Assignment: WK 9Assessing a Healthcare Program/Policy Evaluation
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
· Select an existing healthcare program or policy evaluation or choose one of interest to you.
· Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
· Describe the healthcare program or policy outcomes.
· How was the success of the program or policy measured?
· How many people were reached by the program or policy selected?
· How much of an impact was realized with the program or policy selected?
· At what point in program implementation was the program or policy evaluation conducted?
· What data was used to conduct the program or policy evaluation?
· What specific information on unintended consequences was identified?
· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
· Did the program or policy meet the original intent and objectives? Why or why not?
· Would you recommend implementing this program or policy in your place of work? Why or why not?
· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
By Day 7 of Week 10
Submit your completed healthcare program/policy evaluation analysis.
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/science/article/pii/S0029655418300617
i J LUUU^S
.
Discussion WK 9The Role of the RNAPRN in Policy EvaluationIn .docxJeniceStuckeyoo
Discussion WK 9
The Role of the RN/APRN in Policy Evaluation
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?
Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?
In this Discussion, you will reflect on the role of professional nurses in policy evaluation.
To Prepare:
· In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
· Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
Post an evaluation topic and a brief description of the evaluation. Discuss how social determinants impact this issue.
RESOURCES:
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/user/identity/landing?code=Di7po9j9EMcw3P8H7oOBTNkBnjVKGuf9x44QkC1I&state=retryCounter%3D0%26csrfToken%3D9f776cf2-08bc-4f09-a8f6-072222840d99%26idpPolicy%3Durn%253Acom%253Aelsevier%253Aidp%253Apolicy%253Aproduct%253Ainst_assoc%26returnUrl%3Dhttps%253A%252F%252Fwww.sciencedirect.com%252Fscience%252Farticle%252Fpii%252FS0029655418300617%26prompt%3Dlogin%26cid%3Datp-40f879d1-8ae6-4b6d-b906-4c41401a9ea7
i J LUUU^S
Why Don't We See More Translation
of Health Promotion Research to Practice?
Rethinking the Efficacy-to-Effectiveness Transition
I Russell E. Glasgow, PhD, Edward Lichtenstein, PhD, and Alfred C, Marcus, PhD
The gap between research and practice is well documented. We address one of the
underlying reasons for this gap: the assumption that effectiveness research naturally
and logically follows from successful efficacy research. These 2 research traditions
have evolved different methods and values; consequently, there are inherent differ-
ences between the characteristics of a successful efficacy intervention versus those of
an effectiveness one. Moderating factors that limit robustness across settings, popu-
lations, and intervention staff need to .
National Institute of Health: Theory at a Glance, A Guide for Health Promotio...Zach Lukasiewicz
Introduction viii
Audience and Purpose 1
Contents 1
Part 1: Foundations of Theory in Health Promotion and Health Behavior 3
Why Is Theory Important to Health Promotion and Health Behavior Practice? 4
What Is Theory? 4
How Can Theory Help Plan Effective Programs? 4
Explanatory Theory and Change Theory 5
Fitting Theory to the Field of Practice 5
Using Theory to Address Health Issues in Diverse Populations 7
Part 2: Theories and Applications 9
The Ecological Perspective: A Multilevel, Interactive Approach 10
Theoretical Explanations of Three Levels of Influence 12
Individual or Intrapersonal Level 12
Health Belief Model 13
Stages of Change Model 15
Theory of Planned Behavior 16
Precaution Adoption Process Model 18
Interpersonal Level 19
Social Cognitive Theory 19
Community Level 22
Community Organization and Other Participatory Models 23
Diffusion of Innovations 27
Communication Theory 29
Media Effects 30
Agenda Setting 30
New Communication Technologies 31
ACT500 Research Evaluation TablesArticle 1 Measuring Perfo.docxbobbywlane695641
ACT500: Research Evaluation Tables
Article 1: Measuring Performance
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Balanced Scorecard
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the research methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position with credible resources and examples.
Discuss how your organization might or might not use the findings from these studies. Substantiate your opinion with concrete examples.
Article 2: Incremental Analysis
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Cost Behavior
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position wit.
