An Assessment of Evaluation Instruction Related to the Health Education Specialist Practice Analysis Competencies in Health Education-Related Professional Preparation Programs.

BACKGROUND: Conducting evaluation and research is one of the seven areas of responsibility for health education specialists. However, there is little evidence to suggest that professional preparation programs use the competencies as identified by the 2015 Health Education Specialist Practice Analysis (HESPA) as a basis for instruction. AIMS: To determine the degree to which departments with undergraduate health education-related professional preparation programs provide instruction in the HESPA 2015 Model evaluation competencies. METHOD: This was a descriptive, cross-sectional, nonexperimental study design. Data were collected using an online survey from programs that prepare students to sit for the CHES exam. RESULTS: Faculty provide instruction about all evaluation subcompetencies regardless of entry- or advanced-level designation. Developing an evaluation plan, monitoring implementation, and selecting, adapting, and creating instruments to collect data represent the competencies taught most frequently. On average, two to three class periods are spent on each competency. DISCUSSION: Advanced-level competencies, more commonly associated with graduate-level training and degrees, are commonly taught at the undergraduate level. This may be due to a lack of awareness of changes to the designation of competencies and subcompetencies as entry- or advanced-level in the HESPA 2015 Model framework, a lack of awareness or appreciation for the framework in general, competing values in the selection of curriculum content, or lack of professional consensus related to terms and definitions. CONCLUSION: Faculty should consider emphasizing entry-level competencies and subcompetencies consistent with process and formative evaluation. The health education profession should also standardize evaluation and research terms and definitions.

Attitudes Toward Breastfeeding Among an Internet Panel of U.S. Males Aged 21-44.

Lack of familial support, particularly from fathers or partners, has been identified by the U.S. Surgeon General as a barrier to breastfeeding. Although partners have been identified as an important source of breastfeeding support, research on U.S. men's knowledge about and attitudes towards breastfeeding is limited. An internet panel survey of 502 U.S. males aged 21-44 years was conducted. It included the 17-item Iowa Infant Feeding Attitude Scale (IIFAS), a series of questions assessing prior exposure to breastfeeding and demographic questions. Frequencies, proportions and means were calculated and analysis of variance used to test differences in the mean IIFAS scale score across demographic groups. A multiple linear regression model was used to identify predictors of IIFAS score. The sample was largely white, non-Hispanic (65.7%), college educated (44.4%) and married (47%). The mean IIFAS score was 57 (SD = 8.13; range 25-84). In the adjusted regression model, being white, non-Hispanic, having a college education, having siblings who were breastfed and observing ten or more different women breastfeeding were significantly associated with higher IIFAS scores. In a sample of U.S. men of reproductive age, breastfeeding knowledge and attitudes as measured by the IIFAS are neutral. Race, education, and exposure to breastfeeding are important predictors of breastfeeding attitudes in males as measured by the IIFAS.

Evaluating programs that address ideological issues: ethical and practical considerations for practitioners and evaluators.

There are important practical and ethical considerations for organizations in conducting their own, or commissioning external, evaluations and for both practitioners and evaluators, when assessing programs built on strongly held ideological or philosophical approaches. Assessing whether programs "work" has strong political, financial, and/or moral implications, particularly when expending public dollars, and may challenge objectivity about a particular program or approach. Using a case study of the evaluation of a school-based abstinence-until-marriage program, this article discusses the challenges, lessons learned, and ethical responsibilities regarding decisions about evaluation, specifically associated with ideologically driven programs. Organizations should consider various stakeholders and views associated with their program to help identify potential pitfalls in evaluation. Once identified, the program or agency needs to carefully consider its answers to two key questions: Do they want the answer and are they willing to modify the program? Having decided to evaluate, the choice of evaluator is critical to assuring that ethical principles are maintained and potential skepticism or criticism of findings can be addressed appropriately. The relationship between program and evaluator, including agreements about ownership and eventual publication and/or promotion of data, should be addressed at the outset. Programs and organizations should consider, at the outset, their ethical responsibility when findings are not expected or desired. Ultimately, agencies, organizations, and programs have an ethical responsibility to use their data to provide health promotion programs, whether ideologically founded or not, that appropriately and effectively address the problems they seek to solve.

