Unit 7 Power point & 8 Health Behavior Final Project

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Course Learning Outcomes for Unit VIII Upon completion of this unit, students should be able to:

2. Evaluate the role of the health educator in health behavior change. 2.1 Analyze how health educators use evaluation to determine effective behavior change.

Course/Unit Learning Outcomes

Learning Activity

2.1

Unit Lesson Chapter 15 Article: “A review of Grey and academic literature of evaluation guidance

relevant to public health interventions” Unit VIII Essay

Reading Assignment Chapter 15: Evaluating Theory-Based Public Health Programs: Linking Principles to Practice In order to access the following resource, click the link below. Denford, S., Abraham, C., Callaghan, M., Aighton, P., De Vocht, F., & Arris, S. (2017). A review of Grey and

academic literature of evaluation guidance relevant to public health interventions. BMC Health Services Research, 17, 1–14. Retrieved from https://libraryresources.columbiasouthern.edu/login?url=http://search.ebscohost.com/login.aspx?direc t=true&db=a9h&AN=125122612&site=ehost-live&scope=site

Unit Lesson In Unit VII, we had a great interview about program evaluation with a public health professional. Program evaluation is a key way to determine if behavior change has occurred. In this unit, we will link program evaluation techniques to the practice of health programs. It is not enough just to develop programs that can change health behavior, but the programs have to be evaluated to determine effectiveness. Formative and summative evaluations are tools that can be used to not only determine effectiveness of the health behavior program but help the program be effective as well. Formative and Summative Evaluation When developing and implementing a health program that has a goal to change behavior, it is not always easy to know if you are on the right track. Formative evaluation allows a health educator to have feedback along the way to determine if the health plan is successful. Formative evaluation is more qualitative in nature and assesses the implementation of the health behavior program (DiClemente, Salazar, & Crosby, 2019). Formative evaluation methods could consist of open-ended survey questions for participants or staff, focus groups, and reports. Formative evaluations are often conducted during the development of new programs to determine if the health behavior program is being developed in the way it was intended. Formative evaluations focus on short-term goals of the health behavior program; it gives feedback along the way to guide the implementation process. Summative evaluation is also used quite a bit in new programs as well and assesses the worth and quality of the program after implementation to determine if the program should be implemented again or go to the chopping block. Summative feedback is more quantitative and focuses on data and numbers (DiClemente et al., 2019).

UNIT VIII STUDY GUIDE

Formative and Summative Types of Evaluations

PUH 5304, Health Behavior 2

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Unit VIII Scenario It is often easier to apply information when there is a situational scenario to refer to. For the purpose of this unit, let’s use a hypothetical situation to determine how evaluation can be applied to a health program. The scenario is below, and throughout the rest of the lesson, we will address how the unit’s concepts can apply to this specific scenario.

Evaluations That Are Formative There are several different types of evaluations that are formative. For the purpose of this lesson, we will focus on the ones most widely used in evaluation health behavior: needs assessments, process evaluation, and implementation evaluation. Needs Assessment: This type of evaluation is best when completed before program implementation to identify gaps, strategic priorities, and health issues (DiClemente et al., 2019). Scenario Application: The county health department completed a needs assessment. The needs assessment revealed a large number of residents were smokers, and there was a lack of smoking cessation programs in the area. Based on the needs assessment findings, the need for the county to implement a smoking cessation program was identified. Process Evaluation: This type of evaluation focuses on the effectiveness of the sequence in which the program is taking place (DiClemente et al., 2019). Process evaluations looks to determine if the planned sequence of the program is as successful as it was planned to be. As we all know, sometimes in theory a planned idea may seem like a good one, but once you put your plan into action, it does not always translate well when applied. Process evaluations help to determine what tweaks or changes can be made along the way for unforeseen variables that may not have been accounted for in the planning process. This allows program planners to make changes along the way based on what the data revealed instead of waiting until the end of the health behavior program. Scenario Application: A survey was given to participants in the third week of the program. Data revealed that 84% of the smoking cessation program participants did not attend the one-on-one session but were attending the group sessions regularly with positive feedback. Based on the process evaluation findings, the health program planner may decide to only offer group sessions. When implementing health behavior change programs, the planner should work toward alleviating any roadblocks that may hinder a participant from entering the maintenance stage of change. Implementation Evaluation: This type of evaluation determines if the health program is implemented as planned (Centers for Disease Control and Prevention, 2012). It takes a deep dive into not only if the program planner is doing what he or she set out to do but also in the manner that he or she planned to do it.