Discussion WK 9The Role of the RNAPRN in Policy EvaluationIn .docxJeniceStuckeyoo
Discussion WK 9
The Role of the RN/APRN in Policy Evaluation
In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?
Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?
In this Discussion, you will reflect on the role of professional nurses in policy evaluation.
To Prepare:
· In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
· Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
Post an evaluation topic and a brief description of the evaluation. Discuss how social determinants impact this issue.
RESOURCES:
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/user/identity/landing?code=Di7po9j9EMcw3P8H7oOBTNkBnjVKGuf9x44QkC1I&state=retryCounter%3D0%26csrfToken%3D9f776cf2-08bc-4f09-a8f6-072222840d99%26idpPolicy%3Durn%253Acom%253Aelsevier%253Aidp%253Apolicy%253Aproduct%253Ainst_assoc%26returnUrl%3Dhttps%253A%252F%252Fwww.sciencedirect.com%252Fscience%252Farticle%252Fpii%252FS0029655418300617%26prompt%3Dlogin%26cid%3Datp-40f879d1-8ae6-4b6d-b906-4c41401a9ea7
i J LUUU^S
Why Don't We See More Translation
of Health Promotion Research to Practice?
Rethinking the Efficacy-to-Effectiveness Transition
I Russell E. Glasgow, PhD, Edward Lichtenstein, PhD, and Alfred C, Marcus, PhD
The gap between research and practice is well documented. We address one of the
underlying reasons for this gap: the assumption that effectiveness research naturally
and logically follows from successful efficacy research. These 2 research traditions
have evolved different methods and values; consequently, there are inherent differ-
ences between the characteristics of a successful efficacy intervention versus those of
an effectiveness one. Moderating factors that limit robustness across settings, popu-
lations, and intervention staff need to .
National Institute of Health: Theory at a Glance, A Guide for Health Promotio...Zach Lukasiewicz
Introduction viii
Audience and Purpose 1
Contents 1
Part 1: Foundations of Theory in Health Promotion and Health Behavior 3
Why Is Theory Important to Health Promotion and Health Behavior Practice? 4
What Is Theory? 4
How Can Theory Help Plan Effective Programs? 4
Explanatory Theory and Change Theory 5
Fitting Theory to the Field of Practice 5
Using Theory to Address Health Issues in Diverse Populations 7
Part 2: Theories and Applications 9
The Ecological Perspective: A Multilevel, Interactive Approach 10
Theoretical Explanations of Three Levels of Influence 12
Individual or Intrapersonal Level 12
Health Belief Model 13
Stages of Change Model 15
Theory of Planned Behavior 16
Precaution Adoption Process Model 18
Interpersonal Level 19
Social Cognitive Theory 19
Community Level 22
Community Organization and Other Participatory Models 23
Diffusion of Innovations 27
Communication Theory 29
Media Effects 30
Agenda Setting 30
New Communication Technologies 31
ACT500 Research Evaluation TablesArticle 1 Measuring Perfo.docxbobbywlane695641
ACT500: Research Evaluation Tables
Article 1: Measuring Performance
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Balanced Scorecard
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the research methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position with credible resources and examples.
Discuss how your organization might or might not use the findings from these studies. Substantiate your opinion with concrete examples.
Article 2: Incremental Analysis
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Cost Behavior
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position wit.
Summary Various industries, including health care, have adop.docxpicklesvalery
Summary
Various industries, including health care, have adopted quality
improvement (QI) to enhance practices and outcomes. As
demands on the U.S. public health system continue to increase,
QI strategies may play a vital role in supporting the system and
improving outcomes. Therefore, public health practitioners, like
leaders in other industries, are developing QI approaches for
application in public health settings.
Quality improvement in public health involves systematically
evaluating public health programs, practices, and policies and
addressing areas that need to be improved to increase healthy
outcomes. Although QI methods and techniques have only
recently been applied to public health, public health systems offer
a wide range of opportunities for implementing, managing, and
evaluating QI efforts.
The growing field of Public Health Systems and Services Research
(PHSSR) offers the potential to contribute to and support QI efforts
in public health. PHSSR examines the delivery of public health
services within communities as well as the outcomes that result from
dynamic interactions within the public health system. By examining
the public health system, stakeholder interactions, delivery of services,
and outcomes, PHSSR can inform and support the implementation
of QI initiatives.
