Question

expain in details an example about program implementation assessment in healthcare.

Answer 1

Q: AN EXAMPLE ABOUT PROGRAM IMPLEMENTATION ASSESSMENT IN HEALTHCARE.

Physical activity is a leading health indicator and has numerous benefits, including reduced risk of coronary heart disease, hypertension, colon cancer, and diabetes. Regular physical activity can help prevent the onset of diabetes, even among those at high risk (i.e., those with impaired glucose tolerance, and is part of diabetes self-management among people with the disease.

Selecting an Intervention

Before planning the evaluation, you should be familiar with strategies or interventions proven to increase physical activity at the population level.

For this article, we selected the strategy of creating or enhancing access to places for physical activity, combined with informational outreach activities, from the Community Guide. This strategy involves the efforts of worksites, coalitions, agencies, and communities to change the local environment to create or improve access to opportunities for physical activity.

STEPS IN AN EVALUATION OF A PHYSICAL ACTIVITY INTERVENTION

The Centers for Disease Control and Prevention (CDC's) six-step Framework for Program Evaluation in Public Health will be used to guide this step-by-step example (6). These six steps have been adapted for use in physical activity programs and published in the Physical Activity Evaluation Handbook

Step 1: engage stakeholders

Important stakeholders for you as a health educator at a local health department are partners; these partners will carry out the intervention strategy.

You should invite all of the partner and decision-maker stakeholders to a meeting to describe the recommended strategy. The group should then discuss its role in making this strategy into a reality in its community and what evaluation resources it can offer.

Another group of stakeholders is the participants, individuals at high risk of developing diabetes. One way to engage participants is to invite them to a focus group or town meeting. At such a gathering, their ideas about the program can be assessed and used to refine the program to meet their needs. For the "creating access" strategy, for example, the participants can reveal what physical activity offerings would interest them and what venues might best reach them with information about these offerings.

Step 2: describe the program

The partners should be invited back for a second meeting to work on a logic model to depict graphically the proposed relationship between activities and expected outcomes. In this step, the work pertains to planning both the intervention and its evaluation. On the basis of step 1, the health educator is able to share the list of activities discussed at the first meeting and indicate which ones seem more popular or less popular among participants in the focus groups or town meetings.

To begin creating a logic model, the partners can divide the activities into two columns, early activities and later activities. Then the group should discuss outcomes they can realistically expect from the proposed activities.

After the activities and the outcomes have been placed in sequence, the logic model begins to take shape. Inputs (i.e., resources to carry out the activities) can be added to the far left, and an overarching goal can be added to follow from long-term outcomes.

Step 3: focus on evaluation

As a health educator, you want to be sure that the evaluation is useful not only to your health department but also to the partner organizations that help to implement the program. To ensure buy-in and later use of the evaluation, ask stakeholders to develop questions that they would like to have answered.

In our example, the stakeholders have already agreed on a logic model in step 2, and so they can use it to focus their questions. They might decide to ask both process and outcome evaluation questions.

Process

• Are the proposed activities being carried out by the partners? If not, why not?
• What seem to be the most popular activities, and why?
• Are we reaching individuals at risk for diabetes?

Outcome

• Did awareness of opportunities increase?
• Did participation increase? Why or why not?
• Did HbA1c levels decrease among the population with diabetes?

Process questions relate to the inputs and activities, and outcome questions relate to the expected outcomes. It is possible to generate a long list of possible questions from the logic model, but then the list needs to be prioritized. Evaluating all questions may not be essential or even feasible. The stakeholders should remember the purpose of the evaluation and decide what would be useful for decision makers in prioritizing the list of questions.

Examples of process and outcome questions include the following:

Influential factors: Aspects of the community that may affect program's success either positively or negatively (e.g., politics, other initiatives, socioeconomic factors, staff turnover within each partner site, social norms and conditions, program history, stage of development) Early Inputs Time and resources of: Coordinateto ongoing Later in addition activities: Short-term Mid-term Long-term Outcomes Outcomes Outcomes Activities meeting and focus group Health educator IncreasedIncreasedWalking in town awareness participation Map facilities of PA opportunities aerobics and normative swimming, Increased volleyball, and walking support Parks and recreationinformationalced-fee night for use of pool outreach activities-via clinics and Shopping tour of for PA istorical .I Establish women's volleyball league Market the new and existing opportunities Communitythe city college levels of PA among population Decreased HbAlc bureau and place new signage on historical walking tour prevention and control of diabetes in the community

Figure

Example of a logic model for an intervention to create or enhance access to physical activity (PA) combined with informational outreach activities.

Step 4: gather credible evidence

To answer the questions posed in step 3, evidence needs to be collected. How much evidence (quantity) and what kind of evidence (quality) are central to feasibility and accuracy. There must be a balance between collecting enough data and assuring it is of high quality. Sometimes a mix of quantitative and qualitative data will help achieve that balance: quantitative data can provide the numbers you need to answer some questions (e.g., participation rates), and qualitative data can help you understand why you got those numbers (e.g., interview a few who participate and a few who do not to learn why).

There are three parts to this step: 1) analyze the data, 2) interpret the results, and 3) make judgments about the program. Having the performance measures helps to justify your conclusions. Perhaps a community college student needs an internship. You can hire him or her (often without financial compensation) to help with the evaluation. With guidance from you and the supervising professor, the student can analyze the data. Analysis for some questions will be easier than for others.

Step 5: justify conclusions

After the analyses, you should convene a meeting of stakeholders to go over the results. Talk about possible alternative explanations to the findings of the evaluation. Discuss the limitations. One common limitation is having no control community; if possible, use a selected community as a basis of comparison in a quasi-experimental design. Compare the results with the performance measures, and make judgments based primarily on that comparison. If you realize you did not achieve a performance measure, decide if you are willing to say that the program failed. It could be that almost every indicator showed improvement. With the decision makers present, the group can decide which results matter most and use those to summarize their findings to share with the community at large.

Step 6: ensure use and share lessons learned

To ensure use of your evaluation findings, formulate action-oriented recommendations. To help share lessons learned, consider your audience: use appropriate communications strategies and consider the most effective format for information (e.g., report, fact sheet, oral presentation) and venue (e.g., Web site, television, news media, town hall meeting).