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The television school and family smoking prevention and cessation project. 1. Theoretical basis and program development.

Program development processes for the Television, School, and Family Project, a school-based smoking prevention and cessation project, are presented in this article. We first review applications of social-psychological and communications theory to school-based and mass media program development. These include the three broad areas of (a) mediators of mass media effects on behavior change, (b) the social influences approach to smoking prevention, and (c) a self-management and social support approach to smoking cessation. A program development model for school-based mass media efficacy trials, with a summary of formative research and pilot study processes, is then presented. The importance of reciprocal support among school district administrators, project research staff, and television station personnel is emphasized with recommendations for future research and demonstration efforts.

Adolescent

Modeling: a method for program development.

Successful program development is crucial for nursing. The methodology of modeling systematically integrates program development strategies recommended in the nursing literature. In addition to guiding program planning and design, the series of diagrams which modeling generates can be used to guide program implementation, evaluation, refinement, and reformulation. The diagramming also facilitates communication with others about the program.

Health Services Needs and Demand

Addressing the issue of cataloging and making accessible chiropractic literature: Part II. Pilot software development program.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty, and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A solution to those problems of accessing, obtaining, and storing article citations from the chiropractic literature come from a pilot computerized program developed for use on the Los Angeles College of Chiropractic (LACC) campus. The Chiropractic Literature Archive and Search Program (CLASP) is dedicated to chiropractic literature. It provides rapid access to the literature and directs the user to one of the participating chiropractic campuses where the article can be found. Because of its ease of operation, the program is a useful tool for nearly all areas of chiropractic, ranging from education and research to clinical patient management. The program would be inexpensive to fully implement, and the hardware needed is minimal. Important protocols have been developed for database input, use and maintenance. Testing of this program on the LACC campus reveals that such a program is capable of making citations of the chiropractic literature available within days of their publication.

Abstracting and Indexing

Let's rethink staff development programs.

Staff development programs act as agents of change in the health care organizations in which they operate. This article suggests that certain consultative techniques and strategies be used by staff development personnel as alternatives to traditional instructional techniques, to bring about positive change more effectively

Consultants

Empathy training as the major thrust of a staff development program.

The purpose of the study was to develop a human-relations-modeled staff development program and obtain an objective measure of the level of empathy of registered nurses who practiced in an acute- and chronic-care hospital. The short-term human-relations-modeled staff development program was designed specifically to assist nurses who scored low in empathy to increase their abilities to perceive and respond with greater empathy. The study indicated that all nurses tested possessed an extremely low level of empathy, that the staff development program significantly raised their levels of empathy, but that more training was needed to enable all or the majority of subjects to reach at least the minimal facilitative level necessary to help another person successfully.

Adult

Evaluation of education program developments: illustration of the research and development cycle.

The Research and Development (R and D) cycle is a program development model used to translate research findings into educational programs or products ready for use in the field. The R and D cycle is illustrated by describing its application to Effective Patient Teaching, a course on teaching skills for health professionals. Evaluation is a continuing part of program development. Evaluation methods need not follow a rigid formula; methods will generally change with the stages of program development and the evaluation purposes.

Educational Measurement

Components in program development.

There has been a great deal of discussion and deliberation concerning the composition of program development. Nonetheless, the question still remains--what is program development? What are possible components in program development? In this paper the following components are described, differentiated, and integrated: Statement of Purpose, Curriculum Design, Program Competencies, Content, Content Competencies, and Practice Environments.

Curriculum

Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. The Infant Health and Development Program.

The Infant Health and Development Program is an eight-site clinical trial designed to evaluate the efficacy of a comprehensive early intervention in reducing the developmental and health problems of low-birth-weight (less than or equal to 2500 g) premature (less than or equal to 37 weeks) infants. Nine hundred eighty-five infants, stratified by site and weight (less than or equal to 2000 g or 2001 to 2500 g), were randomly assigned to receive an educational curriculum focused on child development, as well as family support and pediatric follow-up, or only pediatric follow-up. At corrected age 36 months, the intervention group had significantly higher mean IQ scores than the follow-up group (mean difference in the heavier group was 13.2 and in the lighter group 6.6), significantly fewer maternally reported behavior problems, and a small, but statistically significant, increase in maternally reported minor illnesses for the lighter-birth-weight group only, with no difference in serious health conditions.