Most recently, national, state, and local levels have made notable
progress in quality improvement in public health.1, 2 One initia-
tive credited with achieving progress is the Multi-State Learning
Collaborative (MLC). The MLC aims to inform the national accredi-
tation program, incorporate quality improvement practice into pub-
lic health systems, promote collaborative learning across states and
partners, and expand the knowledge base in public health.
Bringing together state and local practitioners and other stakeholders
in a community of practice to achieve MLC goals has yielded several
best practices and lessons for public health stakeholders. However,
more work is needed if QI is to become standard practice in public
health—particularly in understanding health departments’ readiness
for change, building the evidence base for effective public health QI
practices in the context of the public health system, and examining the
sustainability of successful projects, and identifying the determinants
of transformational change.
ÆResearchInsights
Quality Improvement in Public Health: Lessons Learned
from the Multi-State Learning Collaborative
Background: AcademyHealth’s 2009 Annual Research Meeting
At the 2009 Annual Research Meeting (ARM), June 28–30, in Chicago, AcademyHealth convened a panel of three experts, members of the
Multi-State Learning Collaborative (MLC), to discuss their experiences in implementing quality improvement collaboratives in public health.
Leslie Beitsch, M.D., J.D., associate dean for health affairs and professor of family medicine and rural health at the College of Medicine, Florida
State ...
Clearing the Error: Patient Participation in Reducing Diagnostic ErrorJefferson Center
To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
Developing comprehensive health promotion - MedCrave Online PublishingMedCrave
As the global prevalence of obesity and chronic diseases continues to rise, the need for effective health promotion programs is imperative. Whilst research into effectiveness of health promotion programs is needed to improve population health outcomes, translation of these research findings into policy and practice is crucial. Translation requires not only efficacy data around what to implement, but also information on how to implement it.
http://medcraveonline.com/MOJPH/MOJPH-02-00007.pdf
Healthy People 2020Healthy People was a call to action and an.docxpooleavelina
Healthy People 2020
Healthy People was a call to action and an attempt to set health goals for the United States for the next 10 years.
Healthy People 2000 established 3 general goals:
Increase the span of healthy life.
Reduce health disparities.
Create access to preventive services for all.
Healthy People 2010 introduced 2 general goals:
Increase quality and years of healthy life.
Eliminate health disparities.
Practical Policy for Preventive Services
The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform.
There is broad evidence that Americans often do not get the care they need even though the United States spends more money per person on health care than any other nation in the world.
Preventive care is underutilized, resulting in higher spending on complex, advanced diseases.
Practical Policy for Preventive Services
Patients with chronic diseases too often do not receive proven and effective treatments such as drug therapies or self management services to help them more effectively manage their conditions.
These problems are exacerbated by a lack of coordination of care for patients with chronic diseases.
Reforming our health care delivery system to improve the quality and value of care is essential to address escalating costs, poor quality, and increasing numbers of Americans without health insurance coverage.
Why policies need to be developed?
Basic needs are not being met (e.g., People are not receiving the health care they need)
People are not being treated fairly (e.g., People with disabilities do not have access to public places)
Resources are distributed unfairly (e.g., Educational services are more limited in neighborhoods of concentrated poverty)
Why policies need to be developed?
Current policies or laws are not enforced or effective (e.g., The current laws on clean water are neither enforced nor effective)
Proposed changes in policies or laws would be harmful (e.g., A plan to eliminate flextime in a large business would reduce parents' ability to be with their children)
Existing or emerging conditions pose a threat to public health, safety, education, or well-being (e.g., New threats from terrorist activity)
Marjory Gordon’s Functional Health Patterns
Marjory Gordon was a nursing theorist and professor who created a nursing assessment theory known as Gordon's functional health patterns.
It is a method to be used by nurses in the nursing process to provide a more comprehensive nursing evaluation of the patient.
Gordon's functional health pattern includes 11 categories which is a systematic and standardized approach to data collection.
List of Functional Health Patterns
1. Health Perception – Health Management Pattern
describes client’s perceived pattern of health and well being and how health is managed.