Identifying barriers preventing Latina women from accessing WIC online health information.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a program for low-income women and children under age five. The purpose of this study was to identify barriers to accessing online WIC resources among Latina WIC clients. Five focus groups were conducted with Spanish-speaking participants recruited from a single WIC clinic. Two key themes emerged relating to barriers in accessing WIC's online resources. The first theme, access issues, included three subthemes: lack of computer/Internet resources; family barriers to computer use; and computer literacy. The second theme, perceived value of the website, included three subthemes: limited time savings; preference for on-site education; and knowledge about the website. This is the first study to evaluate barriers to accessing online resources among Latina women in the WIC program. WIC sites attempting to increase utilization of online resources may be more successful if they serve clients with easy access to a computer with Internet access. They may also consider strategies to increase the value of the online resources, as compared to their current services offered to clients in a face-to-face setting.

Analysis of the purpose of state health departments' tweets: information sharing, engagement, and action.

BACKGROUND: Public health agencies are actively using social media, including Twitter. In the public health and nonprofit sectors, Twitter has been limited to one-way communication. Two-way, interactive communication on Twitter has the potential to enhance organizational relationships with followers and help organizations achieve their goals by increasing communication and dialog between the organization and its followers. Research shows that nonprofit organizations use Twitter for three main functions: information sharing, community building, and action. OBJECTIVE: It is not known whether state health departments are using Twitter primarily for one-way information sharing or if they are trying to engage followers to build relationships and promote action. The purpose of this research was to discover what the primary function of Twitter use is among state health departments in the United States and whether this is similar to or different from nonprofit organizations. METHODS: A complete list of "tweets" made by each state health department account was obtained using the Twitter application programming interface. We randomly sampled 10% of each state health department's tweets. Four research assistants hand-coded the tweets' primary focus (organization centric or personal health information centric) and then the subcategories of information dissemination, engagement, or action. Research assistants coded each tweet for interactivity, sophistication, and redirects to another website. Data were analyzed using SPSS version 20. RESULTS: There were 4221 tweets from 39 state health departments. There was no statistically significant difference in the number of tweets made by a state health department and the state population density (P=.25). The majority of tweets focused on personal health topics (69.37%, 2928/4221) while one-third were tweets about the organization (29.14% , 1230/4221). The main function of organization-based tweets was engagement through conversations to build community (65.77%, 809/1236). These engagement-related tweets were primarily recognition of other organizations' events (43.6%, 353/809) and giving thanks and recognition (21.4%, 173/809). Nearly all of the personal health information-centric tweets involved general public health information (92.10%, 1399/1519) and 79.03% (3336/4221) of tweets directed followers to another link for more information. CONCLUSIONS: This is the first study to assess the purpose of public health tweets among state health departments. State health departments are using Twitter as a one-way communication tool, with tweets focused primarily on personal health. A state health department Twitter account may not be the primary health information source for individuals. Therefore, state health departments should reconsider their focus on personal health tweets and envision how they can use Twitter to develop relationships with community agencies and partners. In order to realize the potential of Twitter to establish relationships and develop connections, more two-way communication and interaction are essential.

Use of twitter among local health departments: an analysis of information sharing, engagement, and action.

