Community-Based Health Literacy Interventions Proceedings of a Workshop (2018) / Chapter Skim
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4 Evaluating Community-Based Health Literacy Interventions
4 Evaluating Community-Based Health Literacy Interventions
Pages 49-68
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From page 49... ...
POTENTIAL ISSUES AND CHALLENGES IN EVALUATING COMMUNITY-BASED HEALTH LITERACY1 In Pleasant's opinion, ethical health literacy community programming requires looking at effectiveness and efficiency, addressing equity, and evaluating the program. Ethics, he said, refers to a set of principles of proper conduct based on a theory or belief system of moral values and effectiveness 1 This section is based on the presentation by Andrew Pleasant, senior advisor on Health Literacy Interventions, Research, and Evaluation at Health Literacy Media, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 50... ...
. SOURCES: Adapted from presentations by Oscar Espinosa, Andrew Pleasant, Anil Thota, and Sherrie Flynt Wallington at the Community-Based Health Literacy Interventions workshop on July 19, 2017.
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From page 51... ...
He noted that other frameworks are also effective, in that they help the evaluator to think through what to include in the evaluation metrics. When designing a community-based health literacy intervention and accompanying evaluation framework, the number one rule is to engage community members early and often because they have the most to teach anyone developing or evaluating a program.
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From page 52... ...
In many of the communities where Pleasant works, "the last thing you want is a tall white guy with a pen and paper asking people questions, because that means trouble to many people in this world," he said. "If you do not embrace that reality and figure out who is the right person to be asking the questions then you are going to miss the boat because people are going to tell the tall white guy what they always tell the tall white guy." Continuing with his discussion of the logic model, Pleasant said that thinking about prevention in evaluation terms reinforces the absolute need for an objective indicator in the evaluation.
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From page 53... ...
Self-efficacy, he explained, is a good surrogate for the evaluate phase because when people have gained confidence in their ability to act on their increased health knowledge, they have, in essence, evaluated themselves. Use, he said, is the indicator of behavioral changes, and participants in this program realized statistically significant improvements in blood pressure indicators, depression, stress, civic engagement, and other positive health behaviors.
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From page 54... ...
SOURCE: As presented by Andrew Pleasant at the Community-Based Health Literacy Interventions workshop on July 19, 2017.
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From page 55... ...
TABLE 4-1 Evaluation of the Life Enhancement Program Using the Calgary Charter Health Literacy Scale 1 Pre Post Percent Frequency of Engaging in the Following Tasks: Average Average Difference Find/look for health information 2.7 2.8 7% Understand information about your health 2.9 3.2 9% Evaluate how health information relates to your 2.8 3.1 10% life (e.g., determine if and how information is relevant to your life) Communicate about your health to others 2.5 2.9 14% Act on information about your health 2.7 3.1 14% SOURCE: Adapted from a presentation by Andrew Pleasant at the Community-Based Health Literacy Interventions workshop on July 19, 2017.
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From page 56... ...
"If they are FIGURE 4-3 Logic model for the Theater for Health intervention in Peru. SOURCE: As presented by Andrew Pleasant at the Community-Based Health Literacy Interventions workshop on July 19, 2017.
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From page 57... ...
FIGURE 4-4 Health literacy improvements from the Theater for Health intervention in Peru. SOURCE: Adapted from a presentation by Andrew Pleasant at the CommunityBased Health Literacy Interventions workshop on July 19, 2017.
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From page 58... ...
"Health literacy interventions can be expensive, but if they are evaluated well, they are worth it," he said. For example, for 100 Life Enhancement Program participants, the cost of improved health status in the first year following the intervention occurs at a cost between $376,400 and $570,500 less than other interventions to produce similar health gains.
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From page 59... ...
In her opinion, there is a deficit of good exemplars of robust, community-level health literacy interventions, though there are examples of good program evaluation. Two of her favorites are the evaluations of the text4baby program and the Head Start program that Herman discussed in the previous session.
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From page 60... ...
"It increases the validity of your findings tremendously." In terms of tools, Espinosa said that the key is good data collection and determining if the intervention led to actions that will eventually change health outcomes. Once again, he said, engaging community members is the key to getting quality data to demonstrate effectiveness at promoting b etter health outcomes.
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From page 61... ...
One of his strategies is to recruit members of the evaluation team from the community benefit organizations working with the community of interest and the universities that are currently doing research there. That approach reduces the learning curve and it helps establish trust in the community, which he said is critical for measuring the intent of community members to act on the information delivered to them.
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From page 62... ...
Her team, for example, has hired two people from the public housing communities behind the Washington, DC, baseball stadium, and there is now a Lombardi Cancer Center research office in Southeast Washington, which is a medically underserved area. "When the community can see that you are actually investing and you are not doing what is referred to as helicopter research, where researchers come in, collect all these data, then run and
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From page 63... ...
Thota said that when his group examines health equity in community guide reviews of early education interventions targeted to historically underserved populations, they look at applicability for specific populations in that setting and whether the researchers have stratified results by the different participants. Thota noted that as a result of listening to the workshop discussions, he will look closely at how to look at health literacy more explicitly in his group's reviews.
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From page 64... ...
Thota said CDC's Community Guide website5 has more than 250 recommendations based on reviews of community interventions that span the health spectrum. The website also includes methods and processes and contact information for the dissemination and implementation team, which provides technical consultations on implementation.
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From page 65... ...
She also includes community members as co-authors on publications, and noted that constructing community advisory boards made largely of community members is another way of demonstrating equitability. Wallington said one of the biggest compliments she received was when a community member called the main switchboard at Georgetown and asked for "Sherrie Wallington." When the operator asked if the caller meant Dr.
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From page 66... ...
Espinosa said community health workers, particularly those associated with federally qualified health centers (FQHCs) , can be a great resource.
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From page 67... ...
framework and CDC best practices framework include valuable questions that researchers can use in health literacy work. As the practice section editor of the new journal Health Literacy Research and Practice, she encouraged everyone attending the workshop to consider writing up their community-based health literacy interventions and submitting them to the best practices section of the journal.
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From page 68... ...
68 COMMUNITY-BASED HEALTH LITERACY INTERVENTIONS live onsite who can help disseminate information. Wallington noted that as a result of the strong relationship she has developed with her community, she often gets calls from the board or community members requesting help with a problem that may have nothing to do with her area of expertise, but she will connect the caller with a colleague who can help address the issue at hand.
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