2. Nutritional – Metabolic Pattern
describes pattern of food and fluid consumption relative to metabolic need and pattern indicators of loca ...
Assignment DescriptionA reputable hospital has high quality .docxluearsome
Assignment Description
A reputable hospital has high quality ratings from patient satisfaction surveys but is still losing market share. For many years, health care organizations, as well as traditional businesses, have been frustrated that high customer satisfaction scores do not necessarily lead to higher levels of profitability or sales.
Prepare a report examining this phenomenon that address the following elements:
Evaluate and explain inconsistency between customer satisfaction scores and profitability and why it tends to exist in health care organizations.
Apply the statistical procedures discussed in class to support (or refute) the inconsistency.
Assess price vs. quality of services as well as the impact of insurance or managed care contracts on a hospital's market share, regardless of patient satisfaction levels.
Explain how you could use high patient satisfaction results to your advantage when negotiating a new managed care contract for the hospital. Discuss ethical issues involved when presenting results.
Discuss how qualitative and quantitative data can be used to help this hospital improve market share.
The body of the resultant report should be 5–7 pages and include at least 5 relevant peer-reviewed academic or professional references published within the past 5 years.
Library Resources:
Statistical Analysis 1 Below is a list of articles and summary descriptions on effective communication in health care. Click here to use the online library to search for the complete articles. Article 1 The increased use of meta-analysis in systematic reviews of health care interventions has highlighted several types of bias that can arise during the completion of a randomized controlled trial. Study publication bias and outcome reporting bias have been recognized as potential threats to the validity of meta-analysis and can make the readily available evidence unreliable for decision making. This update reviews and summarizes the evidence from cohort studies that have assessed study publication bias or outcome reporting bias in randomized controlled trials. Twenty studies were eligible, of which four were newly identified in this update. Only two followed the cohort all the way through from protocol approval to information regarding the publication of outcomes. Fifteen of the studies investigated study publication bias and five investigated outcome reporting bias. Three studies have found that statistically significant outcomes had higher odds of being fully reported as compared to nonsignificant outcomes (range of odds ratios: 2.2–4.7). In comparing trial publications to protocols, it was found that 40–62% of studies had at least one primary outcome that was changed, introduced, or omitted. It was decided not to undertake meta-analysis because of the differences between studies. This update does not change the conclusions of the review in which 16 studies were included. Direct empirical evidence for the existence of study publica ...
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
Revista de Asisten] Social, anul X, nr. 12011, 25-33 25.docxmalbert5
Revista de Asisten]\ Social\, anul X, nr. 1/2011, 25-33 25
Measuring Effectiveness
in Direct Social Work Practice
Bradford W. Sheafor*
Abstract. In many parts of the world social workers are increasingly expected to
provide documentation of the effectiveness of their services. One useful approach to
such documentation is to measure the amount of change clients experience relative to
the issues in their lives being addressed with the social worker. This is one expression
of the popular demand for evidence-based practice: evidence-based evaluation. While
it is not possible to prove that a social worker�s intervention caused the change,
empirical documentation of change can be shown to be associated with the intervention
and the work of the social worker. This trend is somewhat controversial in social work
and, indeed, there are advantages and disadvantages to efforts to quantify client
change. In this article a process is described for conducting an evidence-based evalu-
ation of client change when working in a direct service capacity, i.e., face-to-face
intervention with individuals, families, and groups. In addition to the usual process
followed in assessing and intervening to help change the client situation, additional
steps in the process are to: 1) generate researchable questions that will inform the
social worker�s actions with this client (formative research) or provide summary infor-
mation about the practice outcomes (summative research) to inform future practice
activities; 2) quantitatively measure change in the important variables related to the
issue(s) being addressed; 3) organize the resulting data in a format that helps to
interpret the client outcomes.
Keywords: direct practice evaluation, evidence-based practice, measurement, single-
-subject designs, empirical practice evaluation
Introduction
As social work has evolved, at least in industrialized nations, simply asserting that we are
doing good when serving our clients is increasingly viewed with suspicion. When called upon
to prove that our interventions make a difference for clients, social workers are often
hard-pressed to uphold their claims of success-or defend against others� claims of our failures.
