MPH 601 Week 6 Health Education Program Evaluation Example

Reach, Effectiveness, Adoption, Implementation and Maintenance: Evaluating the First Year of a Redesigned Diabetes Prevention Education Program

[Student Name]

University of Phoenix

MPH/601: Public Health Promotion and Education

Week 6 Assignment

[Instructor Name]

[Date]

The county program, its participants, evaluation results, comparison group and costs are composites written for a model paper; research findings come from the sources cited.

At the end of the redesigned diabetes prevention program's first year, the board of health asked for a report: did the changes work, and should the county keep funding the program? The program coordinator and an evaluator from the local university designed and carried out an evaluation. This paper presents its framework, methods, results and recommendations.

Evaluation Questions

Stakeholders agreed on five questions: Did the program reach the adults with prediabetes it was meant to serve? Did participants lose weight, become more active and gain confidence? Did clinics and community organizations adopt the program? Was it delivered as designed, and at what cost? Will results and the program last?

The RE-AIM Framework

The evaluation used RE-AIM. Glasgow and colleagues designed it because community programs were being judged almost entirely on whether they worked in ideal conditions. Their framework adds four other questions, about who is reached, which settings adopt a program, how faithfully it is delivered and whether effects and programs persist, and it asks them for individuals and for organizations. Skipping any of the five, they warned, can squander resources and blunt a program's population impact (Glasgow et al., 1999). Because this is a community program, efficacy was assessed as real-world effectiveness.

Process, Impact and Outcome Measures

The evaluation combined three levels. Process measures covered enrollment, attendance, fidelity and cost. Impact measures covered knowledge, skills, self-efficacy and behavior. Outcome measures covered weight change now and diabetes incidence later. Each measure matched an objective written when the program was redesigned, so the evaluation could report objective by objective.

Design

The evaluation compared participants' measures at enrollment, six and twelve months. To address alternative explanations, it compared weight change with a group of 160 eligible patients at the same clinics who were referred but did not enroll, drawn from clinic records and matched on age, sex and baseline weight. The comparison is imperfect, since people who enroll may be more motivated, but it offers a reference point.

Reach

The program enrolled 212 adults, 118% of its target. Of an estimated 2,400 east side adults with diagnosed prediabetes in clinic records, about 9% enrolled. Sixty-one percent of participants were Spanish-speaking or bilingual, and 34% were over 60, reflecting the adapted groups. Men were underrepresented at 22%.

Benchmarks for Effectiveness

Results were judged against evidence. In the Diabetes Prevention Program trial, a lifestyle arm with targets of 7% weight loss and two and a half hours a week of activity lowered diabetes incidence by 58% compared with placebo (Diabetes Prevention Program Research Group, 2002). Community versions set a humbler bar: pooling 28 US programs, reviewers found participants roughly 4% lighter after a year, with each extra session attended worth another 0.26 percentage points (Ali et al., 2012).

Effectiveness: Weight

Participants who attended at least 12 of 16 core sessions, 64% of enrollees, lost an average of 4.6% of body weight at twelve months, and 41% lost 5% or more. All enrollees, including those who attended less, lost an average of 3.1%. The comparison group lost 0.4%. Completers did better than the real-world average, and attendance again predicted results.

Effectiveness: Behavior and Confidence

The share of participants reporting 150 minutes of weekly activity rose from 25% to 57% at six months. Average self-efficacy for activity rose from 4.8 to 7.1 on a ten-point scale. Eighty-three percent of those observed could modify a family recipe by the end of the cooking unit.

Effectiveness by Subgroup

Spanish-speaking participants in the adapted groups lost 4.3% on average among completers, close to English-speaking completers at 4.8%. Participants over 60 lost slightly less but had the highest attendance. Men who completed lost more weight than women, but fewer men enrolled and completed.

What Participants Said

Exit interviews with 30 participants, including 12 who stopped attending, added context. Completers credited the peer leaders, cooking sessions and child care. Those who left most often cited job changes, family illness or transportation. Several men said the sessions felt designed for women, which helps explain their lower enrollment. These comments shaped the recommendations as much as the numbers did.

Adoption

Four of six east side clinics referred patients regularly; two referred rarely, citing staff turnover. Three churches and the community center hosted sessions. The community health center began building referrals into its prediabetes workflow.

Implementation

Average attendance was 11.8 of 16 core sessions, compared with 6 in the original program. A fidelity checklist showed 88% of core elements delivered as planned. Cost averaged about $610 per participant, mainly staff, promotora stipends, food for cooking sessions and child care.

Maintenance

At the individual level, completers regained an average of 0.6 percentage points between months six and twelve. At the organizational level, the health center plans to fund one promotora position, and two churches will continue hosting.

Was the Cost Worth It

At about $610 per participant, the program costs less than a year of treatment for diabetes, though not every participant would have developed the disease. If completers' weight loss translates into even part of the trial's risk reduction, the program is likely to prevent enough cases over several years to justify its cost. A formal cost-effectiveness analysis will follow once three-year incidence data are available.

Using the Findings Inside the Program

Evaluation results went back to the people delivering the program. Peer leaders and promotoras reviewed attendance and weight results by group at a half-day retreat and proposed their own changes, including a men's group on Saturday mornings and a text reminder the day before each session. Staff who help interpret findings are more likely to act on them.

Limitations

Participants chose to enroll, so the comparison group may differ in motivation. Physical activity was self-reported. Twelve months is too short to measure diabetes incidence. Some weights were missing for participants who stopped attending, which could make results look better than they are.

Recommendations

The evaluation recommends continuing the program, recruiting men through workplaces and barbershops, supporting the two low-referring clinics, adding a monthly maintenance group after the core year and tracking diabetes incidence through clinic records for three years.

Surprises

Two findings surprised the team. Participants over 60 had the best attendance, overturning an assumption that older adults would struggle most. And the evening English-language groups, expected to perform best, had the highest dropout, which exit interviews traced to shift work. Evaluation is most useful when it reveals what planners did not expect.

Reporting to the Board

The board received a two-page summary organized by RE-AIM dimension, with a chart of weight loss by attendance and a table of subgroup results.

Conclusion

The redesigned program reached more people, kept them attending and produced weight loss above the real-world average among completers, with Spanish-speaking participants close behind. RE-AIM ensured the evaluation looked beyond outcomes to reach, adoption, implementation and maintenance, and benchmarks from the trial and real-world programs placed results in context. Honest limits and specific recommendations give the board what it needs to decide.

References

Ali, M. K., Echouffo-Tcheugui, J. B., & Williamson, D. F. (2012). How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Affairs, 31(1), 67-75. https://doi.org/10.1377/hlthaff.2011.1009

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393-403. https://doi.org/10.1056/NEJMoa012512

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322