Peer Reviewed: Using the RE-AIM Framework to Evaluate a Physical Activity Intervention in Churches

Introduction

Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors.

Methods

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors.

Results

Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the intervention''s physical activity components continued their participation as long as the church offered them, but churches had difficulties continuing to offer physical activity sessions. The effectiveness analysis showed that the intervention produced promising, but not significant, trends in levels of physical activity.

Conclusion

Our use of the RE-AIM framework to evaluate this intervention serves as a model for a comprehensive evaluation of the health effects of community programs to promote health.     

环境因子对人群健康影响的测量与评估方法

目的建立评价环境因子对人群健康影响的一种新方法。方法按照WHO的可比较风险评估(comparative risk assessment,CRA)框架中对环境因素的评估部分,发展符合我国实际的环境污染物风险评估的框架和指标,通过对各个暴露水平的覆盖率和各暴露水平相应的RR的估计以及对理想场景的选取估算潜在影响分值(potential impact fraction,PIF);并将该方法应用于我国某地区水污染对肝癌发生的风险测量和估计,以受污染的水为环境因子,以肝癌死亡为健康指标,使用空间插值、反事实分析理论以及可比较风险评估(CRA)理论进行分析。结果使用普通Kriging插值法估计了该地区的COD水平,并且根据历年河流中COD水平的变化趋势估计了累积COD暴露水平,计算相应的暴露人口;根据不同的污染等级和相应的肝癌标化死亡率计算RR值,结果显示RR值随累积COD暴露水平的增加而呈单调上升趋势;PIF值显示,如果水污染程度降至对照区水平,将有75.72%的男性和66.39%的女性避免死于肝癌。结论综合使用可比较风险评估(CRA)、反事实理论、空间分析等技术可以较好地评估环境因子对人群健康的影响。     

Engaging the Community to Effectively Plan and Implement Community-Based Mental Health Programs

The Journal of Behavioral Health Services & Research - Community engagement is recognized as an effective means to maximizing public health program impacts despite challenges such as power...     

Using Multicriteria Approaches to Assess the Value of Health Care

Practitioners of cost-utility analysis know that their models omit several important factors that often affect real-world decisions about health care options. Furthermore, cost-utility analyses typically reflect only single perspectives (e.g., individual, business, and societal), further limiting the value for those with different perspectives (patients, providers, payers, producers, and planners—the 5Ps). We discuss how models based on multicriteria analyses, which look at problems from many perspectives, can fill this void. Each of the 5Ps can use multicriteria analyses in different ways to aid their decisions. Each perspective may lead to different value measures and outcomes, whereas no single-metric approach (such as cost-utility analysis) can satisfy all these stakeholders. All stakeholders have unique ways to measure value, even if assessing the same health intervention. We illustrate the benefits of this approach by comparing the value of five different hypothetical treatment choices for five hypothetical patients with cancer, each with different preference structures. Nine attributes describe each treatment option. We add a brief discussion regarding the use of these approaches in group-based decisions. We urge that methods to value health interventions embrace the multicriteria approaches that we discuss, because these approaches 1) increase transparency about the decision process, 2) allow flight simulator-type evaluation of alternative interventions before actual investment or deployment, 3) help focus efforts to improve data in an efficient manner, 4) at least in some cases help facilitate decision convergence among stakeholders with differing perspectives, and 5) help avoid potential cognitive errors known to impair intuitive judgments.     

Ecological Approach to Family-Style,Multilevel Child Care Intervention: Formative Evaluation Using RE-AIM Framework

ObjectiveConduct formative evaluation of Ecological Approach to Family-Style Dining (EAT) Intervention.DesignQualitative semistructured interviews and demographic surveys.SettingEarly care and education (ECE) centers in Nebraska.ParticipantsCooperative Extension coaches (n = 9), ECE administrators (n = 8), and teachers (n = 17) caring for children aged 3–5 years.InterventionThe EAT intervention (a 16-week, 7-lesson, evidence-based online responsive feeding ECE model) uses a multilevel improvement system of 5 implementation strategies. Early care and education administrators and teachers completed 1 lesson/wk followed by a coaching session.Main Outcome MeasuresThe Reach, Effectiveness, Adoption, Implementation, and Maintenance framework includes 5 evaluative dimensions.AnalysisThematic analysis.ResultsOverall, 77% of children aged 3-5 years (n = 216) participated from targeted Child and Adult Care Food Program ECEs (Reach). All perceived EAT improved children's nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches found professional development incentives important, whereas administrators/teachers valued inservice hours (Adoption). Teachers reported successful implementation of responsive feeding, and administrators supported the teachers (Implementation). All reported they intended to continue using EAT, and administrators and teachers discussed incorporating EAT practices into the handbook/school policy (Maintenance).Conclusion and ImplicationsThe EAT was valued by all stakeholders for its perceived effectiveness to positively impact children's nutritional outcomes. Furthermore, stakeholders valued the provided incentives and multilevel design with coaching, ECE administrators, and teachers. Future research is needed on how to use Extension coaches in ECE interventions.     