How can we accurately determine if we are truly helping our clients? One approach is
to ask the opinions of the clients who clearly have an important perspective on our work.
However, there are serious limitations to client assessments of the social worker�s perfor-
mance. Clients may not have an accurate basis of comparison to other service providers,
* School of Social Work, Colorado State University, 119 Education Building, Fort Collins, CO
80523, USA, Tel.: (970) 4915654, E-mail: [email protected]
B.W. Sheafor / Measuring Effectiveness in Direct Social Work Practice26
may base their judgments or disliking the social worker as opposed to assessing his or her
competence in addressing the issues, and the client�s assessment may be subject to manipu-
lation as s.
Be prepared to answer the following questionsWhat are the thr.docxjesuslightbody
Be prepared to answer the following questions:
What are the three components of the DRI?
Describe how RDA, AI, and UL influence health?
After reviewing your results on the Interactive DRI, how well are you meeting the RDAs suggested?
What two changes can you make to improve?
.
Based upon our readings concerning the work of Pierre Bourdieu, ple.docxjesuslightbody
Based upon our readings concerning the work of Pierre Bourdieu, please address the following: a) define his concept of "habitus," specifically citing your reading material, and give at least ONE example of this important concept; b) explain the role that habitus plays in creating inequality (economic, political, social, etc.) between people in society; c) give one example recently covered in the news media (within the last year or so), that demonstrates how the accumulation of "cultural capital" can be used to benefit a person, OR, how a lack of cultural capital can harm a person.
.
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Summary Various industries, including health care, have adop.docxpicklesvalery
Summary
Various industries, including health care, have adopted quality
improvement (QI) to enhance practices and outcomes. As
demands on the U.S. public health system continue to increase,
QI strategies may play a vital role in supporting the system and
improving outcomes. Therefore, public health practitioners, like
leaders in other industries, are developing QI approaches for
application in public health settings.
Quality improvement in public health involves systematically
evaluating public health programs, practices, and policies and
addressing areas that need to be improved to increase healthy
outcomes. Although QI methods and techniques have only
recently been applied to public health, public health systems offer
a wide range of opportunities for implementing, managing, and
evaluating QI efforts.
The growing field of Public Health Systems and Services Research
(PHSSR) offers the potential to contribute to and support QI efforts
in public health. PHSSR examines the delivery of public health
services within communities as well as the outcomes that result from
dynamic interactions within the public health system. By examining
the public health system, stakeholder interactions, delivery of services,
and outcomes, PHSSR can inform and support the implementation
of QI initiatives.
Most recently, national, state, and local levels have made notable
progress in quality improvement in public health.1, 2 One initia-
tive credited with achieving progress is the Multi-State Learning
Collaborative (MLC). The MLC aims to inform the national accredi-
tation program, incorporate quality improvement practice into pub-
lic health systems, promote collaborative learning across states and
partners, and expand the knowledge base in public health.
Bringing together state and local practitioners and other stakeholders
in a community of practice to achieve MLC goals has yielded several
best practices and lessons for public health stakeholders. However,
more work is needed if QI is to become standard practice in public
health—particularly in understanding health departments’ readiness
for change, building the evidence base for effective public health QI
practices in the context of the public health system, and examining the
sustainability of successful projects, and identifying the determinants
of transformational change.
ÆResearchInsights
Quality Improvement in Public Health: Lessons Learned
from the Multi-State Learning Collaborative
Background: AcademyHealth’s 2009 Annual Research Meeting
At the 2009 Annual Research Meeting (ARM), June 28–30, in Chicago, AcademyHealth convened a panel of three experts, members of the
Multi-State Learning Collaborative (MLC), to discuss their experiences in implementing quality improvement collaboratives in public health.
Leslie Beitsch, M.D., J.D., associate dean for health affairs and professor of family medicine and rural health at the College of Medicine, Florida
State ...
