Public health training center evaluation: a framework for using logic models to improve practice and educate the public health workforce.

The nation's 37 public health training centers (PHTCs) provide competency-based trainings and practice-based opportunities to advance the current and future public health workforces. The Emory PHTC, based in Atlanta, Georgia, has developed a comprehensive evaluation plan to address the many evaluation-related questions that must be answered to inform decisions that improve practice. This plan, based on the center's logic model, includes formative assessment, outcome evaluation, process evaluation, and programmatic evaluation. Rigorous evaluation has been used to (a) assess what is working, what is not working, and why; (b) guide decision making about program improvement; and (c) ensure efficient use of resources, such as time and money. This article describes how the Emory PHTC uses its logic model to guide development of a comprehensive evaluation plan and to create specific data collection tools. It also explains the process used to analyze data and make decisions to maximize effectiveness and ensure the best use of resources. Simply conducting trainings and providing opportunities for real-world application are not enough; it is critical to assess whether or not these educational opportunities are, in fact, educating.

Stress coping and changes in health behavior among cancer survivors: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).

This study used the transactional model of stress and coping to examine the relationship between cancer survivors' self-reported efforts to manage stress and the adoption of health behaviors across various lifestyle behavior domains. The authors analyzed data of 2,888 cancer survivors from a national, population-based, cross-sectional survey. Cancer survivors who indicated making active efforts to control stress were more likely to make changes in their physical, psychosocial, and preventive health behaviors as compared to cancer survivors who used passive stress-coping approaches. Future interventions aimed at promoting health behaviors among cancer survivors may benefit from incorporating a stress-coping component.

A drive through Web 2.0: an exploration of driving safety promotion on Facebook™.

This study explored Facebook™ to capture the prevalence of driving safety promotion user groups, obtain user demographic information, to understand if Facebook™ user groups influence reported driving behaviors, and to gather a sense of perceived effectiveness of Facebook™ for driving safety promotion targeted to young adults. In total, 96 driving safety Facebook™ groups (DSFGs) were identified with a total of 33,368 members, 168 administrators, 156 officers, 1,598 wall posts representing 12 countries. A total of 85 individuals participated in the survey. Demographic findings of this study suggest that driving safety promotion can be targeted to young and older adults. Respondents' ages ranged from 18 to 66 years. A total of 62% of respondents aged ≤ 24 years and 57.8% of respondents aged ≥ 25 years reported changing their driving-related behaviors as a result of reading information on the DSFGs to which they belonged. A higher proportion of respondents ≥ 25 years were significantly more likely to report Facebook™ and YouTube™ as an effective technology for driving safety promotion. This preliminary study indicates that DSFGs may be effective tools for driving safety promotion among young adults. More research is needed to understand the cognition of Facebook™ users as it relates to adopting safe driving behavior. The findings from this study present descriptive data to guide public health practitioners for future health promotion activities on Facebook™.

Better learning through instructional science: a health literacy case study in "how to teach so learners can learn".

Health education and behavior change interventions typically pay little attention to the intervention's instructional foundation. Combining the fields of health literacy, cognitive psychology, and adult learning theory, this article provides an integrative scientific approach, called the BEAN (Better Education and iNnovation) model, to creating an instructional foundation based on how individuals acquire knowledge and skills. The article uses a case study example from an adult literacy center's health literacy class to explore how environmental factors and instructional strategies can be applied to health education and behavior change interventions. Data for this case study were derived through 20 hours of classroom observation and qualitative interviews with 21 adult education students and 3 instructors. Results provide practical examples of environmental factors and instructional strategies designed to facilitate learning, such as fostering autonomy, activating prior knowledge, and fostering perspective change. Results also describe the resulting health behavior changes of students attending the health literacy class, such as increased medication adherence and physical activity, improved nutritional habits, and increased question asking of health practitioners. This article serves as a first step to encouraging researchers and educators to consider the importance of drawing on cognitive psychology and theories of adult learning to create a scientifically based instructional foundation for health behavior change programs. Additionally, by drawing on the expertise of adult educators well versed in the science of instructional design, this article also demonstrates that the adult education classroom is an excellent setting for conducting health education and behavior change interventions.

Amplifying diffusion of health information in low-literate populations through adult education health literacy classes.