A smoker who has been smoking a pack and half of cigarettes a day is in the preparation stage of change and has decided he wants to quit smoking. A health educator has been employed by the county health department to develop health behavior programs. The top priority for the health educator is to coordinate a quit smoking program due to high smoking data noted from a community health needs assessment. The county smoking cessation program is 12 weeks long and includes two-hour weekly group meetings facilitated at the county health building with a trained quit smoking specialist and weekly one-hour, one-on-one health coaching sessions held at the county health clinic office.

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Implementation evaluation and process evaluation is often interchanged. Although they are similar, they have distinct differences. Process evaluation focuses on if the program is being conducted in the order that was planned while implementation evaluation looks at whether the program overall is implemented as planned. Implementation evaluation is important, especially if the program planner received a grant for the health behavior program. Once funds are received, it is important to ensure that the program is doing what it said it would do to meet the expectations of the grant funder. Scenario Application: A survey was given to participants about the smoking cessation program. Data revealed that each week the group facilitator focused on physical activity topics such as getting more steps in a day to increase walking, quick chair exercises, joining a gym, etc. Based on the implementation findings, the health program coordinator can determine the program is not being implemented as planned. The coordinator should have a talk with the group facilitator on the importance of program reliability and validity and that it is important to deliver group session curricula as outlined. Evaluations That Are Summative Much like evaluations that are formative, there are different types of evaluations that are summative as well. Similar to the formative forms of evaluation mentioned above, for the purpose of this unit we will focus on the most prevalent forms of summative evaluation in relation to health behavior: economic evaluation, outcome evaluation, and impact evaluation. Economic Evaluation: This type of evaluations looks at the cost-effectiveness and cost-benefits of a health program and reviews the dollars and cents of a program (DiClemente et al., 2019). Economic evaluation looks to determine if the benefit outweighs the cost or vice versa, did the cost outweigh the benefit? Economic evaluation provides a basis for what the return on investment is. A grant-funded program will find this information useful, especially if it is a health behavior program funded for one year at $200,000 but only changed the behavior of 10 people; this could present a problem since the return on investment is low. Scenario Application: The smoking cessation program has 200 participants enrolled; some of the health educator’s program planning time is charged to the program. All materials are printed in house at the county building, and program facilitators are paid $20 per hour for group or one-on-one sessions. If the program facilitator works three hours a week (two-hours for group sessions and one hour for one-on-one sessions), that would be $60 each week over the 12-week program. The smoking cessation program cost would be $720 for the program facilitator and about $1,845 for the health educator for a total of $2,565. If there are 200 participants enrolled in the smoking cessation program, the program costs the county about $12.83 for each participant. Based on the economic evaluation data, the county can determine if the money it is spending on the smoking cessation program is worth the number of residents that it is reaching. Outcome Evaluation: This type of evaluation focuses on the degree of which the intended health behavior has been changed for the target population. Outcome evaluations determine if the health behavior program has effectively met its intended objectives (DiClemente et al., 2019). Scenario Application: A survey was given to each participant at the end of the 12-week program. The data revealed that 71% of participants quit smoking, 92% of participants smoked less in comparison to the beginning of the program, and 100% of participants reported they had the tools needed to quit smoking after the completion of the 12-week program. Based on the outcome evaluation findings, it can be determined that the program objective of 50% of participants reducing the number of cigarettes smoked was reached, supporting the effectiveness of the program. Impact Evaluation: This type of evaluation looks at the degree to which the health behavior program goal was met (DiClemente et al., 2019). Often, outcome and impact evaluations are used interchangeably, but they have two distinct differences. Impact evaluations are broader and look at overall effects. A good way to separate impact evaluation from outcome evaluation is that outcome evaluation assesses objectives while impact evaluations assess goals.

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Scenario Application: After three years of offering the smoking cessation program, the health department pulled program data. The data revealed that the smoking cessation program had reached almost 8,000 residents, asthma rates were down 30%, smoking rates were down 23%, infant mortality was down 12%, and heart disease was down 9%. Based on the impact evaluation findings, it can be determined that the goal of decreasing smoking rates within three years by 10% was met. Bringing it all Together During the past seven units, we have reviewed many principles of health behavior. This units focuses on tools used to evaluate health behavior programs. It is a lot of information, but dissecting it into pieces makes it a little easier to take in. One applicable way that makes these concepts easier to process is that evaluations that are formative reveal information that allow you to improve along the way (such as feedback from a grading rubric), while evaluations that are summative reveal information about what has already happened and cannot be altered. However, summative evaluations can be used as learning lessons for the future (such as a final grade).

References Centers for Disease Control and Prevention. (2012). Introduction to program evaluation for public health

programs: A self-study guide. Retrieved from https://www.cdc.gov/eval/guide/step3/index.htm DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2019). Health behavior theory for public health: Principles,

foundations, and applications (2nd ed.). Burlington, MA: Jones & Bartlett Learning.