Healthy Weigh (El camino saludable) phase 1: a retrospective critical examination of program evaluation.

BACKGROUND: Healthy Weigh (El camino saludable) is an obesity prevention program for low-income, predominantly Hispanic and African American families in an urban community in Tarrant County, Texas. Healthy Weigh Phase 1 was a successful community-campus partnership that took place in summer (June-August) and fall (September-November) 2003. The program met stated objectives and extensively engaged students from several health disciplines in service learning. This article describes what we learned about the evaluation of the program by examining the phase 1 evaluation process. CONTEXT: Family environments are important intervention settings for establishing life-long dietary practices. Available in English and Spanish, Healthy Weigh Phase 1 helped families that were at risk for overweight and obesity to adopt healthy eating, physical activity, and weight management patterns. METHODS: Analysis of a program logic model and formative evaluation data identified evaluation questions that could have improved the phase 1 evaluation process. Questions were categorized according to Donabedian's structure-process-outcome framework, and potential benefits of each question were identified. The Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health standards were used to judge the overall quality of the phase 1 evaluation process. CONSEQUENCES: The phase 1 evaluation process successfully assessed the program's effects and generally met evaluation standards. Our critical examination also highlighted structure and process evaluation issues with potential for strengthening future interventions, community partnerships, and program outcomes. INTERPRETATION: Lessons learned influenced the phase 2 grant activities. Most importantly, we learned that involvement of program participants as full partners in program design, evaluation, and implementation is essential. Our understanding and practice of program evaluation evolved as Healthy Weigh became a true community-based participatory research endeavor.

What we can learn from the British maternal child health system.

Infants born in Great Britain have a better chance of living until their first birthdays than do infants born in the United States. Although Great Britain spends less than half what the United States spends on healthcare, its estimated infant mortality rate was 5.5 as compared to 6.8 in the United States in 2001 (Central Intelligence Agency [CIA], 2001). What is different about healthcare in Great Britain? This article details some of the differences, suggesting that there are ways the United States can improve its infant mortality rates.

Family caregiver assessment. Essential for effective home health care.

Home health care nurses do not routinely assess the health of family caregivers despite their essential contribution to the client's care. In this study, home care nurses collected data on 51 older family caregivers from their caseloads to assess their health. The average age of the caregivers was 75.1 years (SD = 6.09). Most (66.7%) were women and were the home health client's spouse (82.4%). These individuals had been caregivers for up to 20 years, and reported spending an average of 13.3 hours per day in this role (SD = 9.15). Approximately half (n = 25) of the caregivers reported poor or fair health, with 33.3% (17) reporting a decline in their health over the previous 6 months. Unmet health needs included the need for blood pressure monitoring, mammograms, PAP smears, and prostate examinations. Referrals to other health care providers or community agencies were required by 78.4% of the caregivers, 78.4% required health teaching, and 23.5% required home health services themselves. Those requiring home health care were more likely to be on more medications and classify their health as fair or poor. These findings confirm those of a pilot study conducted on 51 other family caregivers. Nurses serving the geriatric population need to conduct systematic family caregiver assessments to identify caregiver health needs that could impair their caregiving ability. In particular, for home health care to be effective, nurses must conduct caregiver assessments.