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Contents

Preface

Acknowledgments

Chapter 1 Purpose

Chapter Objectives

Key Terms

Introduction

Difference Between Research and Evaluation

Purpose of Evaluation

Needs Assessment

Literature Review

Books

Government Documents

Non-Governmental Organization (NGO) Documents

Newspapers

Magazines

Theses and Dissertations

Development of Research Questions or Goal Statements

Evaluation: Goals and Objectives

Evaluation: Role of Stakeholders

Evaluation: Implementation

Types of Evaluations

Formative Evaluation

Summative Evaluation

Process Evaluation

Outcome Evaluation

Impact Evaluation

Evaluation: Logic Models

Summary

Case Study: Healthy Food/Healthy People

Goal Statement

Objectives

Case Study Discussion Questions

Student Activities

References

Chapter 2 Ethics

Chapter Objectives

Key Terms

Introduction

Historical Background

U.S. Public Health Service Syphilis Study in Tuskegee Henrietta Lacks

Basic Principles of Medical Ethics

Ethical Links Between Research and Evaluation

Confidentiality of Medical Information and Research Data

Healthcare Providers: Medical Care Versus Medical Research

Physical Therapy Example

Nursing Example

Medical Example

Hospital Administration Example

Hospital Ethics Committee Example

Evaluation Example

Institutional Review Board

Informed Consent

Risk/Benefit Assessment

Selection of Individuals and Special Populations

Summary

Case Study: Diaz vs. Hillsbourgh County Hospital Authority

An Inquiry

The Next Step

The Lawsuit

Doctors’ Perspective

The Settlement

A Postscript

Case Study Discussion Questions

Student Activity References

Chapter 3 Determinants of Health

Chapter Objectives

Key Terms

Introduction

Historical View of Achievement in Health

Health Disparities

Social Determinants of Health

Physical Activity

Education

Access to Health Care

Resources: Safe Food, Safe Housing, and Employment

Using Healthy People 2020 to Study Health Disparities and

Social Determinants of Health

Summary

Case Study

Case Study Discussion Questions

Student Activity

Census FactFinder Treasure Hunt

References

Answers to Questions Pertaining to Table 3-2

Chapter 4 Theories and Models

Chapter Objectives

Key Terms

Introduction

Deductive and Inductive Reasoning

Types of Theories and Models

Universal Theories

System Theories

Community and Organizational Theories and Models

Individual Behavior Theories and Models

Strategic Planning Models

Gantt Charts

Action Plans

SWOT Analysis

Summary

Case Study

Case Study Discussion Questions

Student Activities

References

Chapter 5 Reliability and Validity

Chapter Objectives

Key Terms

Introduction

Reliability

Stability

Internal Consistency

Validity

Types of Validity

Internal Validity

Threats to Internal Validity

External Validity

Threats to External Validity

Relationship Between Internal and External Validity

Measurement Errors

Random Errors

Systematic Errors

Reliable and Valid Research

Randomized Controlled Trial Designs

Adequate Sample Size

Free of Bias

Pilot Testing

Sample of Respondents

Data Collection for Pilot Tests

Data Analysis Outcome

Summary

Case Study

Step 1: Review Existing Survey Data

Step 2: Reliability of Existing Survey

Step 3: Validity of Existing Survey

Step 4: Creating a New Survey

Step 5: Pilot Testing

Step 6: One Year Later

Case Study Discussion Questions

Student Activity Questions

Answers

References

Chapter 6 Qualitative Data

Chapter Objectives

Key Terms

Introduction

The Qualitative-Quantitative Debate

Qualitative Methods: Validity and Reliability

Types of Qualitative Design

Interviews

Observations

Case Studies

Phenomenology

Historical Documents

Content Analysis

Ethnography

Grounded Theory

Ethical Issues in Qualitative Research

Analyses of Qualitative Data

Data Organization

Coding Data

Data Display

Summary

Case Study

Summary

Case Study Discussion Questions

Student Activity

Case Study 1

Case Study 2

Case Study 3

Case Study 4

References

Chapter 7 Elements of Research

Chapter Objectives

Key Terms

Introduction

Elements of Research

Basic and Applied Research

Variables

Observations or Measurements

Treatments or Programs

Group Assignment

Constructs

Operational Definitions

Types of Research Design

True Experimental Design

Quasi-Experimental Design

Nonexperimental Design

Summary

Case Study

Research Question

Operational Definitions

Recruitment

Study Design

Random Group Assignment

Data Collection

Case Study Discussion Questions

