Evaluating AIDS Prevention Programs Expanded Edition (1991) / Chapter Skim
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4 Evaluating Health Education and Risk Reduction Projects
4 Evaluating Health Education and Risk Reduction Projects
Pages 83-101
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From page 83... ...
Since 1985, when agreements for funding 1 For specific and well-defined products, CDC has occasionally executed cooperative agreements win professional organizations such as the American Public Health Association, the U.S. Conference of Local Heals Officers, the National Association of County Heals Officers and the Association of Teachers of Prevention Medicine.
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From page 84... ...
Consequently, the new direct grants program presents a special challenge to CPS to work with the diversity represented by CBOs and the specific contextual frameworks that define who is proposed to get what services, when, by what means, and to what end. As one example of the extent of this challenge, the management information systems that have been developed for monitoring, Backing, and evaluating official health agency project activities are likely to be of limited usefulness when applied to the broad range of CBO activities.
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From page 85... ...
Furthermore, the panel's own struggle with this task led it to conclude 21n addition to Inning preapplication workshops, CPS's project of fleers continue to provide extensive technical assistance to CBOs after they are funded. Their work is especially critical in the first 3 to 6 months when, through telephone and site visits, project officers encourage a focused approach to CBO interventions, help practitioners establish realistic goals and work plans, cultivate input from their communities, and document the project's deliver processes.
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From page 86... ...
WHAT SERVICES ARE DELIVERED? There are three evaluation strategies to be considered in determining what activities were planned by a project and what activities actually took place: case studies of individual projects, gathering data through a standardized administrative reporting system, and conducting a census or sample survey.
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From page 87... ...
In addition, such case studies could enhance understanding of: · the target groups and subgroups being served; · how individuals learn about services and what other services are available to them; · how a CBO learns about and reaches out to individuals, engages them in receiving services, and limits attrition from the project; · what services or educational material are delivered, by whom, how often, to whom, and in what context; · the accuracy and timeliness of the education or risk reduction information selected groups receive; and · how funds are used. Key elements in the design of such a study would include the selection of a sample of sites for case studies, the collection of data during site visits to each project, and the analysis and interpretation of the data.
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From page 88... ...
A summary report would then be prepared outlining the major findings of the team and identifying the elements of the project that appear appropriate for further data gathering using other procedures. Standardized Administrative Reporting The Center for Prevention Services plans to gather data from Be direct grantees in two ways: site visits made by CDC project officers and quarterly narrative reports provided by the sites.
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From page 89... ...
notes that obtaining information about project goals is especially important, and it is likely to require careful probing. A health education/risk reduction project might readily assert that its primary goal is "education." However, the information that would be most helpful is much more specific: for example, the project might be using street outreach workers to educate Hispanic persons who use IV drugs about (1)
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From page 90... ...
· In what context are these services delivered? A census or sample survey might also gamer information on client flow, and it could probe more deeply than an administrative reporting system into project objectives, characteristics of the services delivered, and other program elements.
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From page 91... ...
For instance, the design of a simple administrative reporting system would have to take into account the diversity of the health education/risk reduction projects being undertaken by Be CBOs and the limited interest of the CBOs in providing such reports. As noted above, CDC's experience in developing a standardized reporting scheme for testing and counseling sites and its experience with Be AIDS demonstration projects are both
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From page 92... ...
Conducting good case studies of a small sample of health education/risk reduction projects to understand project activities engenders somewhat different problems. The diversity among the projects will make the organization of results difficult.
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From page 93... ...
Before-and-After Evaluation Designs CDC's guidelines for evaluation of the new CBO projects propose the use of a "baseline" preprogram measure as a basis for estimating change that occurs as a consequence of these projects (CDC, 1989b)
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From page 94... ...
believes they should be reviewed and, if the results are of sufficient importance to warrant the effort, the evaluation could be repeated using a randomized design. Because of the inferential problems that affect nonexperimental designs such as before-and-after studies, the parent committee's earlier report urged that serious consideration be given to randomized experiments to estimate Be relative effects of AIDS prevention projects.
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From page 95... ...
Then, providing limited service on a random basis to equally deserving individuals or organizations can be justified and implemented, and it does not conflict with professional and social ethics (Riecken et al., 1974; Federal Judicial Center, 1981~. At the present time, the panel does not believe it would be appropriate to interfere with the ongoing operations of the CBO projects funded through the states and the Conference of Mayors in order to impose "control" groups.
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From page 96... ...
2. Develop incentives, notably funding, for the selected CBOs to encourage their cooperation in comparative randomized tests.
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From page 97... ...
They include: · detennining eligibility critena; · identifying and recruiting individuals and ensuring samples of sufficient size; · random assignment and quality controls on the integers of assignments; · tracking individuals; · using sufficiently sensitive measures to assess response to the project; and · coping win missing data problems and fallible measurements. However, the diversity typical of health education/nsk reduction projects that are developed by CBOs win multiply these problems.
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From page 98... ...
The skills needed to conduct high-quality randomized studies of new projects are not commonly found among CBO administrators and staff. The requisite technical skins are more common in academic env~ronments, although experience doing AIDS prevention through CBOs is not.
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From page 99... ...
WHAT WORKS BETTER? The preceding section proposed Hat a small sample of the new projects to be funded under CDC's direct grants program to CBOs be tested against control conditions.
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From page 100... ...
The separation is essential to a fair comparison between the groups, but it may be subverted if individuals assigned to one regimen interact often with individuals assigned to the over. The type of interaction Mat can affect comparative tests (e.g., exchanging information or sharing risk reduction matenal)
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From page 101... ...
Evaluating AIDS Prevention Programs: A Guidebook for the Health Educator. New York: Gay Men's Health Crisis, Inc.
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