EVALUATION AND THE ACCOUNTABLE PRACTITIONER
Table of Contents
Headlines, Timelines, & Milestones
Books and Reviews
Headlines, Timelines, &
Abubaker, WA., Al-Assaf, A.F., & Cleaver, V.L. (1999). Quality
assurance and iron deficiency in Egypt. INTERNATIONAL JOURNAL FOR QUALITY IN
HEALTH CARE 11(2): 163-168.
ABSTRACT: Objective. To develop an intervention in rural Egypt to
address the problem of iron deficiency anemia and to demonstrate the effectiveness of
applying quality assurance (QA) methods in combating this. Design. Assessment of an
intervention study utilizing QA methods. Setting. Rural primary care clinics in Egypt.
Study Participants. One hundred and eighty pregnant mothers (and their 180 children) were
randomly selected at two clinic sites from all those who were diagnosed as having an iron
deficiency disorder. Intervention. Multi-disciplinary teams were formed to develop and
deliver health promotional approaches related to iron deficiency to the study
participants. By using QA techniques the teams were able to strengthen local capacity and
participant compliance to the educational messages. Main outcome measures. Pre- and
post-measurements of client satisfaction, results of hemoglobin lab tests, and the extent
of retention of nutritional messages by the participants. Results. Eighty percent of the
study population demonstrated satisfactory knowledge of the nutritional messages. There
was a 75% improvement of client satisfaction with the clinic and an effective follow-up
system of care was designed and implemented successfully for each clinic. On average, the
number of children aged less than 5 years diagnosed with an iron deficiency disorder
decreased from 37% to 5%. Similar success was achieved with the pregnant mothers: the
prevalence of iron deficiency anemia was reduced from 100% to only 14%. Conclusions. The
use of QA process improvement techniques was extremely effective in reducing iron
deficiency anemia among the target population. There is an increasing need to include
quality methods in micronutrient intervention techniques.
Backett-Milburn, K. & McKie, L. (1999). A critical
appraisal of the draw and write technique. HEALTH EDUCATION RESEARCH 14(3):
Berg-Smith, S. M., Stevens, V. J., Brown, K. M., Van Horn, L., Gernhofer, N., Peters,
E., Greenberg, R., Snetselaar, L., Ahrens, L., & Smith K. (1999). A brief
motivational intervention to improve dietary adherence in adolescents. HEALTH
EDUCATION RESEARCH 14(3): 399-410.
Card, Josefina J. (1999). Teen Pregnancy Prevention: Do
Any Programs Work? ANNUAL REVIEW OF PUBLIC HEALTH 20: 257-286.
Connell, C. M. (1999). Older adults in health education
research: some recommendations. HEALTH EDUCATION RESEARCH 14(3): 427-431.
Davis, S.M., & Reid, R. (1999). Practicing
participatory research in American Indian communities. AMERICAN JOURNAL OF
CLINICAL NUTRITION 69 (4 SUPPL): 755S-759S.
ABSTRACT: The purpose of this article is to explore the historical
issues that affect research in American Indian communities and examine the implications of
these issues as they relate to culturally sensitive, respectful, and appropriate research
with this population. Methods include review and analysis of the literature and
examination of our collective experience and that of our colleagues. Recommendations are
given for conducting culturally sensitive, participatory research, We conclude that
research efforts must build on the establishment of partnerships between investigators and
American Indian communities to ensure accurate findings and analyses and to implement
culturally relevant benefits.
Eades, S.J., & Read, A.W. (1999). The
Bibbulung Gnarneep Project: practical implementation of guidelines on ethics in Indigenous
health research. MEDICAL JOURNAL OF AUSTRALIA 170 (9): 433-436.
ABSTRACT: Human rights and ethical principles justify Indigenous
control of health research conducted in Indigenous communities, but also emphasize the
need for scientific rigour, knowledge and expertise, much of which currently resides with
the non-indigenous community In 1994, we began development of the Bibbulung Gnameep*
Project on Aboriginal maternal and child health in Perth, Western Australia. We describe
the process of developing a protocol to ensure ethical conduct of this research through
consultation and negotiation between Aboriginal and non-Aboriginal people involved in the
Eyler, A.A., Mayer, J., Rafii, R., Housemann, R., Brownson, R.C., & King, A.C.
