A process evaluation model for patient education programs for pregnant smokers.

OBJECTIVE: To describe and apply a process evaluation model (PEM) for patient education programs for pregnant smokers. METHODS: The preparation of a process evaluation plan required each program to define its essential "new" patient assessment and intervention procedures for each episode (visit) of patient-staff contact. Following specification of these core implementation procedures (p) by each patient education program, the PEM, developed by the Smoke-Free Families (SFF) National Program Office, was applied. The PEM consists of five steps: (1) definition of the eligible patient sample (a); (2) documentation of patient exposure to each procedure (b); (3) computation of procedure exposure rate (b/a = c); (4) specification of a practice performance standard for each procedure (d); (5) computation of an implementation index (c/d = e) for each procedure. The aggregate of all indexes (e) divided by the number of procedures (P(n)) produced a program implementation index (PII = Sigmae/P(n)). PARTICIPANTS AND SETTINGS: Data from four SFF studies that represent different settings were used to illustrate the application of the PEM. RESULTS: All four projects encountered moderate to significant difficulty in program implementation. As the number and complexity of procedures increased, the implementation index decreased. From initial procedures that included patient recruitment, delivery of the intervention components, and conducting patient follow ups, a variety of problems were encountered and lessons learned. CONCLUSION: This process evaluation provided specific insight about the difficulty of routine delivery of any new methods into diverse maternity care setting. The importance of pilot testing all procedures is emphasised. The application of the PEM to monitor program progress is recommended and revisions to improve program delivery are suggested.

Breast cancer screening practices among Cambodian women in Houston, Texas.

BACKGROUND: Faced with Western medicine and a health care system that is unfamiliar, Cambodian women experience barriers to breast cancer prevention activities and thus are seldom reached through current breast cancer education and prevention activities. This study examined the knowledge, attitudes, and practices of breast cancer screening among Cambodian women in Houston, Texas. METHODS: Two hundred sixteen Cambodian women aged 18 years or older were surveyed by telephone. RESULTS: Logistic regression analysis identified five variables as significant predictors of ever having had a clinical breast examination: perceived barriers to clinical breast examination, income, written-language acculturation, knowledge about clinical breast examination recommendations, and education in the United States. Education and knowledge of mammography were found to be important predictors of mammography. Language acculturation variables were not associated with ever having had mammography. CONCLUSIONS: The rate of breast cancer screening among Cambodian women in Houston is lower than that for all women in the United States. These results underscore the importance of developing culturally and linguistically appropriate breast cancer prevention activities for Cambodian women, who face cultural and language barriers to traditional services.