Student Activity

Case Study 1

Case Study 2

Case Study 3

Case Study 4

References

Chapter 8 Surveys

Chapter Objectives

Key Terms

Introduction

Survey Selection

Creating a Survey

Survey Data Collection

Types of Surveys

Tests

Personality Inventories

Scales

Cultural and Diversity Influences in Data Collection

Survey: Reliability and Validity

Summary

Case Study

Research Questions

Operational Definitions

Data Collection Training

Data Collection

Data Entry

Data Analysis

Case Study Discussion Questions

Student Activity

Questions

Answers

References

Chapter 9 Data Tools

Chapter Objectives

Key Terms

Introduction

Data Classification

Categorical Data

Continuous Data

Data Organization

Descriptive Data

Graphic Presentation

Measures of Central Tendency

Mean

Median Mode

Normal Curve

Standard Deviation and Variance

Summary

Case Study

Survey Questions

Case Study Discussion Questions

Student Activity

Answers

References

Chapter 10 Populations and Samples

Chapter Objectives

Key Terms

Introduction

Populations and Samples

Probability and Inferential Statistics

Research and Null Hypothesis

Level of Significance

Sample Size Considerations

Margin of Error

Population, Sample, and Variability

Confidence Level

Budget and Budget Justification

Timeline

Probability and Nonprobability Samples

Probability Sampling

Nonprobability Sampling

Sampling Bias

Item Nonresponse Bias

Unit Nonresponse Bias

Summary

Case Study

Case Study Discussion Questions

Student Activity

Answers

References

Chapter 11 Inferential Statistics

Chapter Objectives

Key Terms

Introduction

Types of Statistics

The Need for Statistics

Inferential Statistics

Scientific Hypothesis

Research Questions

Null Hypothesis and Alternate Hypothesis

Basic Inferential Statistical Tests

One-Tailed and Two-Tailed Statistical Tests

Using Excel for Statistics

Chi-Square Test

t-Tests

Correlation Coefficients

Confidence Intervals

Type I and Type II Errors

Summary

Case Study

Case Study Discussion Questions

Answers

Student Activities

Answers

References

Chapter 12 Budgets and Cost Analyses

Chapter Objectives

Key Terms

Introduction

Budgets

Personal Budgets

Evaluation and Research Project Budgets

Budget Summaries: Profit and Loss Statements

Cost Analysis

Cost-Benefit Analysis

Cost-Effectiveness Analysis

Cost-Utility Analysis

Cost-Feasibility Analysis

Summary

Case Study

Case Study Discussion Questions

Student Activity

Answers

References

Chapter 13 Reports and Presentations

Chapter Objectives

Key Terms

Introduction

Types of Written Reports

Elements of the Report

Title Page

Table of Contents

Abstract or Executive Summary

Introduction

Literature Review or Background

Methods

Results

Discussion, Conclusion, Recommendations, and Future Research

References and Appendices

Presentation of Results

Oral Presentations

Poster Presentations

Tips for Successful Presentations

Summary

Case Study

Case Study Discussion Questions

Student Activities References

Chapter 14 Case Study: University Medical Cancer Care Center

Description

Overview of Evaluation

Budget

Budget Justification

Personnel

Graduate Students

Consultants

Focus Groups

Travel

Indirect Costs

Evaluation

Clinical Staff and Clinical Support Staff

Laboratory

Nonclinical Staff

Central Supply, Technical Support, Physical Plant and Environmental Services (CTPES)

Finance and Accounting

Board of Directors, Executive Administration, and Management

Patient Satisfaction

Draft of the Final Report

Evaluation of Clinical Staff and Clinical Support Staff

Evaluation of Laboratory

Evaluation of Nonclinical Staff

Evaluation of CTPES Staff

Evaluation of Finance and Accounting

Evaluation of Board of Directors, Executive Administration, and Management

Evaluation of Patient and Visitor Satisfaction

Recommendations for the Final Report

Student Activity

Preface

This text was written for undergraduate students enrolled in an introductory course related to research or evaluation. The chapters are in a sequential order that forms the foundation for the knowledge needed to understand basic evaluation or research projects. This text is not intended to achieve complete understanding or proficiency in the complex subjects of health science evaluation and research. However, the chapters provide an overview of topics needed to review published literature, collect primary data, analyze data using basic statistics, and present results in written or verbal formats for their intended audiences.

