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Achieving the goals of day treatment.

The problem of defining relevant goals in the rehabilitation of severely ill psychiatric patients was addressed in a day treatment program. A method was evolved from a detailed assessment of each patient's specific community functioning. Behavioral treatment strategies were individually tailored to meet the needs of a wide variety of patients in an intensive time-limited day treatment program. The provision of long term supportive outpatient services as well as overnight hospital care was considered essential for the program. Evaluation of the effectiveness of the day treatment program suggested that it did meet the needs of severely ill psychiatric patients; that good outcome was associated with high levels of participation of patients in defining their goals; and that goals concerning social and vocational functioning were achieved more frequently than intrapersonal goals.

Adult↗

Using an outcomes-logic-model approach to evaluate a faculty development program for medical educators.

PURPOSE: This study used an outcomes-logic-model approach to examine the impact of participating in a nontraditional professional development program. Building and using a logic model provides a structure for the program to examine the degree that the desired learner outcomes, the program delivery methods, and the measurement approaches are aligned. METHOD: Structured telephone interviews were conducted in 2001 with 16 Harvard Medical School (HMS) participants in the Harvard Macy Program for Physician Educators (HM-PE): five who completed the program in 1998, five in 1999, and six in 2000. Interviews were also conducted with four Faculty Scholars, alumni of the HM-PE program who taught in subsequent programs. In 2004, online questionnaires were sent to the 16 participants and four Faculty Scholars. Immediate outcomes, such as greater use of active learning principles, and intermediate outcomes, such as commitment to medical education, were examined. RESULTS: Of those interviewed in 2001, 80% responded to the 2004 online questionnaire. Thirteen of 16 (81%) HMS respondents reported increased knowledge about and confidence using learner-center teaching methods; 10 of 16 (63%) said they gave fewer lectures and added alternative educational methods. Thirteen of 16 (81%) reported a stronger commitment to the field of medical education: almost one third felt the HM-PE program was a turning point in their careers. CONCLUSIONS: The outcomes logic model provided data to judge how well the program mission and plan were implemented, and whether outcomes had been attained.

Boston↗

Advances in development and evaluation of asthma education programs.

PURPOSE OF REVIEW: Effective asthma education requires more than merely providing information on asthma. Behavior change and learning principles must be incorporated into educational programs. However, there remains much debate and research about the most effective strategies to educate people to deal effectively with their asthma. This article focuses on recent advances in theoretical and practical strategies and examines core elements of successful asthma education programs. RECENT FINDINGS: Asthma education has improved in recent years as a result of application of evidence-based, theoretical principles that guide learning and behavior modification. Many studies show a refreshing focus on how to teach and have made substantial contributions to testing educational theories and making meaningful improvements to those with asthma. Successful asthma education programs include behavior change strategies, shared care practices and communication skills, a clear educational process, tailoring to client needs and influencing factors, multiple teaching formats, and a continuum of care. SUMMARY: An array of effective and innovative asthma education programs have been developed and tested. However, numerous areas in asthma education require improvement and further research, such as real-world models, sensitivities to underserved populations or venues, innovative partnerships, continuum of care, and patient incentive/participation.

Asthma↗

Evaluating a nutrition education program for pregnant teen-agers: cognitive vs. behavioral outcomes.

A manual-based program of nutrition education for pregnancy and lactation was developed. This program was evaluated in a classroom setting using two measures of effectiveness. A pretest and posttest format was used to assess cognitive outcomes and predietary and postdietary records were used to assess behavioral changes. The difference between cognitive test scores was significant. However, actual dietary improvements were slight and were within the range of normal intake variation. This study emphasizes the need to assess behavior in order to more fully evaluate educational effectiveness. Observations of the study also suggest the desirability of environmental support for the successful translation of classroom knowledge into appropriate behaviors.

Adolescent↗

GAO's role in the evaluation of federal health programs.

