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Three Emerging Issues in Measurement and Evaluation of Dissemination

This research focuses on disseminating health promotion programs to schools, covering topics such as smoking prevention, physical activity, nutrition, alcohol and drug prevention, and school dropout prevention. Three key issues explored are the impact of secular trends, the importance of organizational theory/change, and understanding the concept of sustainability.

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Three Emerging Issues in Measurement and Evaluation of Dissemination

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  1. Three Emerging Issues in Measurement and Evaluation of Dissemination Allan Steckler June 3, 2005

  2. What I do Research on: • Disseminating health promotion programs to schools. • Smoking prevention, physical activity, nutrition, alcohol and drug prevention, school drop out prevention. • Mostly middle schools, some high schools. • Process evaluation: to what extent was intervention implemented as planned? Why?

  3. Three Issues • How do secular trends affect dissemination efforts? • Why is organizational theory/change critical to dissemination? • What does “sustainability” mean?

  4. How do Secular Trends affect dissemination efforts? • One of the main reasons that interventions are shown to be ineffective is due to strong secular trends – particularly physical activity, nutrition, smoking, maybe others. • We plan interventions to be disseminated without considering secular trends. • “Secular trends” will be determined by the control group, is the mantra. • By the time an intervention has been tested in efficacy trial, often secular trends have changed.

  5. Why is organizational theory/change critical to dissemination? • Innovations are most often adopted, implemented, and sustained by organizations, not individuals. • Organizations pose many barriers to dissemination but these barriers are often overlooked and not evaluated in dissemination research.

  6. Why is organizational theory/change critical to dissemination? • We need to do a better job in developing measures of organizational level variables that both facilitate and hinder the dissemination of innovative health programs. • Examples: organizational capacity/ resources; mission/goals/ priorities, leadership, training.

  7. What does “sustainability” mean? • The problem of “core elements” versus local adaptation. When is an innovation no longer the same? • Who decides what the “core elements” are? - Need an agreed upon process for deciding; needs to involve end-users. • Are there differences in meaning of “sustainability,” “maintenance,” “institutionalization,” and “embedded”? • Need to develop methods for evaluating whether core elements are disseminated, used and sustained.

  8. NC ChoiceThe colorectal screening program SECULAR TRENDS • How do we know that CHOICE is effective and is ready for dissemination? It may have been developed and tested in controlled conditions with a lot of resources? • Was the efficacy trial done by the program developer? • High level of secular trends re: colorectal screening; a lot public and physician awareness and actual screening. • 3.4 million Google hits for “colorectal cancer”760,000 hits for “colorectal cancer screening.” • If CHOICE is not disseminated, what will happen re: CRC “naturally?”

  9. NC ChoiceThe colorectal screening program • ORGANIZATIONAL VARIABLES • Many organizational issues involved – doctors practices, clinics, hospitals, etc. • Do those organizations see CRS and the web program as part of their mission? • In a given community do hospitals, clinics, doctors offices have the capacity and resources to handle a significant increase in number of people being screened?

  10. NC CHOICEThe colorectal screening program SUSTAINABILITY • What is being sustained? Is it the social marketing campaign? The actual screening of community members? The increased capacity of community organizations to do screening? The educational program? • What are the “core elements” of the CHOICE program? Who should decide? What can be removed or changed without destroying it? • What would be an appropriate measure of sustainability. - After what time period? What percent of offices, clinics, etc.?

  11. Thought of the Day • If at first you don’t succeed, then skydiving is definitely not for you.

  12. The End

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