Current and Future Challenges in School-Based Prevention: The Researcher Perspective

During the next decade we will see broad dissemination of a growing number of empirically validated school-based prevention programs. The processes of effectiveness research, broad program diffusion, and program integration at the school and community level will become a central focus of research activity. The paper presents six future directions for research in the field of school-based prevention and health promotion. The directions include developing new programs and models, developing standards and accountability systems related to school success, moving from efficacy to effectiveness research, understanding factors influencing program integration, broad dissemination of programs and policies, and the sustainability of programs, policies, and community partnerships. These future directions are driven by three significant research-to-service challenges faced both by practitioners and researchers that involve systems integration across developmental stages, levels of care, and institutional structures.     

Development and evaluation of an occupational therapy program for refugee high school students

Background: Adolescents from refugee backgrounds experience challenges participating in their new school environments. This study aimed to describe and discuss the development of an occupational therapy program to facilitate school participation of high school students from refugee backgrounds. Methods: Three cycles of action research were used to develop a program over 18 months in collaboration with two high schools. Data were collected from four occupational therapists, seven school staff members and two school principals using in‐depth interviews, questionnaires and review of documents. Results: The program changed significantly over the three cycles from a focus on individual task mastery in the classroom environment to development of social competence through an activity‐based group program. Conclusions: Building capacity for social competence helped create better alignment between the roles of occupational therapist and teacher within the school context and was perceived to contribute to refugee students’ overall availability for learning in their new environments. Action research is useful in collaboratively developing programs in emerging areas of practice.     

Evaluating the Effectiveness of Premarital Prevention Programs: A Meta‐Analytic Review of Outcome Research

We present a comprehensive, meta‐analytic review and critical evaluation of outcome research pertaining to the effectiveness of premarital prevention programs. Results revealed that the mean effect size for premarital programs was .80, which means that the average person who participated in a premarital prevention program was significantly better off afterwards than 79% of people who did not participate. Stated differently, the average participant in a premarital program tends to experience about a 30% increase in measures of outcome success. Our findings suggest that premarital prevention programs are generally effective in producing immediate and short‐term gains in interpersonal skills and overall relationship quality and that these improvements are significantly better than nonintervention couples in these areas. However, because of a lack of extended follow‐up research, conclusions about long‐term effectiveness remain elusive. We propose implications for future research, education, and policy.     

Peer Coaching: Building Collegial Support for Using Innovative Health Programs

ABSTRACT: To ensure students achieve intended benefits from effective health programs, it is necessary to maximize program implementation and maintenance. Peer coaching provides a post-inservice staff development approach for health educators to strengthen teacher use of new health programs during implementation trials. While peer coaching positively influences teacher behavior and student outcomes, previous coaching programs have been limited in scope, have not been theoretically derived or adequately evaluated, and have not been systematically applied to health programs. This paper addresses teacher needs during trials, reviews peer coaching program features, and proposes a model to guide future planning, evaluation, and research. In this model, critical components of the coaching program include classroom assessments, coaching team cluster meetings, and administrative support. Strategies based on Social Learning Theory and Diffusion Theory are incorporated into the peer coaching program to influence teacher perceptions of their work roles, capability to implement a program, and commitment to the new instructional program. Interrelations among components are discussed and directions for future research and practice are suggested.     

加强项目实施管理提高医院科研管理水平

对新技术、新项目的管理不仅要重视立项环节,在项目立项后还要注重实施常态管理.对科室新技术、新项目要进行全过程管理与监督,确保在规定的时间内按计划目标每半年书面报告一次项目进展情况,而且在完成项目论证评估后,要备案存档.获得资助的新技术、新项目要设立专帐管理;涉及科研立项、设备购置的过程,应按医院有关规定办理.     

Suggestions for improving the study of health program implementation.