Child Behavior

Occupational health program development.

A model occupational health program was developed for 300,000 U. S. Army employees in Europe. Despite the availability of both fiscal resources and personnel, those charged with developing the program discovered that the traditional approach to occupational health could not be applied directly. Complex command channels required a well-stated delineation of responsibilities. Compounding the problems inherent in demographic complexity were geographical dispersion and organizational complexity, a broad spectrum of potential industrial hazards, and diverse occupational health laws for multiple-employee groups, all of which resulted in the need for flexibility. Because of limited capabilities to provide technical and clinical services, all services required a maximum amount of tailoring. The model described here, called the functional approach to occupational health, was designed to address these requirements.

Accidents, Occupational

Characteristics of effective family medicine faculty development programs.

Five federally funded family medicine faculty development programs were site visited from December 1985 to June 1986 to collect from experienced project directors, staff, and faculty their thoughts on training practices and future funding. The sites selected were the Faculty Development Center of Texas in Waco (McLennan County Medical Education and Research Foundation), the National Center for Faculty Development at the University of Miami, and programs at Michigan State University, the University of North Carolina-Chapel Hill, and Duke University. Since the late 1970s these programs have trained 259 fellows and 3,284 other participants. In total, $7,515,350 in federal dollars were spent. A variety of program formats and strategies were used to recruit faculty, and to prepare them in teaching, research, and other skill areas. Interviews (as well as phone conversations and letters) with key personnel at each site resulted in a summary of 30 critical elements identified for effective faculty development. Additionally, respondents made 11 specific recommendations to the Federal Faculty Development Grant Program that concern funding and future programs.

Curriculum

Preceptor development programs: an interpretive approach.

The behavioral model commonly used in preceptor educational programs is inadequate for conveying the complexity of precepting. An interpretive approach is offered as an alternative for preceptor education. Using an interpretive approach is one way to extend our understanding of precepting as an educational process. A preceptor education program is described along with examples of narratives from preceptors. Interpretations of each narrative provide nurse educators with a model for utilizing narratives with preceptors. Themes of teaching, nursing as precepting, and timing are explored. Restoring the narrative to the nursing practice of precepting promises to recapture the richness and complexity of precepting.

Adaptation, Psychological

Evaluating community development programs for health promotion: problems illustrated by a New Zealand example.

This paper illustrates problems in the evaluation of community development programs for health promotion. It is based on the authors' retrospective process evaluation of the Wanganui Community Alcohol Action Program (WCAAP), a recent example of a health promotion program directed at reducing alcohol-related problems in a small New Zealand town. Described by its designers as a community-based program, it included coordination of community organizations, education, publicity and increased enforcement of drinking laws. Discussion of the problems in the evaluation of such programs puts them within the context of the substantial body of previous social science research in both evaluation and community development. This, it is argued, is a body of knowledge with which health promotion researchers need to be conversant. Community development programs usually stem from a process of negotiation between interest groups with differing objectives. This results in a changing definition of both the problem to be solved and the nature of the solution, making evaluation difficult. Community development is also likely to be seen as a new solution providing a panacea for old problems. This can lead to such programs being too ambitious. From the point of view of experimental design these programs are likely to have a number of technical problems. This paper argues that these problems are so significant that it often unwise to attempt large scale evaluations of community development programs. Rather, attention should be concentrated on critically assessing the policy-making process and disseminating previous knowledge about such programs.

Alcoholism

Behavior analysis of residential program development.

