Finding What Works: Answers to Evidence-Based Program Planning

1. Finding What Works: Answers to Evidence-Based Program Planning October 22, 2009

2. Welcome Pre and post evaluation Introductions Name, organization, years in breast health or other health issue Agenda for day

3. Today • Focus on a behavior(s) to change • Describe the population you are planning to work with • Describe the health problem and quality of life concerns • Review literature to ask about reasons for behavior • Understand what has worked to change the behavior – evidence based programs/strategies • Learn how to write S.M.A.R.T objectives • Match objectives with evaluation methods

4. Evidence-Based Program Planning

5. Evidence in Program Planning Evidence from prior research Evidence from the community Assess Needs of Population Assess Causes and Resources Evaluate Program Adopt / Adapt / Design, and Implement Program Program Evidence Evidence from experimental studies Green LW, Kreuter MW. (1999) Health Promotion and Planning: An Education and Ecological Approach. 3rd Ed.

6. Why start with a needs assessment? To assess the health problem Related behaviors Environmental conditions and Understand associated factors for the at-risk population

7. Needs Assessments Include stakeholders or those vested interested in the problem Remember to:* Avoid blaming the victim Involve community participants Examine environmental causes of the problem * Suarez-Balcazar, 1992 • Help understand the personal and environmental factors that impact a health behavior • An effective program must address a real problem or need

8. Example Factors • How does fear impact getting screened for breast cancer? • How do family opinions impact enrollment in clinical trials? • How does no insurance impact women regaining range of motion after surgery? • How do personal and environment factors impact a health behavior and ultimately a health problem?

9. Collecting Data in a Meaningful Way

10. Using a Planning Model Plan how to assess the problem or need Help guide the assessment by using a modified PRECEDE model This model views behavior influenced by: Individuals and Environmental factors Just as a medical diagnosis is needed to design a treatment plan An educational diagnosis is needed to design a health promotion intervention

11. Using a Planning Model to Look a Health Problem

12. Conducting a Needs Assessment Using a Model Health issue and quality of life indicators Behaviors contributing to the health problem Personal factors impacting the behavior Environmental factors impacting the behavior

13. Health Issue • What is the problem? • Who has it? • Higher risk for health problem • Already have the health problem • Aren’t doing the health behavior • Certain age, race/ethnicity, income, education level • What is the mortality and distribution of the problem? • What are the: • Demographics, • Characteristics of the population with the problem? • Who has excess risk or excess burden?

14. Quality of Life What is the cost of the problem? How is the work performance impacted with those with the health problem? How are the activities of daily life impacted with those with the problem? Does isolation occur?

15. Behavioral Factors • What behaviors are contributing to the health problem? • Takes more than education to change behavior • What is not happening? • Not getting a mammogram or repeat mammogram • Not following up for a diagnostic mammogram • Not considering clinical trials • Not following treatment plan • Not managing side effects of treatment WHY?

16. Multiple Levels of Influence • _______ • _________ • ________ • ________ • ______ • _____ • ________ • ___ __ _________ _____ ______ ______ ___ _________ _______________ • ________ ________ ___ ________ __ _________ • ________ ______ ______ _________ • ___ __ _______ ______ • ____________ • __ ____ ________ ___ _ _____ ____ ___ __ __ • Personal • Individual • Knowledge • Attitudes • Beliefs • Skills • Questions • Lack of knowledge about breast cancer and screening recommendations • Perceived barriers and benefits of screening • Attitudes toward cancer/screening • Fear of finding cancer • Embarrassment • Low self-efficacy (don’t think they can do it) • Environmental • Interpersonal • Family and peers • Institutional • Rules and informal structures • Community • Social networks and norms • Public policy • Policies and laws • Questions: • Lack of available services • Cost/lack of health insurance • No provider referral • Transportation problems • Social norms around screening McLeroy and colleagues, 1988

17. Your Grant Proposal Should: • Present a systematic way of understanding events or situations • Define concepts, definitions and propositions • Explains or predicts situations • Illustrates the relationships between factors to explain behaviors • Helps answer why, what, how health problems should be addressed

18. Breast and Cervical Cancer Model Maria Fernandez

19. Locate and Use Data to Describe the Burden of a Health Problem

20. Using a Planning Model to Look at a Health Problem

21. Health Issue What is the problem? Who has it? What are the incidence and distribution of the problem? Who has excess risk or excess burden? Breast cancer found in later stages Low screening rates More treatment needed for later stages Risk factors Mortality rates Disparities

22. Quality of Life What is the cost of the problem? How is the work performance impacted with those with the health problem? How are the activities of daily life impacted with those with the problem? Higher stress levels Financial stress and burden Not able to return to work and household activities Body image issues