More will be learned about health programs and the implementation of health policy in this country if we pay more attention to issues of program implementation. Of particular use would be more studies which explicitly link program implementation with program outcomes and which recognize the need to combine quantitative and qualitative analysis of program implementation; the use of triangulated methods in focusing on the relationship between program implementation and program outcomes; the incorporation and study of planned variation in the methods of implementing programs; recognition that the process is essentially one of organizational change and innovation, and the incorporation of existing theory and evidence relevant to these issues; and recognition that the ongoing nature of the implementation process requires longitudinal study designs for implementation as well as for outcome assessment. Cronbach [9] has remarked that evaluation research "lights a candle in the darkness, but it never brings dazzling clarity." It may be that more attention to program implementation and better research on the process, such as that suggested in this note, will provide a little more light and will bring if not dazzling , at least modest, improvements in clarity.     

Meanings of targeting from program workers

Program workers have a critical role in targeting in nutrition programs, but little has been studied about the concept and the operation of targeting from their perspectives. This paper introduces and compares meanings of targeting from the perspectives of program workers in food assistance programs in the United States. There exist some variations in perceptions of targeting and actual operational procedures adopted by program workers at the local and federal levels. Regardless, program workers' perspectives on targeting suggest a new framework of targeting, which consists of key components (program access, service, and evaluation) and issues in need of careful attention in targeting nutrition programs. The success of targeting depends on how well these components and related issues can be translated into targeting policy, rules, and procedures. With increased devolution to the state and local levels in the United States, it is even more critical for federal policy makers and administrators to understand how frontline program workers perceive and implement targeting. The new framework based on the perspectives of program workers may contribute to developing a conceptual definition as well as practical guidance for targeting that can be used to formulate better ways of targeting in nutrition programs.     

Social contexts and children's health outcomes: Researching across the boundaries

While significant progress has been made on several fronts in child health research in recent years, research findings have not always been readily translated to better policies and programs for creating healthy conditions for children. Child health policies and research have not always aligned in a manner that would inform each other to the benefit of children. In this paper it is argued that child health research and interventions need to proceed from an explicit recognition of the fundamental causes of poor child health, namely parents’ socioeconomic status and the social context in which children live. A conceptual framework is presented that organizes the key domains of child health determinants and the possible causal pathways that link these domains to produce health outcomes. This framework assisted the development of a multi-method research program specifically linking community members, program developers and policy-makers in the research process. It also helped to identify methodological issues inherent in a comprehensive approach to child health research, which is commented on drawing from illustrative examples from the authors’ research program. The article concludes with some observations on the authors’ experience in engaging policy and civil society constituents in order to better align research, policy and intervention programs.     

Explaining Michigan: developing an ex post theory of a quality improvement program

Context: Understanding how and why programs work—not simply whether they work—is crucial. Good theory is indispensable to advancing the science of improvement. We argue for the usefulness of ex post theorization of programs. Methods: We propose an approach, located within the broad family of theory‐oriented methods, for developing ex post theories of interventional programs. We use this approach to develop an ex post theory of the Michigan Intensive Care Unit (ICU) project, which attracted international attention by successfully reducing rates of central venous catheter bloodstream infections (CVC‐BSIs). The procedure used to develop the ex post theory was (1) identify program leaders’ initial theory of change and learning from running the program; (2) enhance this with new information in the form of theoretical contributions from social scientists; (3) synthesize prior and new information to produce an updated theory. Findings: The Michigan project achieved its effects by (1) generating isomorphic pressures for ICUs to join the program and conform to its requirements; (2) creating a densely networked community with strong horizontal links that exerted normative pressures on members; (3) reframing CVC‐BSIs as a social problem and addressing it through a professional movement combining “grassroots” features with a vertically integrating program structure; (4) using several interventions that functioned in different ways to shape a culture of commitment to doing better in practice; (5) harnessing data on infection rates as a disciplinary force; and (6) using “hard edges.” Conclusions: Updating program theory in the light of experience from program implementation is essential to improving programs’ generalizability and transferability, although it is not a substitute for concurrent evaluative fieldwork. Future iterations of programs based on the Michigan project, and improvement science more generally, may benefit from the updated theory present here.     