BACKGROUND: Social media offers unprecedented opportunities for public health to engage audiences in conversations and collaboration that could potentially lead to improved health conditions. While there is some evidence that local health departments (LHDs) are using social media and Twitter in particular, little is known about how Twitter is used by LHDs and how they use it to engage followers versus disseminating one-way information. OBJECTIVE: To examine how LHDs use Twitter to share information, engage with followers, and promote action, as well as to discover differences in Twitter use among LHDs by size of population served. METHODS: The Twitter accounts for 210 LHDs were stratified into three groups based on size of population served (n=69 for less than 100,000; n=89 for 100,000-499,999; n=52 for 500,000 or greater). A sample of 1000 tweets was obtained for each stratum and coded as being either about the organization or about personal-health topics. Subcategories for organization included information, engagement, and action. Subcategories for personal health included information and action. RESULTS: Of all LHD tweets (n=3000), 56.1% (1682/3000) related to personal health compared with 39.5% (1186/3000) that were about the organization. Of the personal-health tweets, 58.5% (984/1682) involved factual information and 41.4% (697/1682) encouraged action. Of the organization-related tweets, 51.9% (615/1186) represented one-way communication about the organization and its events and services, 35.0% (416/1186) tried to engage followers in conversation, and 13.3% (158/1186) encouraged action to benefit the organization (eg, attend events). Compared with large LHDs, small LHDs were more likely to post tweets about their organization (Cramer's V=0.06) but were less likely to acknowledge events and accomplishments of other organizations (χ²=12.83, P=.02, Cramer's V=0.18). Small LHDs were also less likely to post personal health-related tweets (Cramer's V=0.08) and were less likely to post tweets containing suggestions to take action to modify their lifestyle. While large LHDs were more likely to post engagement-related tweets about the organization (Cramer's V=0.12), they were less likely to ask followers to take action that would benefit the organization (χ²=7.59, P=.02. Cramer's V=0.08). While certain associations were statistically significant, the Cramer's V statistic revealed weak associations. CONCLUSIONS: Twitter is being adopted by LHDs, but its primary use involves one-way communication on personal-health topics as well as organization-related information. There is also evidence that LHDs are starting to use Twitter to engage their audiences in conversations. As public health transitions to more dialogic conversation and engagement, Twitter's potential to help form partnerships with audiences and involve them as program participants may lead to action for improved health.

Using the community readiness model as an approach to formative evaluation.

This article presents an adapted version of an established model for assessing community readiness along with an illustrative case example from the evaluation of Positive Action, a school-based social and character development intervention, implemented as part of a randomized controlled trial in Chicago Public Schools from 2004 through 2010. Community readiness is an emerging assessment approach that can be used to gauge the level of understanding, desire, and ownership that community members have regarding a community problem and/or intervention. This approach is useful in engaging the community and leveraging particular aspects of readiness that the community may exhibit in order to maximize an intervention's successful implementation. The article concludes with a discussion of ways in which a community readiness model may be useful in health promotion practice, both in schools and in other community settings.

Evaluating social media's capacity to develop engaged audiences in health promotion settings: use of Twitter metrics as a case study.

Use of social media in health promotion and public health continues to grow in popularity, though most of what is reported in literature represents one-way messaging devoid of attributes associated with engagement, a core attribute, if not the central purpose, of social media. This article defines engagement, describes its value in maximizing the potential of social media in health promotion, proposes an evaluation hierarchy for social media engagement, and uses Twitter as a case study to illustrate how the hierarchy might function in practice. Partnership and participation are proposed as culminating outcomes for social media use in health promotion. As use of social media in health promotion moves toward this end, evaluation metrics that verify progress and inform subsequent strategies will become increasingly important.

Advocacy evaluation: challenges and emerging trends.

Devising, promoting, and implementing changes in policies and regulations are important components of population-level health promotion. Whether advocating for changes in school meal nutrition standards or restrictions on secondhand smoke, policy change can create environments conducive to healthier choices. Such policy changes often result from complex advocacy efforts that do not lend themselves to traditional evaluation approaches. In a challenging fiscal environment, allocating scarce resources to policy advocacy may be particularly difficult. A well-designed evaluation that moves beyond inventorying advocacy activities can help make the case for funding advocacy and policy change efforts. Although it is one thing to catalog meetings held, position papers drafted, and pamphlets distributed, it is quite another to demonstrate that these outputs resulted in useful policy change outcomes. This is where the emerging field of advocacy evaluation fits in by assessing (among other things) strategic learning, capacity building, and community organizing. Based on recent developments, this article highlights several challenges advocacy evaluators are currently facing and provides new resources for addressing them.

Adoption and use of social media among public health departments.