The Sociobiologic Integrative Model (SBIM): Enhancing the Integration of Sociobehavioral, Environmental, and Biomolecular Knowledge in Urban Health and Disparities Research

Disentangling the myriad determinants of disease, within the context of urban health or health disparities, requires a transdisciplinary approach. Transdisciplinary approaches draw on concepts from multiple scientific disciplines to develop a novel, integrated perspective from which to conduct scientific investigation. Most historic and contemporary conceptual models of health were derived either from the sociobehavioral sciences or the biomolecular sciences. Those models deriving from the sociobehavioral sciences generally lack detail on involved biological mechanisms whereas those derived from the biomolecular sciences largely do not consider socioenvironmental determinants. As such, advances in transdisciplinary characterizations of health in complex systems like the urban environment or health disparities may be impeded. This paper suggests a sociobiologic organizing model that encourages a multilevel, integrative perspective in the study of urban health and health disparities. Gibbons and Fox are with the Johns Hopkins Urban Health Institute, Baltimore, MD, USA; Brock, Baylin, and Levine are with the Johns Hopkins School of Medicine, Baltimore, MD, USA; Gibbons, Alberg, LaVeist, Levine, and Fox are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Brock, Alberg, and Baylin are with the Johns Hopkins Oncology Center, Baltimore, MD, USA; Gibbons and LaVeist are with the Johns Hopkins Center for Health Disparities Studies, Baltimore, MD, USA; Glass is with the Johns Hopkins Bloomberg School of Public Health Center on Aging and Health, Baltimore, MD, USA.     

引力可达性模型在上海市三级医院布局评价中的应用

目的 探讨基于GIS的引力可达性模型在医院布局评价中的应用.方法 借助互联网地图服务商API功能,使用引力可达性模型对上海市三级医院布局进行测评.结果 2011年全市引力可达性指数均值为1.39(β=1)、1.41(β=1.2),市区引力可达性指数均值是郊区的3.53(β=1)、4.52(β=1.2)倍.结论 基于GIS的引力可达性模型可用于评价医院布局,上海三级医院布局存在城乡差异.     

环境镉污染及其对人群健康影响的研究

比较某冶炼厂15年前后环境镉污染对人群健康影响的变化,并为该厂扩建投产后的污染变化评价提供依据。方法：选取与上次调查相同的污染区和对照区,调查两区大米,蔬菜,饮水镉以及25岁以上妇女的尿中镉,β2－M,NAG酶含量,并与上次资料比较,结果：米镉（干重）,菜镉（湿重）,饮水镉,尿镉,尿β2－M和尿NAG酶的几何均数,污染区分别为1．75mg/kg,0.27mg/kg,0.0008mg/L,13.34ug/g.cr,185.39ug/g.cr和5．80U/g.cr,对照区分别为0．46mg/kg.0.08mg/kg.0.001mg/L,2.27ug/g.cr.136.57ug/g.cr和4.06U/g.cr;其中米,菜,尿3项镉浓度,污染区比对照区高（P＜0．01）,尿镉,尿NAG酶,尿β2－M及其总的异常率,污染区（37．63％,19．35％,18．28％和51．6％）高于对照区（7．23％,3．61％,7．23％和15．7％）（P＝0．000－0．013）;本次调查污染区的尿镉均值（23．80ug/L)和异常率（44．09％）约为1982年的（12．06ug/L和22．52％）2倍（P＜0．01或P＝0．022）,并检出3例（3．2％）慢性早期健康危害。结论：研究认为该污染区以及污染区人群仍在继续遭受某冶炼厂环境镉污染的影响,而且这种影响有不断累积加重的趋势。但该污染区镉尚未地当地人群构成慢性早期健康危害。关键词：镉,环境污染;健康效应;尿β2－微球蛋白;尿N－乙酰－β－D－氨基葡萄糖苷酶。     

Students' Knowledge of Child Health and Development: Effects on Approaches to Discipline

Unrealistic developmental and behavioral expectations of children, which are associated with child abuse, are related to a lack of knowledge about child development and child rearing. The Iowa Child Development Test (ICDT) was administered to college students to determine their knowledge of child health and development and effects on disciplinary approaches. The results indicated that college students had inadequate knowledge and those who most frequently chose harsh disciplinary methods in simulated child management situations were least knowledgeable. This finding is similar to that reported in an earlier study of high school seniors. College men knew less than college women about child development and health, and more frequently selected harsh punishment. Although noneducation and education majors did not differ with regard to level of knowledge on the ICDT, noneducation majors more frequently chose punish and abuse responses. The findings suggest a need to provide broad-based programs in child rearing education prior to parenthood to reduce the potentiating effects of inadequate knowledge of child health and development on the incidence of child abuse.     