Research on Disseminating and Implementing Health Education Programs in Schools

Numerous school health education programs have been developed. No matter how effective a given program may be, however, its impact will be determined by the extent to which it actually is disseminated and maintained in classrooms. The dissemination of a program involves purposeful efforts by agencies usually outside the school to implement the program in many different schools, efforts by agencies usually outside the school to implement the program in many different schools, while program implementation involves efforts by those within a given school to effectively use the program in its classrooms. This paper has been prepared to review concepts, strategies, and methods used to study dissemination and implementation; to specify the functions of dissemination and implementation research; and to describe general approaches and specific procedures to evaluate the effectiveness of dissemination and implementation activities. As we develop more and better school health education interventions, the need for research that will allow us to efficiently transport these interventions to classrooms throughout the nation becomes increasingly important.     

Engagement in paraprofessional home visitation: families' reasons for enrollment and program response to identified reasons.

Home visitation programs have exhibited modest impact in promoting maternal and child health outcomes; therefore, formative research is necessary to examine whether home visiting program models or actual implementation need to be modified. In particular, client engagement and retention have been identified as areas in which program implementation can be enhanced. This study assessed home visiting clients' reasons for entering home visiting programs and their perception of programs' response to these identified needs. We asked newly enrolled home visiting clients (n = 123) to identify reasons for entering their home visiting program, including their first and second most important reasons. The most frequently cited reasons for enrolling were wanting information about job training, completing one's education, keeping in good health during pregnancy, and learning about infant growth and development. Home visiting programs' response to clients' identified needs varied. Needs more closely related to home visiting program goals of providing parenting education and promoting prenatal health were most often met, whereas needs less closely related to program goals (e.g., life course needs such as information about job training or education) were less often met. Our findings suggest that home visiting programs in urban contexts should consider modifying their program protocols to better respond to employment- and education-related issues facing their clients.     

Program Characteristics and the Length of Time Clients are in Substance Abuse Treatment

Is there a relationship between the characteristics of drug addiction treatment programs and an important correlate of better outcomes, the length of time clients are in treatment? Previous research has consistently shown longer periods in treatment and a range of services each have a salutary effect on client outcomes after treatment. Much of this research has examined the characteristics of clients. Program attributes are another important consideration. Multivariate analysis of data collected from a national survey of outpatient drug addiction treatment programs shows offering a range of services along with several other program characteristics are relevant to the duration of treatment. When a range of services are available, this has a positive association with both the number of months programs report clients are in treatment and with the number of counseling sessions programs report clients receive over the course of treatment. Ultimately, this should lead to better outcomes for clients.     

A five-year plan for population research and family planning services. 3. Family planning services

A tentative family planning program plan for 1971-1975 is presented. The estimated need for family planning services by 1975 is projected to be 6.6 million individuals, classified as poor and medically indigent. The author states that more research is needed to project a similar need for higher income groups who have trouble controlling the number and timing of their children. With better research family planning services could help meet their needs too. The plan projects greater expansion of services to non-metropolitan areas to overcome a maldistribution of present programs. It is estimated that 90% of those in need can now be served by existing services, while new delivery agencies would need to be created to serve the remaining need. Manpower development of this plan calls for an expansion in the use and role of paraprofessional personnel. The utilization of operational research, planning and evaluation is needed for objective data, to help programmers determine shape and scope of required program, and to improve its efficiency and effectiveness. To do this a 3 phase 5 year plan is presented. As program services expand the role information, education and communication plays is critical. Development of these functions will help in reaching program goals. Projected estimates by 1975 of direct costs of provision of family planning services will be between 360 and 395 million dollars.     