When institutions are viewed not as locales but as forms of organizing and regulating human behavior, we see that we "deinstitutionalize" by changing the way we organize and regulate, not necessarily by moving people about. This paper examines residential program development as a process of designing and developing community learning environments. The paper asks "What are the essential behaviors of designing community environments?", that is, what do residential program developers do? Six essential dimensions of program development are identified, and each dimension is critiqued in terms of contemporary practices and needs for innovation. The paper concludes that behavior analysts can play an important role in changing the nature of human service organizations.

Activities of Daily Living

Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence.

The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother's ethnicity, age, or education or with child's birth weight, gender, or neonatal health status; but they were positively related to children's IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ less than or equal to 70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.

Child Day Care Centers

A new look at nursing school program development: self- and external evaluation.

Developing and evaluating educational programs in schools of nursing is one of the most critical functions of the faculty. This process can be approached from a variety of perspectives. Historically, most faculty efforts have been directed at development or evaluation; however, a more proactive approach is to incorporate a process which will encompass both. To accomplish this, two models, the Holistic Formative Evaluation Model and the Stakes Countenance Model, have been merged to produce a model which is applicable to the integrated development and evaluation of a nursing curriculum. This model, the Internal Program Development and Self-Evaluation Model, provides faculty, curriculum developers, and administrators with a comprehensive process which focuses on the monitoring program internal consistency and congruence.

Curriculum

Do consensus conferences work? A process evaluation of the NIH Consensus Development Program.

The purpose of this evaluation study is to identify problems and suggest modifications in the NIH Consensus Development Program. The current program consists of three-day conferences in which experts assess medical technologies for issues of efficacy, safety, conditions of use, and other related topics (e.g., costs and social impact). Eight consensus conferences held between 1980 and 1982 were studied in depth using a variety of methods; five of the conferences were investigated concurrently. In addition, archival material was examined for all but one of the 33 conferences held up to that time, and four planning meetings for future conferences were observed. The delay in publishing our findings provided an opportunity to examine the changes introduced by NIH; it also allowed us to avoid the criticism of numerous prior evaluations for finding fault with programs that are still developing. NIH adopted many of the recommendations in our evaluation report and has investigated others. Based on our evaluation and more recent evidence, however, we conclude that the major problem that was uncovered--selection bias, particularly with respect to the choice of questions and panelists--remains a significant threat to the credibility of the consensus process. More specifically, the results indicate that controversial issues cannot be properly addressed within the present conference format, although that was one of its major purposes. Recommendations for improving the consensus process are presented, as are their implications for a larger set of consensus activities that are currently being conducted.

Consensus Statements as Topic

Effects of the National Institutes of Health Consensus Development Program on physician practice.

The effects of the National Institutes of Health Consensus Development Program on physician behavior were investigated. The medical records of 2770 patients treated in ten hospitals throughout the state of Washington were reviewed to determine if quality of care improved with respect to 12 recommendations put forth by four consensus panels concerning surgical management of primary breast cancer, the use of steroid receptors in breast cancer, cesarean childbirth, and coronary artery bypass surgery. Care was studied during 24 months before and 13 to 24 months after each consensus conference. Results showed that the conferences mostly failed to stimulate change in physician practice, despite moderate success in reaching the appropriate target audience. It was concluded that the consensus development conference is an important educational tool whose effects might be enhanced by focusing on areas of practice that need improvement and by encouraging follow-up programs at the state and local level.

Breast Neoplasms

The adult development program: an educational approach to the delivery of mental health services.

The adult development program is an intensive, shortterm program for individuals who want to change their behavior. It is based on an educational model; participants, who are called students, set their own behavior-change goals, and a multidisciplinary staff teach them techniques for reaching those goals. The program curriculum consists of about 20 seminars and workshops, which give the students an opportunity to learn and to practice new behaviors. Students pay fees that vary from $40 to $500 per month depending on the number of classes they take. Approximately 1750 students have participated in the program since it began six years ago.

Behavior Therapy