23. Data Sources • Susan G. Komen for the Cure Community Profile • Texas Department of State Health Services • BRFSS • US Census Bureau

24. Health Data for Your Community with an Emphasis on Breast Cancer Make this a favorite: • http://www.sph.uth.tmc.edu/library/default.aspx?id=9450 • Let’s take a look • You have handouts too

25. Uninsured Populations • Percentage of Non-Institutional Civilian Population Without Health Insurance in Texas, by County or County Group (PUMA), 2008 • http://texasweekly.com/files/txuninsured20090925.pdf • Health Insurance Coverage Maps • http://texasweekly.com/files/healthcgvmaps.pdf

26. List Resources That Describe Factors That Influence Behavior

27. Using a Planning Model to Look at a Health Problem

28. Types of Journal Literature • Meta-analyses • Statistical analysis of data from multiple independent studies on a topic • Systematic review • Collates empirical evidence from multiple independent studies that fit the specified eligibility criteria • Designed to answer a specific research question • Literature Review • Authors describe the research done in an area • Not compiled as in a systematic review

29. Health Data for Your Community with an Emphasis on Breast Cancer Make this a favorite: • http://www.sph.uth.tmc.edu/library/default.aspx?id=9450 • Let’s take a look • You have handouts too

30. Types of Journal Literature • Original Research • Author has gathered the data him/herself and written up results • Professional articles • Generally not in a peer-reviewed journal • Reporting on a new study that appeared in a scholarly journal OR • A “how I done good” report on a project • No true evaluation of the project • Not research based!

31. Which Should You Use? • If one is available, a systematic review or meta-analyses is preferred • Literature reviews helpful for an overview • Original research with caveats • Did they use a health theory to develop intervention? • Did they evaluate? • Does their population match yours? • Race, ethnicity, urban vs. rural, male vs. female, SES • Review the levels of evidence

33. Confirm Findings with Your Community ASK! Individuals Observation Key informant interview Survey Interview Interacting Focus groups Community forum Photovoice

34. Using a Planning Model to Look at a Health Problem Interventions

35. Describe an example of an Evidence-Based Program

36. Questions That Drive Our Work What are the most important things I can do to promote population health? How do I make the most impact with the least money? Which interventions are most effective to impact the health behavior? What interventions can I implement?

37. Evidence-Based Programs An evidence-based program has been: • Implemented • Evaluated • Found to be effective

38. Continuum of Evidence • Weak • Evidence • That’s the way we always did it • The “powers that be” want this • My gut says so • Evidence-Informed • Determine extent of the problem – census, registry • Review literature • Find similar programs, PLANET, literature • Talk to colleagues doing similar types of programs • Talk to experts in the field • Consensus • Program evaluation • Evidence-Based • Replication Studies • Multiple Sites • Well designed research with outcome and impact results • Programs in PLANET, SAMHSA, Community Guide • Evidence • Based • Adaptation • Identify needed adaptations – content or delivery • Determine level of fidelity • Use adaptation guidelines • Fit Developed by Linda Fleisher, 2005

39. Where Can We Find Evidence-Based Strategies and Programs • Cancer Control Planet • http://cancercontrolplanet.cancer.gov/ • Guide to Community Preventive Services • http://www.thecommunityguide.org/ • Research-tested Intervention Programs (RTIPs) • http://rtips.cancer.gov/rtips/index.do • National Resource for Evidence-based Programs and Practices • http://www.nrepp.samhsa.gov/ • Other sources

40. Benefits Effective in the groups & settings in which they were evaluated Cost-effective Shortens development time Can reduce research time Can help focus the evaluation

41. Why the Fuss? • Funding agencies want to see • Evidence that is proven through research and/or • Evidence that is derived from experience or practice • The best evidence may be a combination of research and practice.

42. Find Programs and Practices That Have Been Shown to Work

43. Using a Planning Model to Look at a Health Problem Interventions

44. Ways to Include Program Evaluation in Grant Proposals • Cite results of program evaluation to justify program increases and changes • “In the last year, our clinic increased repeat mammograms by 10% with the use of client reminders, compared to the previous year. Our findings are similar the research on the effectiveness of client reminders to increase breast cancer screening (citation from Community Guide).”

45. Look at Current Program • Review the strategies of your program • Review resources to see if there is evidence to support their use • Cite the evidence to support program strategies

46. Propose New Strategies or Program • Propose implementing evidence-based strategies/program • Propose to adapt and pilot test an evidence-based strategy/program • Cite evidence

47. Using a Planning Model to Look at a Health Problem Interventions

48. Goals and Objectives

49. Program Goals and Objectives • They help: • Narrow program scope • Avoid straying from the findings of the needs assessment

50. Goals • The “grand reason” for engaging in your public health effort • Span three or more years • State the desired end result of the program