(1999). Key informant surveys as a tool to implement and evaluate physical
activity interventions in the community. HEALTH EDUCATION RESEARCH 14 (2):
ABSTRACT: Key informant surveys are important tools for planning and
evaluating community health programs. A survey was conducted to gather views on policies
toward physical activity from four sets of key informants: physicians, church leaders,
business leaders and civic leaders. Surveys were mailed to 797 key informants who were
selected from 12 southeastern Missouri counties. For comparison, data from a telephone
survey of 2106 persons in the general population were also analyzed, The majority
(>85%) in all four key informant groups were very supportive of required physical
education in schools, but less supportive (<69%) of government funding for places where
community members can exercise. Physicians perceived community members as having somewhat
greater access to places to exercise relative to the other key informant groups.
Comparisons of the key informant surveys to the population survey indicated similar levels
of support for physical activity policy. The information from this survey has been useful
in identifying support for physical activity policy and gaining access to potential
influences for community change, Since key informant research in the area of physical
activity policy and cardiovascular disease prevention is sparse, there is a need for
Graham, J. D., Corso, P. S., Morris, J. M., Segui-Gomez, M., &
Weinstein, M. C. (1998). Evaluating the cost-effectiveness of clinical and
public health measures. ANNUAL REVIEW OF PUBLIC HEALTH 19: 125-152.
Green, J., & Tones, K. (1999). Towards a secure
evidence base for health promotion. JOURNAL OF PUBLIC HEALTH MEDICINE 21 (2):
ABSTRACT: The importance of a sound evidence base for health promotion
is recognized. Criteria for establishing evidence have, in the past, been heavily
influenced by the bio-medical agenda. The problems in using experimental and
quasiexperimental approaches and their limited relevance for evaluating health promotion
interventions are examined. The multifactorial nature of the health promotion enterprise
in relation to both inputs and outputs is recognized and a range of direct, indirect and
process indicators are identified. The relevance of combining quantitative and qualitative
methods for data collection is discussed and the paper concludes by advocating a 'judicial
principle' for assessing evidence.
Jacob, P. III, Yu, L., Shulgin, A. T., & Benowitz, N. L. (1999). Minor
tobacco alkaloids as biomarkers for tobacco use: Comparison of users of cigarettes,
smokeless tobacco, cigars, and pipes. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5):
ABSTRACT: Objectives. This study (1) determined levels of
various tobacco alkaloids in commercial tobacco products; (2) determined urinary
concentrations, urinary excretion, and half-lives of the alkaloids in humans; and(3)
examined the possibility that urine concentrations of nicotine-related alkaloids can be
used as biomarkers of tobacco use. Methods. Nicotine intake from various tobacco products
was determined through pharmacokinetic techniques. Correlations of nicotine intake with
urinary excretion and concentrations of anabasine, anatabine, nornicotine, nicotine, and
cotinine were examined. By using urinary excretion data, elimination half-lives of the
alkaloids were calculated. Results. Alkaloid levels in commercial tobacco products, in
milligrams per gram, were as follows: nicotine, 6.5 to 17.5; nornicotine, 0.14 to 0.66;
anabasine, 0.008 to 0.030; and anatabine, 0.065 to 0.27. Measurable concentrations of all
alkaloids were excreted in the urine of most subjects smoking cigarettes, cigars, and
pipes and using smokeless tobacco. Correlations between nicotine intake and alkaloid
concentrations were good to excellent. Conclusions. Anabasine and anatabine, which are
present in tobacco but not in nicotine medications, can be used to assess tobacco use in
persons undergoing nicotine replacement therapy. AUTHOR ADDRESS: P Jacob III, Univ Calif
San Francisco, San Francisco Gen Hosp, Bldg 100,Room 235, San Francisco, CA 94110 USA
Jeffery, R. W., & French, S. A. (1999). Preventing weight gain in adults:
The pound of prevention study. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 747-751.
ABSTRACT: Objectives. This study examined whether weight gain with age
could be prevented through the use of a low-intensity intervention. Methods. Participants,
228 men and 998 women recruited from diverse sources, were randomized to one of the
following groups: (1) no-contact control, (2) education through monthly newsletters, or
(3) education plus incentives for participation. All participants were weighed and
completed questionnaires about behaviors and attitudes related to weight at baseline and
annually for 3 years thereafter. Results. Individuals in intervention groups reported
favorable changes over time in frequency of weighing and healthy dieting practices
relative to those in the control group. These behavior changes were in turn related to a
reduced rate of weight gain over time. However, weight gain over 3 years did not differ
significantly by treatment group. Conclusions. This low-intensity educational approach to
weight gain prevention sustained interest over a lengthy time period and was associated
positively with behavior change, but it was not strong enough to significantly reduce
weight gain with age.