Efforts to Design,Implement, and Evaluate Community-Based Education for Stepfamilies: Current Knowledge and Future Directions

Stepfamilies are prevalent and have increased in numbers over the past several decades in the United States. Indications are that these families may experience enhanced vulnerabilities and inequities related to relational, psychological, and physical health outcomes; thus, they represent an important target population for family life educators. Efforts have been made to develop detailed, research-informed conceptual frameworks to guide best practices for stepfamily education and a small body of evaluation research has tested these guidelines. Studies of stepfamily education, particularly in the past decade and a half, provide some information on potential benefits of stepfamily education. In addition, information is provided by formative evaluations of program implementation processes that enhance recruitment and retention, particularly for Latinx stepfamilies. Suggestions for future work center on attention to the limited advancements in stepfamily research and program development and efforts to better meet the needs of diverse types of stepfamilies based on relationship type, social address, culture, and developmental context.     

Environmental Health Indicators of Climate Change for the United States: Findings from the State Environmental Health Indicator Collaborative

Objective

To develop public health adaptation strategies and to project the impacts of climate change on human health, indicators of vulnerability and preparedness along with accurate surveillance data on climate-sensitive health outcomes are needed. We researched and developed environmental health indicators for inputs into human health vulnerability assessments for climate change and to propose public health preventative actions.

Data sources

We conducted a review of the scientific literature to identify outcomes and actions that were related to climate change. Data sources included governmental and nongovernmental agencies and the published literature.

Data extraction

Sources were identified and assessed for completeness, usability, and accuracy. Priority was then given to identifying longitudinal data sets that were applicable at the state and community level.

Data synthesis

We present a list of surveillance indicators for practitioners and policy makers that include climate-sensitive health outcomes and environmental and vulnerability indicators, as well as mitigation, adaptation, and policy indicators of climate change.

Conclusions

A review of environmental health indicators for climate change shows that data exist for many of these measures, but more evaluation of their sensitivity and usefulness is needed. Further attention is necessary to increase data quality and availability and to develop new surveillance databases, especially for climate-sensitive morbidity.     

环境香烟烟雾对非吸烟人群健康影响研究进展

采用环境香烟烟雾和被动吸烟与健康危害有关的关键词,对近五年的国内外文献作了回顾,就１．室内ＥＴＳ污染水平和生物监测;２．ＥＴＳ对非吸烟人群的非癌性健康影响,包括：被动吸烟与呼吸系统疾病,被动吸烟与心血管系统疾病,妊娠与哺乳妇女被动吸烟危害,儿童及青少年被动吸烟危害;     

Improving the Quality of Childcare Provision Through Self-Assessment: Organizational Characteristics of Nurseries as Predictors of the Ability to Plan and Implement Change

Raising standards of provision in childcare services is a priority of the UK government's National Childcare Strategy. Self-evaluation, a key element of several successful school improvement initiatives, has been used with some early years service providers. Results have been equivocal. Developing self-assessment as an effective tool for raising standards in early years settings may require greater understanding of organizational processes typical of service providers in this sector. Building on research evidence from the field of Organizational Development, this study investigated the use of standardized questionnaires to establish organizational characteristics of group day care providers. It also set out to describe processes by which nurseries establish priorities for change, develop action plans, and subsequently implement change. Eight group day care providers participated in a developmental study over a period of approximately twenty weeks. Results identified several self-report measures of organizational characteristics that could be used to evaluate group day care settings. In addition, the results raise issues of how the effectiveness of self-assessment procedures, as a means of improving standards of group day care provision, might be enhanced.     

某院医疗中心整合TOPSIS法的效果评价

目的：应用TOPSIS法对新疆某三甲医院医疗中心评价,探讨大型综合性三甲医院整合医疗资源后医疗中心服务能力的变化。方法应用TOPSIS法对新疆某三甲医院医疗中心6个核心指标变化进行评价。结果核心指标变化最优的前三名依次是：血液病中心、心理医学中心、妇科·生殖助孕中心。结论该排名显示整合后的医疗中心院内核心指标变化的综合排序、非综合实力排序。构建医疗中心对巩固优势专科,合力助推弱势专科具有实际意义。