BACKGROUND: Effective communication is a critical function within any public health system. Social media has enhanced communication between individuals and organizations and has the potential to augment public health communication. However, there is a lack of reported data on social media adoption within public health settings. The purposes of this study were to assess: 1) the extent to which state public health departments (SHDs) are using social media; 2) which social media applications are used most often; and 3) how often social media is used interactively to engage audiences. METHODS: This was a non-experimental, cross sectional study of SHD social media sites. Screen capture software Snag-It® was used to obtain screenshots of SHD social media sites across five applications. These sites were coded for social media presence, interactivity, reach, and topic. RESULTS: Sixty percent of SHDs reported using at least one social media application. Of these, 86.7% had a Twitter account, 56% a Facebook account, and 43% a YouTube channel. There was a statistically significant difference between average population density and use of social media (p = .01). On average, SHDs made one post per day on social media sites, and this was primarily to distribute information; there was very little interaction with audiences. SHDs have few followers or friends on their social media sites. The most common topics for posts and tweets related to staying healthy and diseases and conditions. Limitations include the absence of a standard by which social media metrics measure presence, reach, or interactivity; SHDs were only included if they had an institutionally maintained account; and the study was cross sectional. CONCLUSIONS: Social media use by public health agencies is in the early adoption stage. However, the reach of social media is limited. SHDs are using social media as a channel to distribute information rather than capitalizing on the interactivity available to create conversations and engage with the audience. If public health agencies are to effectively use social media then they must develop a strategic communication plan that incorporates best practices for expanding reach and fostering interactivity and engagement.

Use of social media in health promotion: purposes, key performance indicators, and evaluation metrics.

Despite the expanding use of social media, little has been published about its appropriate role in health promotion, and even less has been written about evaluation. The purpose of this article is threefold: (a) outline purposes for social media in health promotion, (b) identify potential key performance indicators associated with these purposes, and (c) propose evaluation metrics for social media related to the key performance indicators. Process evaluation is presented in this article as an overarching evaluation strategy for social media.

Integrating social media and social marketing: a four-step process.

Social media is a group of Internet-based applications that allows individuals to create, collaborate, and share content with one another. Practitioners can realize social media's untapped potential by incorporating it as part of the larger social marketing strategy, beyond promotion. Social media, if used correctly, may help organizations increase their capacity for putting the consumer at the center of the social marketing process. The purpose of this article is to provide a template for strategic thinking to successfully include social media as part of the social marketing strategy by using a four-step process.

Developmental evaluation: building innovations in complex environments.

Developmental evaluation is an emerging approach to program evaluation that emphasizes innovation and learning. It is particularly well suited to evaluating innovative programs in their earliest stages of development and adapting existing programs to complex or changing environments. Key features of the developmental evaluation approach include a tight integration between evaluators and program staff and the use of data for continuous program improvement. This article presents developmental evaluation as a complementary approach to the traditional formative-summative evaluation cycle, especially when used for preformative evaluation. To illustrate this emerging approach, the article features a case example from the Illinois Caucus for Adolescent Health's evaluation of its school board sexuality education policy change project. The article concludes by suggesting ways that developmental evaluation can be useful in health promotion practice.

Basic priority rating model 2.0: current applications for priority setting in health promotion practice.

Priority setting is an important component of systematic planning in health promotion and also factors into the development of a comprehensive evaluation plan. The basic priority rating (BPR) model was introduced more than 50 years ago and includes criteria that should be considered in any priority setting approach (i.e., use of predetermined criteria, standardized comparisons, and a rubric that controls bias). Although the BPR model has provided basic direction in priority setting, it does not represent the broad array of data currently available to decision makers. Elements in the model also give more weight to the impact of communicable diseases compared with chronic diseases. For these reasons, several modifications are recommended to improve the BPR model and to better assist health promotion practitioners in the priority setting process. The authors also suggest a new name, BPR 2.0, to represent this revised model.

A multidirectional communication model: implications for social marketing practice.

The landscape of sending and receiving information has changed dramatically in the past 25 years. The communication process is changing from being unidirectional to multidirectional as consumers are becoming active participants by creating, seeking, and sharing information using a variety of channels and devices. The purpose of this article is to describe how this shift in the communication process- where gatekeepers control the creation and content of information and consumers are less active recipients to one that reflects a multidirectional and more dynamic process with participative consumers-will affect the social marketing process. This shift in communication does not represent an option for social marketers so much as a necessity. As professionals respond to this evolving communication model, the practice of social marketing can remain vibrant as a relevant consumer-oriented approach to behavior change.

Enhancing promotional strategies within social marketing programs: use of Web 2.0 social media.