The General Accounting Office (GAO) is a legislative branch agency whose mission is to support the oversight role of Congress. Health policy issues have constituted a substantial part of GAO's recent workload. Whereas GAO's work on health has ranged broadly, it has often focused on fraud and abuse in federal programs, particularly Medicare and Medicaid; the lack of meaningful indicators and other information, particularly on outcomes in health programs; access to care, increasingly connected to managed care; quality of care; and issues related to cost control.

Cost Control↗

An illustration of item homogeneity scaling and multilevel analysis techniques in the evaluation of drug prevention programs.

Many reports of successful school-based intervention programs can be criticized for their choice of a unit of analysis and for the neglect of measurement errors. This article is an illustration of how different conclusions can be reached from different choices of units of analyses and/or of different treatment of the data. This is done by a reanalysis of a well-reported data set. The data is thoroughly taken apart, using different statistical techniques. The result of the analyses shows that earlier reported effects of a normative school-based drug prevention program were not found. The subsequent search for moderator effects of the same program, such as a lowering effect on the relationship between the pre- and posttest or on the relationship between respondents' use and the use of their friends, was not successful either. It is concluded that the null hypothesis of zero effects should be retained. More successful was a search for individual characteristics that show significant relationships with respondents' alcohol use. Among them was the abuse of alcohol by adults in respondents' direct social environment and the use of friends.

Adolescent↗

Evaluating the vocational rehabilitation program using longitudinal data. Evidence for a quasiexperimental research design.

The study presents benefit-cost ratios for 14 disability cohorts served by the Vocational Rehabilitation (VR) Program. The earnings impacts are estimated in a quasiexperimental framework using an internal comparison group. The earnings data are from a unique national panel constructed by linking client data of the Rehabilitative Services Administration with earnings histories from the Social Security Administration. These earnings data accommodate a series of statistical tests that allow us to identify and control for the presence of selection bias when estimating treatment impacts. The results indicate that the VR program is cost-effective in general, although not universally so across specific disabilities.

Adult↗

Study of sunbathing in children: the preliminary evaluation of a prevention program.

AIMS AND BACKGROUND: Sunburn during childhood is associated with an increased risk for developing melanoma in an adult age. The aim of the present study was to define the validity of our educational program in order to teach the positive effects and risks of sun exposure during childhood. PATIENTS AND METHODS: We conducted a population-based, case-control study in primary schools of three towns in Northern Italy (Brescia, Bergamo and Trento) between 2001 and 2002. The study was carried out on 1945 pupils (aged 8-9 years) and included 1309 case children who received an educational program before the summer to increase awareness towards sun exposure and 636 control children who did not. Parents of case and control children were interviewed using a questionnaire about their children's skin characteristics, sun protective behavior and sunburns. The questionnaire was completed twice, before and after the summer, to verify the changes of sun exposure habits. RESULTS: A significant decrease in sunburns was demonstrated in the group of subjects who received the educational program, indicating the validity of our operative procedure (from 14.6% to 10%, P = 4 x 10(-4). CONCLUSIONS: Our educational melanoma program may be important to disseminate in a wider range of children a correct education on sun exposure during childhood.

Case-Control Studies↗

The Falmouth Safe Skin Project: evaluation of a community program to promote sun protection in youth.

A multidimensional community-based skin cancer prevention program was conducted in Falmouth, Massachusetts, combining community activism with publicity campaigns and behavioral interventions to improve sun protection knowledge; attitudes; and practices in parents, caregivers, and children. The program was associated with improvements in target outcomes, based on two telephone surveys of random samples of parents (n = 401, 404). After program implementation, fewer parents reported sunburning of their children, particularly among children 6 years old or younger (18.6% in 1994 vs. 3.2% in 1997), and more parents reported children using sunscreen, particularly continuous use at the beach (from 47.4% to 69.9% in younger children). Hat and shirt use did not increase. Improvements also were seen in parent role modeling of sun protection practices, parents' self-efficacy in protecting children from the sun, and sun protection knowledge. While these findings must be interpreted cautiously, they do suggest that this project was effective in promoting sun protection.

