NURS6150, Section 14, Promoting and Preserving Health in a Diverse Society April 16, 2011
Outcomes and Evaluation of Community Health Project It is important to evaluate any public health program to determine its contribution and health impact on the population it was designed to help, in addition to its sustainability. Processes should be established during the inception of the program to establish a baseline, and methods of gathering data, which would be used for this evaluation. The RE-AIM evaluation model was chosen to guide the process of evaluating the American Indian Diabetes Program (AIDP). This paper examines how the AIDP program’s methods and results will be measured and evaluated to ensure the best possible outcomes. Elements of the Evaluation Model The RE-AIM model is specifically well suited for evaluating the population based-impact of large public health programs. It contends that some more effective, expensive, programs that conduct trials using a highly motivated population, are usually not generalizable to the real world. It is preferable for a program to have a more realistic efficacy goal, reach more people, and achieve a larger adoption by communities and policy makers, a program that is implemented as intended, and results in behavioral change that is maintained over the long term (Glasgow, Vogt, & Boles, 1999). The name RE-AIM is an acronym that stands for reach, efficacy, adoption, implementation, and maintenance. The five RE-AIM dimensions are each given a 0 to 1 (or 0% to 100%) score during program evaluation (Glasgow et al., 1999). It is suggested that the program’s implementation be evaluated over a period of at least 6 months to a year, and 2 years or longer for the maintenance portion of the program (Glasgow et al, 1999). This model is appropriate to use as a framework for evaluating the AIDP because it works well with programs that seek to reach large numbers of people. In the AIDP we will be attempting to screen the entire adult Indian reservation population for diabetes or pre-diabetes. The model also works well with programs that require more than one intervention. This program offers both preventative and disease management interventions. We will be evaluating the marketing, screening, and the education process of the diabetes prevention side of the program by taking an initial census of the reservation adult population (age 18 and older), and comparing that number with those who participate in the screening and attend educational classes. This will demonstrate the programs reach. “Screening for type 2 diabetes in high risk populations is widely recommended” because epidemiological studies have shown evidence to suggest that 30% to 50% of all diabetics are undiagnosed (Goyder, Wild, Fischbacher, Carlisle, & Peters, 2008, p. 370). This could be especially true for the American Indian. We will also be doing further tests on those who have been shown to be pre-diabetics and diabetics. Both groups plus family members will go through diabetes education courses. Those with pre-diabetes would be rechecked every six months the first year and every six months in following years, with telephone follow-up on diet changes and exercise progress in between. All data would be recorded for future evaluation. The diabetics would be seen quarterly and all test results, patient compliance to diabetes management practices, along with physical improvement or complications would be utilized for evaluation via record review. It would be necessary to obtain patient consent prior to their participation in the program. Measurable Objectives There are four main objectives this program would be seeking to achieve: behavioral...