technique (CHART) was designed to quantify the extent of handicap in individuals. Using dimensions of handicap identified and described by the WHO, CHART uses measurable, behavioral terms to compare such individuals with the norms of able-bodied members of society. Test-retest, proxies, and independent raters have established the validity and reliability of CHART. Rasch analysis has verified the CHART scaling and scoring procedures. In addition, an initial application of CHART, with a group of 342 spinal cord injured individuals, is described. Beyond demonstrating the instrument's effectiveness in assessing the extent of handicap or social disadvantage, this application, by documenting rehabilitation outcomes, demonstrates the potential usefulness of CHART for program evaluation.

Activities of Daily Living↗
PubMed1976

The relative effectiveness of a medical hospitalization program vs a feedback-behavior modification program in treating alcohol and drug abusers.

There is a sparsity of studies specifying the relative effectiveness of different types of treatment programs in treating a similar target population of drug and alcohol abusers in the same locale. In this paper, two drug and alcohol rehabilitation programs are described and their relative effectiveness compared in treating similar target populations. The first treatment program evaluated is a medically oriented hospitalization program and the second is a short-term therapeutic community program, called "Feedback" because it is structured on the basis of a collection of feedback and behavior modification principles and techniques. Both programs were implemented by basically the same staff and both treated similar target populations of multiple drug abusers and alcohol abusers during comparable time periods. The results indicated that the feedback program was significantly more effective in rehabilitating multiple drug abusers (nonheroin abusers) than the hospitalization program with regard to three criteria (return to work for 60 days, perform effectively according to the supervisor, and control drug or alcohol problems). But both programs were equally effective in rehabilitating alcohol abusers (problem drinkers and alcoholics).

Alcoholism↗