The first three chapters set the stage for evaluation and research. Chapter 1 explains the differences and similarities between evaluation and research, along with how to review literature and develop research questions or goals and objectives that will be addressed in various studies. Chapter 2 introduces ethics, which is a core element in evaluation and research and needs consideration during the development phase. Chapter 3 explores determinants of health, such as health disparities and access to health care. Without regard to social determinants, evaluators and researchers miss key elements in the lives of their target audience that influence health outcomes outside of health care.

The next several chapters define terms and concepts that should be understood prior to planning an evaluation and research study. Chapter 4 introduces various types of theories and models along with examples from

current literature on how the theories and models have been used as the framework for project development. The list of theories and models is not intended to be comprehensive, but rather an introduction to examples that are commonly used. Once the research questions or evaluation goals and objectives and an appropriate theory are selected, it is time to explore types of data. Chapter 5 defines the concepts of reliability and validity as well as random and systematic errors. The chapter ends with a detailed description of how to conduct a pilot test and why they are essential. Chapter 6 provides a detailed discussion of qualitative data including types qualitative designs, potential ethical issues, and analyses utilized in qualitative data. Chapter 7 presents some basic elements of research including the difference between basic and applied research, variables, group assignment, constructs, and operational definitions. After these concepts are understood, the three basic types of research design (true experimental, quasi-experimental, and nonexperimental) are defined and examples are provided to enhance understanding. Chapter 8 focuses on survey design, including types of surveys and how to select them. Various tests, inventories, and scales are introduced along with examples and reasons for selecting one survey type over another. A discussion of how culture and diversity influences data collection is included near the end of the chapter.

Chapters 9, 10, and 11 focus on basic skills related to data. Chapter 9 introduces how data are classified as categorical or continuous and then organized using frequency distributions. Building on this knowledge, the concepts of measures of central tendency, the normal curve, standard deviation, and variance are explained in detail with plenty of examples. This chapter serves as the foundation for understanding the next two chapters. Chapter 10 describes terms related to population and samples. There are three main topics covered: sample size considerations, probability and nonprobability samples, and sampling bias. Each topic deserves important consideration when determining the sample size needed for any evaluation or research project. Chapter 11 introduces inferential statistics and defines the terms scientific hypothesis, research questions, null hypothesis, and alternative hypothesis. The next section presents basic statistical tests (e.g., chi-square, t-tests, and correlation coefficients). The chapter ends with a discussion of type I and type II errors.

The last chapters provide skills related to budgets, reports, and presentations, and the text culminates with a case study. Chapter 12 is divided into two sections. The first section describes various types of budgets with examples to practice basic skills. Budget justifications are also presented. The second section defines the types of cost analyses and how each type is used. Chapter 13 illustrates several ways to present results including abstracts, executive summaries, reports, manuscripts, posters, and verbal presentations. Chapter 14 is a lengthy case study reinforcing all aspects presented in this book.

Acknowledgments

During process of writing this book, I received assistance and support from numerous family members, friends, and colleagues.

Kevin, my husband, supported me through the many weekends that were consumed with writing. He allowed me the opportunity to fulfill my dream.

Laura Merrell edited each chapter with great attention to detail. Her superb skills greatly contributed to the quality of this text.

Dr. Richard Riegelman provided guidance and mentoring as I embarked on writing my first textbook. His constructive comments improved the overall quality of this text.

Dr. R. Clifford Blair offered valuable advice throughout the process. As a biostatistician and author, he offered humor and encouragement whenever I got tired of writing.

Over decades of teaching, hundreds of students taught me the skills and expertise needed to write this text.

The University of South Florida College of Public Health granted me time to complete this text.

Most educators say that the best way to learn a subject is to teach it. After writing this text, I have revised this advice to say:

“The best way to learn a subject is not to teach it, but rather to write a book about it.”