Graduate programs in health administration: faculty academic reputation and faculty research reputation by program location and program reputation

This study used program location and program reputation to describe two important faculty characteristics: academic reputation and research reputation. The study involved 44 graduate programs in health administration representing four program locations: schools of public health, business, medicine/allied health, and graduate/independent. Fourteen programs were identified as ranked programs and the remaining 30 programs were identified as unranked programs. While the study identifies many differences, few are significant, thus adding credence to the argument for diversity in program location and diminishing credence in the argument for program reputation.     

Simulating smokers' acceptance of modifications in a cessation program.

Recent research has underscored the importance of assessing barriers to smokers' acceptance of cessation programs. This paper illustrates the use of computer simulations to gauge smokers' response to program modifications which may produce barriers to participation. It also highlights methodological issues encountered in conducting this work. Computer simulations were based on conjoint analysis, a consumer research method which enables measurement of smokers' relative preference for various modifications of cessation programs. Results from two studies are presented in this paper. The primary study used a randomly selected sample of 218 adult smokers who participated in a computer-assisted phone interview. Initially, the study assessed smokers' relative utility rating of 30 features of cessation programs. Utility data were used in computer-simulated comparisons of a low-cost, self-help oriented program under development and five other existing programs. A baseline version of the program under development and two modifications (for example, use of a support group with a higher level of cost) were simulated. Both the baseline version and modifications received a favorable response vis-à-vis comparison programs. Modifications requiring higher program costs were, however, associated with moderately reduced levels of favorable consumer response. The second study used a sample of 70 smokers who responded to an expanded set of smoking cessation program features focusing on program packaging. This secondary study incorporate in-person, computer-assisted interviews at a shopping mall, with smokers viewing an artist's mock-up of various program options on display. A similar pattern of responses to simulated program modifications emerged, with monetary cost apparently playing a key role. The significance of conjoint-based computer simulation as a tool in program development or dissemination, salient methodological issues, and implications for further research are discussed.     

Building Evidence for Sustainability of Food and Nutrition Intervention Programs in Developing Countries

After making large investments to put in place effective health and nutrition interventions, researchers, program implementers, policy makers, and donors all expect lasting effects. However, it is uncertain whether this is the case, and there is less certainty on how to approach the study of program sustainability. This symposium, “Building Evidence for Sustainability of Food and Nutrition Intervention Programs in Developing Countries,” provided not only frameworks for conceptualizing sustainability but concrete evidence about the approaches and methods used as well as lessons on how they do or do not work in particular contexts. We presented the following findings: 1) sustainability of activities and impacts of Title II food aid programs in Bolivia and Kenya, 2) sustainability of impact in terms of adoption and consumption of a biofortified orange sweet potato in Uganda, and 3) lessons from incorporating pro-sustainability investment strategies in child survival programs in Guinea. Our symposium introduced a new important body of research on program sustainability to provide insights and stimulate innovative thinking in the design and planning of further applied research and future prosustainability intervention programs.     

Evaluating an employee wellness program

What criteria should be used to evaluate the impact of a new employee wellness program when the initial vendor contract expires? Published academic literature focuses on return-on-investment as the gold standard for wellness program evaluation, and a recent meta-analysis concludes that wellness programs can generate net savings after one or two years. In contrast, surveys indicate that fewer than half of these programs report net savings, and actuarial analysts argue that return-on-investment is an unrealistic metric for evaluating new programs. These analysts argue that evaluation of new programs should focus on contract management issues, such as the vendor’s ability to: (i) recruit employees to participate and (ii) induce behavior change. We compute difference-in-difference propensity score matching estimates of the impact of a wellness program implemented by a mid-sized employer. The analysis includes one year of pre-implementation data and three years of post-implementation data. We find that the program successfully recruited a broad spectrum of employees to participate, and it successfully induced short-term behavior change, as manifested by increased preventive screening. However, the effects on health care expenditures are positive (but insignificant). If it is unrealistic to expect new programs to significantly reduce healthcare costs in a few years, then focusing on return-on-investment as the gold standard metric may lead to early termination of potentially useful wellness programs. Focusing short-term analysis of new programs on short-term measures may provide a more realistic evaluation strategy.