An evaluation of undergraduate family care programs

Evaluation of the many new family care programs (FCP), and others of similar intent, however defined, is as essential as determining the value of any other curriculum change. Replies to a questionnaire from 101 U.S. and 15 Canadian medical schools indicated that 80% of the former and 93% of the latter had FCPs; 35% and 29%, respectively, were not evaluating their program by any method. No single evaluative technique was used by more than 42% of the American medical schools. A review of the literature on FCPs frequently indicated that the conclusions that could be drawn about the programs were ambiguous. Students in the University of Cincinnati Medical Center FCPs elected family practice or pediatric internships significantly more often than did the FCP nonparticipants, but they indicated that the program had little effect on this choice, despite almost uniformly favorable testimonials. We discuss the possibility that FCPs may be educating the wrong students, that FCPs, if not reinforced in other clinical areas, may have few lasting effects on student attitudes or career choice, and that we may be asking the wrong questions, and with inadequate methods.     

Parents’ perspectives on quality in family support programs

Support services for families who have a member with developmental disabilities are a growing component of many state mental health systems. Family empowerment is a key principle of these programs, but parents and the staff who work with them are often challenged in their efforts to have parents participate in policy development, program management, and evaluation of programs. The use of nominal group techniques is described as a means of identifying factors parents believe characterize quality family support programs. Parents’ identified factors are then compared with factors from a theoretical framework for quality. Parents stressed access to information, adherence to empowerment philosophy, and the importance of interpersonal relationships with staff. Parents placed less emphasis on factors generally found in accreditation criteria.     

Comparison of accredited and non-accredited family child care programs on program quality,provider professionalism,and family support

Observations of program quality, using the Family Day Care Assessment Profile (Profile), and questionnaire information on job professionalism, spousal support and family functioning were obtained from 39 registered Georgia family child care providers, 12 of whom were accredited by the National Association of Family Child Care. As expected, accredited providers had significantly higher total Profile scores, scoring 90% or better across subscales, while the non-accredited providers’ subscale mean scores were lower and quite variable. Also as predicted, the accredited group scored higher on professionalism variables such as education, hours of training, future job commitment, and number of professional affiliations, but not on experience, current job commitment, or job satisfaction. Further, the two groups did not differ on a measure of spousal support or two measures of family functioning.     

The utilization of conception cohorts for the evaluation of family planning programs.

Data were collected from women who conceived during specified period from 1971 through June 1973 in order to determine: (a) the rates of planned and unplanned conception throughout the state, over time and by clinic service area; and (b) the characteristics which are known to influence fertility behavior (age, marital status, and ethnic group) of those women who failed to plan their conceptions. These data were compared with the characteristics of women served by the family planning clinics in various areas to determine whether services were being extended to high risk groups.Evaluation of the groups in need of service in each clinic area, and comparison of these findings with the characteristics of women actually served by the clinic, identified areas where services were not being directed to groups in need. These area differences provided examples of situations potentially amenable to application of evaluation results in order to give direction to family planning services.     

A comparison of university-based and community-based family practice residency programs

The issue of differences between university-hospital-based and community-hospital-based family practice residency programs was studied in a network that included five community programs and one large university program. American Board of Family Practice (ABFP) Intraining Examination scores and ABFP board certification scores indicated comparative cognitive knowledge. A graduate follow-up study compared post-residency experience of the graduates of both types of programs. Conclusions from the study showed little difference between subjects trained in the two types of programs. Differences in examination scores were not significant. Small differences in graduate perception of adequacy of preparation for content areas and in postresidency practice characteristics seemed equally insignificant, but were not amenable to statistical testing.     

Developing a vaccination evaluation model to support evidence-based decision making on national immunization programs

