Program evaluation and chronic diseases: methods, approaches, and implications for public health.
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Centers for Disease Control and Prevention, U.S.↗
Biomedical subjects
Maurice Martin
Publications and source records attributed to Maurice Martin.
Using the Office of Management and Budget (OMB) clearance process in program planning and evaluation.
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Data Collection↗
Evaluating progress toward Healthy People 2010 national diabetes objectives.
INTRODUCTION: In 1999, the National Diabetes Prevention and Control Program at the Centers for Disease Control and Prevention and its 59 Diabetes Prevention and Control Programs adopted five Healthy People 2010 objectives. These objectives aim to improve the rates of preventive care services among people with diabetes and include annual foot examinations, hemoglobin A1c tests, and annual dilated eye examinations. This paper examines progress toward meeting these three objectives. METHODS: Questions from the diabetes module of the Behavioral Risk Factor Surveillance System (BRFSS) were used to evaluate changes in age-adjusted rates for annual foot examinations, hemoglobin A1c tests, and annual dilated eye examinations of 44 jurisdictions between 2000 and 2003. Questions from the diabetes module were also used to compare percentage rates of 47 jurisdictions in 2003 with Healthy People 2010 percentage targets. RESULTS: From 2000 to 2003, for the 44 jurisdictions, the aggregate, age-adjusted rate of annual foot examinations increased from 63.7% to 69.3% (P < .001); the rate of self-reported hemoglobin A1c tests increased from 68.3% to 69.5% (P = .35); and the rate of annual dilated eye examinations decreased from 67.7% to 65.2% (P = .05). In 2003, 20 of 47 jurisdictions met the Healthy People 2010 target for foot or eye examinations, and all 47 jurisdictions met the target for hemoglobin A1c tests. An inverse association was found between baseline rates in 2000 and the magnitude of change from 2000 to 2003 for all three national diabetes objectives. CONCLUSION: The National Diabetes Prevention and Control Program should consider adopting additional Healthy People 2010 objectives. Baseline rates should be considered in 1) selecting objectives, 2) setting percentage targets, and 3) evaluating current or future objectives. Program-related information should be linked with traditional data sources such as BRFSS so that we can understand the role of environmental factors and evaluate progress of jurisdictions toward national diabetes objectives.
Diabetes Complications↗
The Annual African American Conference on Diabetes: evolving program evaluation with evolving program implementation.
BACKGROUND: According to 2003 Behavioral Risk Factor Surveillance System data, South Carolina has the fourth highest rate of overall diabetes among the 50 states (9.3%) but the second highest rate among African Americans (15.5%). Nationwide, African Americans are disproportionately affected by diabetes. In addition, 40% of the African American population in South Carolina lives in a rural area, and approximately 26% live at or below the poverty level. Lack of access to health care and diabetes education are additional barriers for people with diabetes and their families. CONTEXT: Since 1997, the South Carolina Diabetes Prevention and Control Program and the Diabetes Today Advisory Council have sponsored the African American Conference on Diabetes, which targets African Americans with diabetes, their families, and their caregivers. This article describes the evolution of the conference and its evaluation. METHODS: In 2002, we conducted focus groups with 20 African American conference attendees with diabetes to 1) assess the program's effects, 2) determine how to reach more individuals, and 3) improve programming. In 2004, we incorporated the preconference and postconference Diabetes Understanding Scale survey to assess the cognitive impact of the conference on participants. CONSEQUENCES: Focus group results revealed that participants wanted to attend the conference because of the opportunity to increase their knowledge and change their behaviors through 1) education, 2) social support, 3) resources, and 4) logistics. Self-rated understanding increased significantly after the conference for each cognitive understanding item on the Diabetes Understanding Scale. INTERPRETATION: Focus group results suggested that participants who continue to attend the conference year after year may improve diabetes self-management skills. A quantitative evaluation showed that this 1-day diabetes education conference significantly increased short-term, self-rated cognitive understanding of diabetes behaviors.
Black or African American↗
Shared decision making: views of first-year residents and clinic patients.
PURPOSE: Patients' and physicians' views of their roles in decision making have implications for patient care and medical education. This study was designed to determine perspectives of residents and patients on the amount of control each should have in health care decisions. METHOD: Data were collected from a self-administered questionnaire of 45 first-year residents and a parallel structured interview with 92 patients from three resident clinics. Information Seeking (IS) and Decision Making (DM) scales from the Autonomy Preference Index were supplemented by five clinical scenarios focused on decisions concerning hypertension, depression, cholecystectomy, hysterectomy, and prostate cancer. Analysis of variance (ANOVA) and repeated-measures ANOVA were used to test for significant differences in scores. RESULTS: Patients' and residents' mean scores on IS were practically equivalent, indicating strong desire for information sharing. For DM, patients indicated a desire for slightly less than equal control in decisions, while residents thought patients should have a more than equal role. Given the specific clinical scenarios, the picture varied. Patients wanted equal roles in the hypertension, depression, and prostate cancer scenarios, while residents wanted to have more control in these decisions. Conversely, patients wanted greater control in the hysterectomy and cholecystectomy scenarios, and residents wanted a less than equal role in these decisions. Patients thought consultants such as surgeons desired the same role as their physicians, but residents assumed consultants wanted more control. CONCLUSIONS: Patients from a disadvantaged population indicated a strong desire for information and participation in making decisions about their care. Understanding the similarities and discrepancies in patients' and first-year residents' perspectives on shared decision making can have consequences for the patient-physician relationship and medical education.
Adolescent↗