The second generation of Internet-based applications (i.e., Web 2.0), in which users control communication, holds promise to significantly enhance promotional efforts within social marketing campaigns. Web 2.0 applications can directly engage consumers in the creative process by both producing and distributing information through collaborative writing, content sharing, social networking, social bookmarking, and syndication. Web 2.0 can also enhance the power of viral marketing by increasing the speed at which consumers share experiences and opinions with progressively larger audiences. Because of the novelty and potential effectiveness of Web 2.0, social marketers may be enticed to prematurely incorporate related applications into promotional plans. However, as strategic issues such as priority audience preferences, selection of appropriate applications, tracking and evaluation, and related costs are carefully considered, Web 2.0 will expand to allow health promotion practitioners more direct access to consumers with less dependency on traditional communication channels.

A policy and environmental response to overweight in childhood: the impact of Gold Medal Schools.

BACKGROUND: The prevalence of overweight among US children and adolescents has increased substantially since 1980. As a result, overweight in childhood and adolescence has become a substantial health problem that requires effective health promotion programs and interventions. CONTEXT: Coinciding with the 2002 Winter Olympic Games in Salt Lake City, the Utah Department of Health (UDOH) developed a pilot program called Gold Medal Schools (GMS) to promote healthy lifestyles among school-aged children. METHODS: The GMS program was designed to help schools develop policies and create healthy school environments to meet specific criteria at 5 levels: bronze, silver, gold, platinum, and platinum focus. Participating schools, mentored by the UDOH, earn incentives to create a healthy school environment. CONSEQUENCES: A total of 316 schools and approximately 166,600 students in 37 Utah school districts have participated in the GMS program. As a result, 1,029 medals have been awarded, 2,205 policies have been developed, and 2,121 environmental changes have been reported since program inception (2001-2002 school year). INTERPRETATION: Because of their participation in the GMS program, schools have developed and implemented a wide range of school-based policies and environmental changes. To improve the program, we recommend enhanced efforts in impact and outcome evaluation and increased participation in vigorous-intensity physical activity during the school day.

Developing a promotional strategy: important questions for social marketing.

Health practitioners often use the terms marketing and promotion interchangeably. Yet, promotion is just one element of an overall marketing strategy. To realize the greatest impact there must be a combination of all the marketing components, including product, price, place, and promotion. The purpose of this article is to clarify the role of promotion and describe key elements of developing a promotional strategy within the broader context of a social marketing initiative.

Disparities in diabetes management practice between racial and ethnic groups in the United States.

PURPOSE: The purpose of this study was to evaluate the association between race/ethnicity and self-management practices of people with diabetes. METHODS: Analyses were based on data from the 2001 Behavioral Risk Factor Surveillance System. Contingency tables and multiple logistic regression were used to assess the data. RESULTS: Frequency distributions of selected diabetes management variables significantly varied across levels of race/ethnicity. These differences persisted after adjusting for current age, age at diagnosis, gender, marital status, income, and education. Analyses revealed that Hispanics, compared with whites, were more likely to take oral agents to control their blood glucose, less likely to monitor their blood glucose daily, and less likely to check their feet for sores or irritation. There was no difference among the racial/ethnic groups use having participated in a diabetes education class. CONCLUSIONS: Health literacy and cultural factors, including the influence of family, beliefs about diabetes, and access and utilization of health care, may influence Hispanic diabetes management behaviors. Understanding these influences is essential to the development of programs, policies, and other strategies that are culturally appropriate and relevant.

Measuring the Relevance of Evaluation Criteria among Health Information Seekers on the Internet.

This study identified the criteria that are valued among Internet users when rating and accessing health information on the World Wide Web. Participants (N = 578) successfully completed a Web-based survey by ranking 12 criteria for evaluating health information. Then, by applying those same evaluation criteria, rated the quality of three preselected health-related websites and indicated their preference for one of the three sites. Six criteria including content, design and aesthetics, currency of information and contact addresses were significant predictors for selecting high-quality health information on the Internet. However, compared to their perceived importance, participants' perceptions about quality health information on the Internet were not consistent when selecting quality websites. This study identified the implications for evaluation criteria among Internet users, health professionals and website developers.