Measuring consumer experiences with primary care.

OBJECTIVE: To assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) for evaluating the attainment of the key characteristics of primary care services for children and youth. DESIGN: Community-based telephone survey. SETTING: Specific political subdivision in Washington, DC. PARTICIPANTS: Four hundred fifty parents/guardians of offspring 18 years of age or less. MEASURES: Reliability, validity and principal component analysis of 5 scales representing key aspects of the 4 cardinal domains of primary care included in the PCAT-CE. In addition, 2 subdomains (first contact use and extent of affiliation with a primary care source) were included as indices to describe overall patterns of use and affiliation with the particular source of care. RESULTS: Most scales had adequate internal consistency, test-retest reliability, and construct validity. The principal components factor analysis yielded 5 separate factors. These corresponded to the subdomains of first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; and comprehensiveness (both services available and indicated services received). CONCLUSIONS: Psychometric assessment supported the integrity and general adequacy of the PCAT-CE for assessing the characteristics and quality of primary care for children and youth. Testing of revised versions in a variety of different settings is underway. A major component of this testing is to explore the possibility of reducing the number of items while retaining sufficient detail about each component of primary care to make judgements about people's experiences with that care.

Model indicators for maternal and child health: an overview of process, product, and applications.

OBJECTIVES: Further improvements in the health of mothers and children depend, in part, on collecting, analyzing, and interpreting relevant data correctly. Despite consistent efforts to improve data capacity and use during the past two decades, the need persists for a model set of maternal and child health (MCH) indicators to guide decisions about health conditions to be monitored, elements to be included in data sets, and definitions of measures. This article describes development, key characteristics, and major applications of a set of MCH Model Indicators (MCH MI) created to address these needs. METHODS: A conceptual model with five domains was created to organize and guide development of the indicators. The development process included systematic specification of concepts, formulas, age/gender groups, and data sources, as well as recommendations for frequency of surveillance. Information sources included published reports and expert opinion. RESULTS: There are 217 indicators distributed across domains as follows: 75 health status, 9 contextual characteristics, 16 health systems capacity and adequacy, 49 risk/protective status, and 68 health and related services. Twenty of the indicators, all of them in the health status domain, are recommended for routine surveillance. CONCLUSIONS: The indicators can be used to identify and address MCH problems, to complement and expand other sets of MCH indicators, to serve as standards for consistent definitions, to provide guidance for creation and revision of MCH and related data bases, and to provide a foundation for the development of related sets of indicators. Some of the indicators require further development, but the total MCH MI package constitutes a solid foundation for subsequent work, as well as for ongoing modifications that are essential if the Model Indicators are to remain responsive to MCH needs.

Measuring the implementation of injury prevention programs in state health agencies.

OBJECTIVE: Injury prevention programs have been implemented with varying degrees of success in the United States. The objective of this study was to identify the variables that influence the successful implementation of injury prevention programs. METHODS: The key indicators of implementation success and its correlates were identified through consultation with a panel of experts. This consultation informed the content of a mail questionnaire sent to all United States state health departments, followed by telephone interviews. Data were analyzed using factor analysis and regression to identify significant relationships between variables. RESULTS: Data were obtained from 64 programs, representing 44 states; these included 24 programs in injury control units, 12 in maternal and child health units, 10 in health promotion/education units; and eight in emergency medical services units. Analysis identified four factors that are associated with an index of successful injury prevention program implementation; (1) participation and advocacy by constituent groups; (2) organizational capacity; (3) administrative control; and (4) attributes of relevant policies. CONCLUSIONS: Findings indicated that constituent participation (the extent and efficacy of constituency support and advocacy) and organizational capacity (a function of program staff and their skill levels) had the greatest influence on successful program implementation. Support from advocacy groups and knowledgeable staff members, whose time is dedicated to the program, are critical for conducting the activities necessary for successful implementation of these programs.

Linking implementation to outcomes: evaluation of a community-based breast and cervical cancer screening program.

UNLABELLED: An implementation analysis of the first eighteen months of the Maryland Breast and Cervical Cancer Program examined the variability among participating local agencies in the extent of screening services delivered; local program implementation processes; and the relationships between extent of screening and the local level processes. The study used: 1) a mail and telephone survey of local health departments (LHD, N = 24) and 2) state program surveillance data, with correlational methods. OUTCOMES MEASURED: 1) "Penetration," the proportion of the target population screened; and 2) "Efficiency," the number of women screened per program staff member. Categories of implementation variables were: 1) Environment, 2) Staffing, 3) Collaboration with community organizations, 4) Outreach, 5) Provider variables, 6) Relationships with State and LHDs, 7) Organizational variables, and 8) Service delivery. Results showed wide local variability in screening levels. Availability of local resources; provider involvement; success of community linkages; and local health department readiness showed relationships with the extent of local screening. Studying implementation is needed to improve the effectiveness and efficiency of community-based programs.

Measuring the implementation of health promotion programs: the case of the Breast and Cervical Cancer Program in Maryland.

This paper introduces critically important issues and benefits for measuring the extent and processes of program implementation when conducting and studying health education and health promotion programs. These methods are illustrated with reference to the Breast and Cervical Cancer Program in Maryland. We suggest using a chain of events research paradigm rather than confining community intervention research to the more frequently used experimental model. Combined roles as researchers and technical advisors serve complementary functions of gathering relevant, valid information about implementation and making these data useful to program managers. Measures of implementation should be used to examine the detailed delivery of program components, to assess organizational and environmental processes influencing the extent of implementation and to analytically link variations in program delivery to desired short-term outcomes. Measuring these processes is needed to move implementation research for health promotion programs beyond an anecdotal set of case stories about implementation problems to a fully developed area of research-based knowledge.