Over the next decade, as literacy rates are predicted to decline, the health care sector faces increasing challenges to effective communication with low-literate groups. Considering the rising costs of health care and the forthcoming changes in the American health care system, it is imperative to find nontraditional avenues through which to impart health knowledge and functional skills. This article draws on classroom observations and qualitative interviews with 21 students and 3 teachers in an adult education health literacy class to explore the efficacy of using adult education courses to teach functional health literacy skills to low-literate populations. Data were analyzed using a combination of thematic and content analyses. Results describe the motivation of students to share information within the classroom and with friends and family outside the classroom. This article also provides several recommendations to help ensure accuracy of diffused information both within and outside of the classroom. Ultimately, this study suggests that the adult education system is in a prime position to impart functional health literacy skills to low-literate populations in the classroom. Significantly, this study demonstrates that adult education students themselves may be a powerful vehicle for health communication beyond the walls of the classroom.

The evidence base for effectiveness of preparedness training: a retrospective analysis.

OBJECTIVES: In 2007, the Centers for Disease Control and Prevention (CDC) commissioned an Evidence-Based Gaps Collaboration Group to consider whether past experience could help guide future efforts to educate and train public health workers in responding to emergencies and disasters. METHODS: The Group searched the peer-reviewed literature for preparedness training articles meeting three criteria: publication during the period when CDC's Centers for Public Health Preparedness were fully operational, content relevant to emergency response operations, and content particular to the emergency response roles of public health professionals. Articles underwent both quantitative and qualitative analyses. RESULTS: The search identified 163 articles covering the topics of leadership and command structure (18.4%), information and communications (14.1%), organizational systems (78.5%), and others (23.9%). The number of reports was substantial, but their usefulness for trainers and educators was rated only "fair" to "good." Thematic analysis of 137 articles found that organizational topics far outnumbered leadership, command structure, and communications topics. Disconnects among critical participants--including trainers, policy makers, and public health agencies--were noted. Generalizable evaluations were rare. CONCLUSIONS: Reviews of progress in preparedness training for the public health workforce should be repeated in the future. Governmental investment in training for preparedness should continue. Future training programs should be grounded in policy and practice needs, and evaluations should be based on performance improvement.

Effectiveness of school network for childhood obesity prevention (SNOCOP) in primary schools of Saraburi Province, Thailand.

This research was designed to test the effectiveness of a school network for childhood obesity prevention (SNOCOP) in primary schools; a program that aimed to improve student behavior in terms of knowledge, attitude, intention towards obesity prevention, and their food consumption behavior. A quasi-experimental pretest-posttest time series study was conducted. By 2-stage stratified sampling selection 180 students from 6 schools were assigned to the intervention group and 195 students from 6 schools to the control group at Saraburi Province, Thailand in 2006- 2007. In addition, thirty-one participants being school administrators, teachers, parents, and community members from six schools formed the social network initiating the intervention. The schoolchildren in the intervention group improved their eating behavior, knowledge, attitude, intention towards obesity preventive behavior. The six schools of the intervention group changed school policies and school activities aiming to reduce the proportion of obesity among their student. No such activities could be observed in the control group. These findings suggest that the School-Social Network of Childhood Obesity Prevention program is an effective means to prevent childhood obesity.

Can summits lead to curricula change? An evaluation of emergency preparedness summits for schools of nursing in Georgia.

The Emory University Center for Public Health Preparedness held two summits for nurses that were evaluated by survey. Participants cited multiple deficiencies and challenges with integrating emergency preparedness into nursing curricula. The summits and the related materials were reported as highly useful by survey respondents. More than three fourths of respondents reported incorporating emergency preparedness education into their curricula after summit attendance. Nursing professionals could use summits to encourage active practitioners to pursue continuing education and to initiate efforts to incorporate emergency preparedness and related health care issues into the curricula of schools of nursing.

A competency-based approach to expanding the cancer care workforce: proof of concept.

As part of an effort to address shortages in the cancer workforce, C-Change developed competency standards and logic model-driven implementation tools for strengthening the cancer knowledge and skills of non-oncology health professionals. Testing of these standards and tools at four diverse pilot sites yielded very promising results.

Logic model use in developing a survey instrument for program evaluation: emergency preparedness summits for schools of nursing in Georgia.

The objective of this paper is to describe a method for using a logic model to guide program evaluation by detailing the steps used, providing diagrams that visually depict the process, and giving an example based on the evaluation of emergency preparedness nursing summits in Georgia. Developing a logic model is an ideal way to visually depict the inputs, activities, outputs, and outcomes of a program, thus providing a clear framework of the workings and functions of the program. In planning a comprehensive evaluation, being able to view all the elements in a program and how they interrelate makes it easier to determine the areas that should be addressed. When a survey is part of a program evaluation, determining that the goals, objectives, research questions, logic model, and survey questions maintain consistency in the way they relate and lead to each other can help document the completeness and symmetry of the assessment. By showing these linkages, the utility of the logic model is maximized and the stakeholders in the assessment of the program have clear evidence that their expectations and needs have been met for a valuable, useful evaluation product.