Kawakami, N., Haratani, T., Iwata, N., Imanaka, Y., Murata, K.,
& Araki, S. (1999). Effects of mailed advice on stress reduction among
employees in Japan: A randomized controlled trial. INDUSTRIAL HEALTH 37 (2):
237-242. KEYWORDS: stress reduction; breakfast; mental health; health education;
ABSTRACT: We conducted a randomized controlled trial (RCT) to examine
the effects of mailed advice on reducing psychological distress, blood pressure, serum
lipids, and sick leave of workers employed in a manufacturing plant in Japan. Those who
indicated higher psychological distress (defined as having GHQ scores of three or greater)
in the baseline questionnaire survey (n=226) were randomly assigned to an intervention
group or a control group. Individualized letters were sent to the subjects of the
intervention group, informing them of their stress levels and recommending an improvement
in daily habits and other behaviors to reduce stress. Eighty-one and 77 subjects in the
intervention and control groups, respectively, responded to, the one-year follow-up
survey. No significant intervention effect was observed for the GHQ scores, blood
pressure, serum lipids, or sick leave (p>0.05). The intervention effect was marginally
significant for changes in regular breakfasts and daily alcohol consumption (p=0.09). The
intervention effect was marginally significant for the GHQ scores among those who
initially did not eat breakfast regularly (p=0.06). The study suggests that only sending
mailed advice is not an effective measure for worksite stress reduction. Mailed advice
which focuses on a particular subgroup (e.g., those who do not eat breakfast regularly)
may be more effective.
Kaneko, M. (1999). A methodological inquiry into the
evaluation of smoking cessation programmes. HEALTH EDUCATION RESEARCH 14(3):
Linnan, L. A., Fava, J. L., Thompson, B., Emmons, K.,
Basen-Engquist, K., Probart, C., Hunt, M. K., & and Heimendinger, J. (1999). Measuring
participatory strategies: instrument development for worksite populations. HEALTH
EDUCATION RESEARCH 14(3): 371-386.
McBride, C.M., Curry, S.J., Lando, H.A., Pirie, P.L., Grothaus, L.C.,
& Nelson, J.C. (1999). Prevention of relapse in women who quit smoking during
pregnancy. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 706-711.
ABSTRACT: Objectives. This study is an evaluation of relapse prevention
interventions for smokers who quit during pregnancy. Methods. Pregnant smokers at 2
managed care organizations were randomized to receive a self-help booklet only, prepartum
relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were
conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months post-partum.
Results. The pre/post intervention delayed but did not prevention postpartum relapse to
smoking. Prevalent abstinence was significantly grater for the pre post intervention group
than for the other groups at 8 weeks (booklet group, 30%, prepartum group, 35%, pre/post
group 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6
months (booklet group, 26%; prepartum group, 24%; pre/post group, 33%; P = .04)
postpartum. A nonsignificant reduction in relapse among the pre post group contributed to
differences in prevalent abstinence. There was no difference between the groups in
prevalent abstinence at 12 months postpartum. Conclusions. Relapse prevention
interventions may need to be increased in duration and potency to prevent postpartum
McKenzie, J. F., Wood, M. L., & Kotecki, J. E. (1999). Establishing
content validity: Using qualitative and quantitative steps. AMERICAN JOURNAL OF HEALTH
BEHAVIOR 23 (4): 311-318, July-August.
Slade, M., Thornicroft, G., & Glover, G. (1999). The feasibility
of routine outcome measures in mental health. SOCIAL PSYCHIATRY AND PSYCHIATRIC
EPIDEMIOLOGY 34 (5): 243-249, May.
ABSTRACT: Background: Standardised outcome measures are not being used
in routine mental health care. Method: The importance of routine use of Standardised
outcome measures is argued, and reasons for their lack of use suggested. Results: One
reason for Standardised outcome measures not being used routinely is the lack of
appropriate instruments. This property of being suitable for routine use is often called
feasibility, but there is no consensus about the meaning of feasibility, or how it should
be measured. We propose a definition of feasibility as a psychometric property of a
Standardised outcome measure, provide criteria for assessing feasibility, and then present
a framework for changing practice to increase the routine use of Standardised outcome
measures. Conclusions: If mental health care is to maximize outcome, then more attention
needs to be paid both to the process of developing and to facilitating the routine
clinical use of feasible outcome measures.