Adolescent↗

Heterogeneity within the Asian American community.

BACKGROUND: Educational interventions are grounded on scientific data and assumptions about the community to be served. While the Pan Asian community is composed of multiple, ethnic subgroups, it is often treated as a single group for which one health promotion program will be applicable for all of its cultural subgroups. Compounding this stereotypical view of the Pan Asian community, there is sparse data about the cultural subgroups' similarities and dissimilarities. The Asian Grocery Store based cancer education program evaluation data provided an opportunity to compare data collected under identical circumstances from members of six Asian American cultural groups. METHODS: A convenience sample of 1,202 Asian American women evaluated the cultural alignment of a cancer education program, completing baseline and follow-up surveys that included questions about their breast cancer knowledge, attitudes, and screening behaviors. Participants took part in a brief education program that facilitated adherence to recommended screening guidelines. RESULTS: Unique recruitment methods were needed to attract participants from each ethnic group. Impressions gained from the aggregate data revealed different insights than the disaggregate data. Statistically significant variations existed among the subgroups' breast cancer knowledge, attitudes, and screening behaviors that could contribute to health disparities among the subgroups and within the aggregate Pan Asian community. CONCLUSION: Health promotion efforts of providers, educators, and policy makers can be enhanced if cultural differences are identified and taken into account when developing strategies to reduce health disparities and promote health equity.

Journal Article↗

Monitoring the uninsured: a state policy perspective.

Because states have primary responsibility for the implementation of public health insurance programs, states need timely, good quality data to evaluate programs, monitor trends in the number and characteristics of the uninsured, and better understand the dynamics of health insurance coverage. This article provides a synthesis of the data sources available to states for monitoring rates of health insurance coverage. Information was collected through a comprehensive review of state and national health surveys and in-depth interviews with state analysts in all fifty states. Our findings suggest that national surveys do not meet states' needs for data, and in response, states have initiated their own household surveys. We provide information on thirty-six household surveys that are used to estimate state levels of health insurance coverage. We recommend that national and state efforts be better coordinated to facilitate efficient use of resources to achieve good state-level date.

Data Collection↗

[Evaluation of an educational program for patients with glaucoma].

PURPOSE: To analyze the results of an educational program applied to glaucoma patients; to serve as a guideline for a definitive educational program to be developed at the Glaucoma Service of the University of Campinas. METHODS: Fifty glaucoma patients were given information about the disease and its treatment by an experienced nurse and answered the same questionnaire before and 2.7 months after the initial explanation. The technique of eyedrop instillation was compared before and after the educational program. RESULTS: There was no significant improvement concerning the knowledge of the identification of the ocular disease, the side effects, the meaning of glaucoma, the importance of treatment, the purpose of medications and the normal value of intraocular pressure. There was a significant improvement in all steps of eyedrop instillation (p < 0.01) and in knowledge regarding the importance of heredity (p < 0.001) and the purpose of perimetry (p=0.033). CONCLUSION: Although a significant improvement was observed in the technique of eyedrop instillation, the authors conclude that this plan was not complete enough for its contents fully to be understood. These findings may be secondary to the vertical teaching-learning process, which is inappropriate for the patient, and to the difficulty in comprehending the information, which is associated with low cultural and instruction levels, and to psychosocial factors related to their disease.

Adolescent↗

[Human hydatidosis: field echography for the determination of groups at high risk in the evaluation of a control program].

The development of small ultrasonographic equipment has permitted to incorporate this technique to the methods of early detection of Human Hydatidosis. 689 echographies were carried out in this experience, and 5.51% of compatible images in the whole population, and 12.24% in groups of risk (those living together with the operated ones) were found. It was observed a significant decrease in the infection percentages in man in the whole population of areas under Control Program, using the echographic screening. In conclusion, echography might be incorporated to the epidemiologic surveillance system of human Hydatidosis.

Adolescent↗