Health behavior change models and theories: contributions to rehabilitation.

PURPOSE: This article highlights the importance of health behavior change (HBC) theory, and its relevance to rehabilitation research and practice. METHOD: An extensive review of HBC-related literature pertinent to rehabilitation was conducted, focusing on the potential impact of these theories and models in enhancing long-term results of rehabilitation with regard to lifestyle change and health promotion, and outlining the benefits of incorporating HBC themes into rehabilitation practice. For our purposes, the HBC concept is based on initiation and maintenance of health behaviors, functioning, wellness, and self-management of chronic conditions or disabilities within an environmental context. While comparing and contrasting three widely known theories of HBC, the contributions of these theories to rehabilitation research and practice are discussed. RESULTS: Three propositions are put forward: (1) HBC variables should regularly be used as outcome measures in evidence-based rehabilitation research; (2) there should be a better understanding of the role of the rehabilitation provider as a facilitator in eliciting healthy behaviors; and (3) there is a need to expand the HBC concept into a more comprehensive view encompassing a person's functioning within the environmental context. CONCLUSIONS: A conceptual merger between HBC theories and rehabilitation practice can have major implications for individuals with disabilities, their functioning, health, and well-being.

Internet use for health information among college students.

Use of the Internet to retrieve health information is increasingly common. The authors surveyed 743 undergraduate students at 2 academic institutions to examine their Internet use, health-seeking behaviors, and attitudes related to the use of the Internet to obtain health information. Fifty-three percent of the respondents indicated that they would like to get health information online, and 28% reported that they would like to attend a health program online. Overall, 74% of the students reported having ever received health information online, and more than 40% reported that they frequently searched the Internet for information. They used various search engines and multiple Web sites to find health information. Issues related to the credibility of the information on health Web sites were crucial considerations for students. The study found differences in Internet use for health information by gender and by level of Internet experience.

The 1998 Master Settlement Agreement: a public health opportunity realized--or lost?

On November 23, 1998, a legal settlement of historic proportions took place. The five major U.S. tobacco manufacturers signed an agreement with 46 states, the District of Columbia, and five U.S. territories to settle pending lawsuits by compensating the states for Medicaid costs of treating smoking-related illness. This multistate Master Settlement Agreement (MSA) seemed to herald a new era in public health as it provided a potential source of funds for state-based tobacco-control programs (estimated at U.S.$206 billion for the first 25 years) and also banned an array of advertising and marketing efforts to attract young people to tobacco. Five years after the settlement, however, it appears that most states have not committed a significant portion of the funds for tobacco prevention efforts but rather have used the money to support other state needs. Moreover, tobacco companies have continued aggressive marketing efforts to reach youth.

Building capacity for success: the Tobacco Technical Assistance Consortium.

The Master Settlement Agreement with the tobacco industry has infused resources into tobacco control and prevention, which has helped fund tobacco control programs at the national, state, and local levels. Many tobacco control programs face challenges in areas such as strategic planning, fiscal operations, advocacy, and personnel management. To provide technical assistance to these programs, the Robert Wood Johnson Foundation, the American Legacy Foundation, and the American Cancer Society combined resources to fund the Tobacco Technical Assistance Consortium (TTAC). TTAG, housed at the Rollins School of Public Health at Emory University, provides support for tobacco control programs and matches requests for technical assistance with consultants who have the appropriate expertise. TTAC is a valuable addition to tobacco control and prevention resources and is a viable component within a school of public health.

Intent to breast-feed: the impact of attitudes, norms, parity, and experience.

OBJECTIVE: To examine the influence of breast-feeding attitudes, social norms, and prior experience on predicting breast-feeding intention utilizing the theories of reasoned action and planned behavior. METHODS: Low-income pregnant women (n = 963) completed a theory-based questionnaire. RESULTS: Attitudes were more predictive of breast-feeding intention than were norms, regardless of parity or prior behavior. Among multiparous women, amount of prior breast-feeding experience contributed independently to predicting breast-feeding intention and rendered norms insignificant. CONCLUSION: Results support the theories. Breast-feeding promotions targeting low-income women should emphasize enhancing women's personal breast-feeding attitudes, and, among primiparous women, promoting positive breast-feeding attitudes among their significant others.