Among all public health provisions national immunization programs (NIPs) are beyond doubt one of the most effective in reducing mortality, morbidity, and costs associated with major infectious diseases. To maintain their success, NIPs have to modernize in response to many new and old demands regarding efficacy, safety, availability of new vaccines, emerging and evolving pathogens, waning immunity, altered epidemiological situations, and the public's trust in the program. In this paper we present an evaluation model in the form of a checklist that may help in collecting relevant scientific information that is necessary for evaluation and decision making when considering changes in a NIP. Such a checklist points to relevant information on the vaccine-preventable disease, the pathogen causing it, the vaccine, and the cost-effectiveness ratio of the vaccine. However, the final judgment on a potential change in the NIP cannot be based on a simple algorithm, as the relevant information reflects factors of a very different kind and magnitude, to which different value judgements may be added, and which may have certain degrees of uncertainty. Because any change in the NIP may be accompanied by more or less unforeseen changes in the vaccine's efficacy, evolutionary consequences, including the antigenic composition of the pathogen, and the vaccine's safety profile, an intensive surveillance program should accompany any NIP. Elements thereof include clinical-epidemiological surveillance, surveillance of vaccination coverage, immune surveillance, surveillance of microbial population dynamics, and surveillance of adverse events and safety issues. We emphasize that the decision to introduce a vaccine in the NIP should be taken as seriously, both scientifically and ethically, as the decision to withhold a vaccine from the NIP. In the latter case one might be responsible for vaccine-preventable disease and mortality.     

The future of family planning programs

National family planning programs have been an important instrument in accelerating global fertility decline and in restricting ultimate world population to a level probably below ten billion. They began to come into being after 1950 and will probably go out of existence in most of the world's regions by 2050. The archetypal programs were instituted in Asia and North Africa. The end of the twentieth century is an appropriate half-way mark at which to evaluate the twentieth-century programs and to assess what changes in them will be needed for the twenty-first century. Some changes are necessary because dramatic events have occurred: (1) long-term replacement-level fertility has been attained in most of East Asia and some of Southeast Asia, and accordingly, some programs there are being phased out; (2) mainland South Asian fertility has been slower to decline; (3) international donor funding is diminishing and may not be significant during much of the twenty-first century; (4) the 1994 International Conference on Population and Development held in Cairo called for a radical change in programs away from demographic aims and toward reproductive health and the improvement of the situation of women; and (5) the future family planning frontier will be sub-Saharan Africa, for which radically new types of programs may have to be developed. These issues were discussed in January 2000 at a conference held in Dhaka, Bangladesh. A selection of contributions to the conference is published here. This article provides an overview of the issues based partly on this selection and partly on the discussions that took place at the conference.     

A conceptual framework for the evaluation of health programs

Evaluation can have three distinct goals: to help plan and develop programs, to provide information which will improve programs and to determine the outcomes and impact of programs. Evaluation questions flow from each of these goals. Described in this paper are different types of evaluation useful in answering these questions. Whatever type of evaluation is chosen, the evaluator must attempt to assess its validity. This validity concerns the equivalence between answers to evaluation questions and the "true value" of the program. It is just as concerned with measurement strategy and instruments as it is with the designs and techniques of analysis used, and the population studied.     

Community-based integrated family planning programs.

Since 1976, the Japanese Organization for International Cooperation in Family Planning has operated a series of pilot projects in several Asian countries in which family planning fieldworkers are given the added taks of controlling soil-transmitted intestinal parasite (hookworm) and providing associated nutrition education, as a means of increasing their credibility, contributing to more favorable attitudes toward family planning. Given that family planning is a new and formal program being introduced into a community, the Integrated Program has 4 stages: 1) Strategic planning. The earlier people at all levels are brought into the project processes, the higher the chances of positive commitment. A tripartate steering committee is thus formed, involving influential people from government, private, and expert sectors, with primary policy-making responsibility and responsibility for project design, implementation and assessment, and with links to funding sources. 2) Project design and development. Local leadership is identified and involved in discussions, and additional project staff, other personnel, and community groups are drawn in, a process called "bottom-up planning." Community leaders, properly motivated and trained, are best for organizing in the community, with project staff providing technical and logistical support. Plans are often modified, and identifying community leaders can be time consuming, but they are essential to program success. 3) Implementation. At this stage project staff has 2 functions: promotion and delivery of services and helping the community to take over the program at its maintenance stage. Where potentially cooperative local groups are not functioning, project staff must form them. 4) Assessment. While rates of family planning acceptance and continuation and declines in parasite infestation are indicators of success or failure, more important is people's attitude as shown by participation and assumption of responsibility. In addition to conventional measurements, 4 kinds of evidence also needed are positive reaction of the community; increased government recognition or support; increased cooperation and activity among government and private organizations on information, education, and communication; observable change in the community. The final, maintenance stage, when the program has become institutionalized and self sustaining within the community, has not yet been reached by any of the pilot proejcts.     

Obtaining leadership support for medical safety programs: A practical approach

Development of an educational presentation that describes a comprehensive program for the hospital board is the first step.