St James, P.S., Shapiro, E., & Waisbren, S.E. (1999). The
resource mothers program for maternal phenylketonuria. AMERICAN JOURNAL OF PUBLIC
HEALTH 89 (5): 762-764.
ABSTRACT: Objectives. The purpose of this study was to measure the
effectiveness of resource mothers in reducing adverse consequences of maternal
phenylketonuria. Methods. Nineteen pregnancies in the resource mothers group were compared
with 64 pregnancies in phenylketonuric women without resource mothers. Weeks to metabolic
control and offspring outcome were measured. Results. Mean number of weeks to metabolic
control was 8.5 (SE = 2.2) in the resource mothers group, as compared with 16.1 (SE = 1.7)
in the comparison group. Infants of women in the resource mothers group had larger birth
head circumferences and higher developmental quotients. Conclusions. The resource mothers
program described here improves metabolic control in pregnant women with phenylketonuria.
Wang, M.Q., Collins, C.B., Kohler, C.L., DiClemente, R.J., &
Wingood, G. (1999). AIDS knowledge among Black drug users: An issue of
reliability. PSYCHOLOGICAL REPORTS 84 (1): 121-124.
ABSTRACT: This study examined the reliability of an inventory measuring
AIDS-related knowledge among 553 black drug users. Data were collected from a socially
high-risk community in Birmingham, Alabama. The KR-20 reliability scores were computed
from the inventory for each drug-use group. The KR-20 reliabilities ranged from .39 to
.57. These findings may suggest that the inconsistent reports of the predictive power of
AIDS knowledge among drug users reported in previous studies might be related to the low
internal consistencies of the inventory.
Books and Reviews
Research on Human Subjects - Ethics, Law and Social
Policy (Amsterdam: Elsevier Science, 1999). D. Weisstub (Ed.),
Chair de Psychiatrie Legale et Biomdicale, Universite de Montreal, Quebec, Canada.
Many would think that 50 years after Nuremberg and 20 years after
legislation was first introduced in the USA, all the ethical concerns in medical research
would have been resolved. However, as this important volume contends, the legal, ethical,
philosophical and cultural issues have never been more complex. What are the ethical
implications of experimentation on subjects unable to give competent consent ? What are
the opportunities for social and economic fraud ? How has the pressure to compete as a
company or a nation affected our view of the ethics of experimentation ? This book
addresses the key implications of experimentation on humans. For further information
or to order online, visit the book's homepage at
Healthy People 2000 Review 1998-2000. 246 pp.
(PHS) 99-1256 go to:
For more information on the new initiative for the first decade of the new century, Healthy
People 2010, go to http://web.health.gov/healthypeople.
The Evaluation Kit, is a nine-volume set of handbooks for planning and executing
evaluations of programs from Sage Publishing Co. For more information, visit
Big Brothers Big Sisters of America study linking the impact of positive adult
relationships with at-risk youth. Information on the study is available from their
In 1992 and 1993, some 959 boys and girls in eight states, ages 10
through 16, entered into a historic experiment. Half the children were matched with a Big
Brother or Big Sister, while the other half were assigned to a waiting list, or control
group. On average, the matched children met with their Big Brothers or Big Sisters about
three times a month for at least a year.
Researchers found that 18 months later, the Little Brothers and Little Sisters were:
- 46 percent less likely to begin using illegal drugs
- 27 percent less likely to begin using alcohol
- 53 percent less likely to skip school, and
- 37 percent less likely to skip a class
- more confident of their performance in schoolwork
- less likely to hit someone, and
- getting along better with their families.
Slide presentation on indicators for development
communications evaluation. A major challenge in evaluation is agreement on the
set of core indicators on which to collect information. Those indicators need to provide
short-term feedback that predicts long term change and relates the communication
intervention to that change. The Network has begun the process of applying itself to this
task. 6 general indicators have been developed. 3 of these are: expanded public and
private dialogue and debate; increased accuracy of the information that people share in
the dialogue/debate; supported the people centrally affected by an issue[s] voicing their
perspective. These provide a strong social change perspective to balance the established
behavioral approaches to evaluation. Full presentation: http://www.comminit.com/power_point/measure_eval
Course on Ethical Issues on International Health Research