CHAPTER 1

Purpose

CHAPTER OBJECTIVES

By the end of this chapter, students will be able to:

• Discuss the steps in evaluation

• Prepare a review of the literature for a specific topic

• Develop specific questions for research and evaluations

• Evaluate goal statements and objectives

• Produce a logic model

• Evaluate the positive and adverse influence of stakeholders

• Differentiate the various types of evaluations

KEY TERMS

Goals and objectives

Research questions

Needs assessment

Literature review

Logic model

Stakeholders

Types of evaluations

Introduction

This chapter begins with a discussion about the differences and similarities between evaluation and research. Because this text covers both topics, it is important to learn the definitions of both concepts. The next discussion presents an overview of how to develop research questions and the purpose of conducting a needs assessment. Program planning involves identification of the type and design of program needed; achieving consensus from individuals providing or participating in the program; securing essential financial, personnel, and location resources; and sustained program implementation by staying true to the original design, also called program fidelity. Program evaluation is used for determining the day-to-day program management, short-term results, and long-term program impact. Program evaluations involve data collection and analysis to influence changes to improve program effectiveness.1 As the first step, researchers read the published literature to determine research questions, whereas evaluators read the published literature to learn about the best practices related to their proposed goals for the planned program. Whether an individual is evaluating a program or conducting research, after reading the published literature, the investigation begins to take shape.

If you are wondering why you need to know about research and evaluation, let’s explore the practical side of these skills. Suppose that you are interested in purchasing a new computer. You will plan, research, and evaluate your options prior to making a purchase. The same basic steps are used in research and evaluation.

1. How did you determine that you need a new computer? (Needs assessment)

2. What consumer rating reports will you read to gain information? (Literature review)

3. What questions need to be answered prior to your decision? (Research questions)

4. How will you map out your strategy for making this decision? (Logic model)

5. When visiting stores, what questions will you ask a salesperson?

(Qualitative data)

6. What type of numerical data will you obtain online? (Quantitative data)

7. What questions do you ask your friends about their computers? (Qualitative data)

8. Are there budget constraints or stakeholders influencing your decision? (Budget and stakeholders)

9. What type of evaluation is most appropriate? (Evaluation)

10. How will you merge the data and make your final decision? (Data analysis)

11. Purchase a computer, install software, and read the manual. (Final report)

Once you realize the usefulness that research and evaluation skills play in daily life, this text becomes more practical and beneficial. You will learn skills and methods to assist with a wide range of program planning, research, and evaluation methods in your personal and professional lives.

Difference Between Research and Evaluation

Let’s begin with some simple definitions followed by more details about the similarities and differences between research and evaluation. Research creates new knowledge2 with the intention of generalizing results from a sample to the population.3 Evaluations are conducted to improve an internal situation with no intent to generalize to another population.2 Now let’s compare a few more specific similarities and differences between research and evaluation. Because this text introduces the concepts of both research and evaluation, it is not expected that the reader already understands all of the information provided in Table 1-1. Understanding and proficiency will increase as you move through each chapter.

Table 1-1 A Comparison of Research and Evaluation

Research Evaluation

Creates new knowledge

Reviews the literature to determine questions that remain unanswered on the topic

Improves program effectiveness

Reviews the literature to determine best practices of similar programs

Tests hypotheses Utilizes facts

Uses a theory for framework and research design

Answers specific questions

Seeks to be value-free4

Generalizes results from sample to a population

Uses primary and/or secondary data

Utilizes statistical test for data analysis

Draws conclusions

Uses a logic model

Answers general questions

Assigns value to a program4

Recommends improvement for an existing program with a target audience

Uses primary and/or secondary data

Utilizes statistical test for data analysis

Provides useful feedback

Determines what might be significant Determines what is important

Researcher publishes results

Evaluator writes report for stakeholders

Data from Doherty, T. Research and Evaluation? It’s Complicated! Population Health. Department of Health and Human Services of Australia. Available at: www.menzies.utas.edu.au/pdf/Nov%202011%20MRI final.pdf6. Accessed January 9, 2012.

Because this text covers both evaluation and research topics, the terms related to evaluation and research are presented throughout each discussion. As noted in Table 1-1, many of the same skills, such as development goals or research questions, data collection, data analyses, and report writing, are used in both evaluation and research.5

Purpose of Evaluation

Over the past 20 years, because of advances in evaluation, we know that “one size fits all” programs are not effective, and therefore, program planners currently design tailor-made programs to address the unique needs of

individuals in a defined community. Keep in mind that the word community ranges from students in one specific department, to the employees at a corporation, to the population of an entire city. According to Rossi and Freeman,6 any tailor-made design requires the evaluator to explore how the proposed program affects individuals and communities. It is also useful to investigate the possible political ramifications and sustainability of the program within the defined community. For example, in 1982, one of first school antidrug programs was initiated by First Lady Nancy Reagan when she developed the “Just Say No” campaign.7 By 1989, researchers realized that this program was too simplistic to meet the needs of students in diverse cultural, geographic, economic, and social settings. Therefore, it became important to design targeted programs for each population.

Although it seems logical to start any program with the planning phase and end with the evaluation, this logic is not correct. It is essential to design the plan and its implementation in parallel with the evaluation. For example, it is not possible to implement a program that has not been fully planned, nor it is possible to create an evaluation after the implementation phase is complete. Because each phase is intertwined with the other program components, it is important to begin thinking about the following questions related to cost during the planning phase of the program:

• What type of data collection is needed to answer the question?

• Is the target population easily assessable?

• What is the geographical area of the program? Is extensive travel involved?

• Will a control group be used?

• How many staff members will be required to complete the designed program?

• Will incentives be given to recruit participants?

• Are the participants going to be followed over time?

As evaluators begin planning and evaluating a program, there are numerous decisions to make during the initial phase. Before moving into the remainder of this chapter, let’s review what types of projects are not either evaluation or research.

As previously stated, research focuses on answering research questions and gaining new knowledge, whereas evaluations concentrate on identifying unmet needs and services, planning effective program implementation, investigating how to improve program services, and assisting staff with program decisions based on cost-effectiveness. Theories are developed, established, and emphasized in research. Although evaluations benefit from using theories, theories are not developed as an evaluation product. So now that research and evaluation have been compared, let’s add one more category, called audit, that utilizes basic statistics, but is not research or evaluation. Audits are linked to compliance, accreditation, laws, and regulations. For example, the Government Accountability Office utilizes agency and institution data to determine level of culpability in an agency receiving federal funding. Another example is The Joint Commission (TJC, formerly known as the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]). This organization conducts performance and standard measures, health services research, and accountability measures for healthcare institutions across the United States.8

The rest of this chapter introduces how to review the literature, conduct a needs assessment, develop questions, identify the type of evaluation, and determine the role of stakeholders in planning programs and evaluations.

Needs Assessment

The purpose of a needs assessment is to identify the strengths, weaknesses, opportunities, and threats (SWOT) in the organization or community. The needs assessment is conducted in collaboration with the stakeholders, such as staff members, community leaders, neighborhood organization members, and political leaders. The goal is to obtain a broad range of opinions about the benefits and worries, because a concern for one group may be an asset for another group.

The first step of the needs assessment is to form a partnership with individuals involved in the organization or community. It is advisable to include at least one member with expertise in conducting a needs assessment to offer an outside perspective to the process. At the introductory meeting, it is important that every member is treated equally and with respect. The

neighborhood housing member’s opinion and contribution are given the same weight as the city council member’s. After getting to know each other, they should coalesce around a few common goals for the needs assessment. It is advisable to focus on two or three goals, so the effort is not too ambitious. After establishing the goals, team members need to address the following questions:

• Who is the target audience for the needs assessment?

• Are there sufficient personnel to staff the needs assessment?

• What funds are available to finance the needs assessment?

• What are the roles, responsibilities, and expectations of each team member?

• Are there data available to ascertain what has been accomplished on this topic previously?

• What is the optimal timeline of the needs assessment?

Once the team answers these questions, it is time to move to the next step. Data collection begins with exploring what types of data are necessary to complete the needs assessment. Generally, data are divided into two categories: qualitative (words) and quantitative (numbers). Qualitative data include but are not limited to focus groups, interviews, town hall meetings, and public forums. The conversations at these events are recorded, transcribed, and analyzed for themes. On the other hand, with quantitative data, the survey responses are converted into numerical data for analysis. For example, the survey question “How would you rate your health today?” provides four scaled choices: excellent (4), good (3), fair (2), and poor (1). The responses are added together and divided by the number of individuals responding, to obtain a mean score or average. In addition, demographic data can be converted to numbers. When asking the respondents how long they have lived in the community, the choices would be: 10+ years (4); 5–9 years (3); 1–4 years (2); less than 1 year (1). As you can see, any type of data may be converted into numbers for quantitative analysis. Besides surveys, quantitative data may come from secondary data sources. When data is collected by another researcher or organization, it is called secondary data. Anyone using secondary data develops her own research objectives and

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