Clearing the Error: Patient Participation in Reducing Diagnostic ErrorJefferson Center
To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
Developing comprehensive health promotion - MedCrave Online PublishingMedCrave
As the global prevalence of obesity and chronic diseases continues to rise, the need for effective health promotion programs is imperative. Whilst research into effectiveness of health promotion programs is needed to improve population health outcomes, translation of these research findings into policy and practice is crucial. Translation requires not only efficacy data around what to implement, but also information on how to implement it.
http://medcraveonline.com/MOJPH/MOJPH-02-00007.pdf
Healthy People 2020Healthy People was a call to action and an.docxpooleavelina
Healthy People 2020
Healthy People was a call to action and an attempt to set health goals for the United States for the next 10 years.
Healthy People 2000 established 3 general goals:
Increase the span of healthy life.
Reduce health disparities.
Create access to preventive services for all.
Healthy People 2010 introduced 2 general goals:
Increase quality and years of healthy life.
Eliminate health disparities.
Practical Policy for Preventive Services
The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform.
There is broad evidence that Americans often do not get the care they need even though the United States spends more money per person on health care than any other nation in the world.
Preventive care is underutilized, resulting in higher spending on complex, advanced diseases.
Practical Policy for Preventive Services
Patients with chronic diseases too often do not receive proven and effective treatments such as drug therapies or self management services to help them more effectively manage their conditions.
These problems are exacerbated by a lack of coordination of care for patients with chronic diseases.
Reforming our health care delivery system to improve the quality and value of care is essential to address escalating costs, poor quality, and increasing numbers of Americans without health insurance coverage.
Why policies need to be developed?
Basic needs are not being met (e.g., People are not receiving the health care they need)
People are not being treated fairly (e.g., People with disabilities do not have access to public places)
Resources are distributed unfairly (e.g., Educational services are more limited in neighborhoods of concentrated poverty)
Why policies need to be developed?
Current policies or laws are not enforced or effective (e.g., The current laws on clean water are neither enforced nor effective)
Proposed changes in policies or laws would be harmful (e.g., A plan to eliminate flextime in a large business would reduce parents' ability to be with their children)
Existing or emerging conditions pose a threat to public health, safety, education, or well-being (e.g., New threats from terrorist activity)
Marjory Gordon’s Functional Health Patterns
Marjory Gordon was a nursing theorist and professor who created a nursing assessment theory known as Gordon's functional health patterns.
It is a method to be used by nurses in the nursing process to provide a more comprehensive nursing evaluation of the patient.
Gordon's functional health pattern includes 11 categories which is a systematic and standardized approach to data collection.
List of Functional Health Patterns
1. Health Perception – Health Management Pattern
describes client’s perceived pattern of health and well being and how health is managed.
2. Nutritional – Metabolic Pattern
describes pattern of food and fluid consumption relative to metabolic need and pattern indicators of loca ...
Assignment DescriptionA reputable hospital has high quality .docxluearsome
Assignment Description
A reputable hospital has high quality ratings from patient satisfaction surveys but is still losing market share. For many years, health care organizations, as well as traditional businesses, have been frustrated that high customer satisfaction scores do not necessarily lead to higher levels of profitability or sales.
Prepare a report examining this phenomenon that address the following elements:
Evaluate and explain inconsistency between customer satisfaction scores and profitability and why it tends to exist in health care organizations.
Apply the statistical procedures discussed in class to support (or refute) the inconsistency.
Assess price vs. quality of services as well as the impact of insurance or managed care contracts on a hospital's market share, regardless of patient satisfaction levels.
Explain how you could use high patient satisfaction results to your advantage when negotiating a new managed care contract for the hospital. Discuss ethical issues involved when presenting results.
Discuss how qualitative and quantitative data can be used to help this hospital improve market share.
The body of the resultant report should be 5–7 pages and include at least 5 relevant peer-reviewed academic or professional references published within the past 5 years.
Library Resources:
Statistical Analysis 1 Below is a list of articles and summary descriptions on effective communication in health care. Click here to use the online library to search for the complete articles. Article 1 The increased use of meta-analysis in systematic reviews of health care interventions has highlighted several types of bias that can arise during the completion of a randomized controlled trial. Study publication bias and outcome reporting bias have been recognized as potential threats to the validity of meta-analysis and can make the readily available evidence unreliable for decision making. This update reviews and summarizes the evidence from cohort studies that have assessed study publication bias or outcome reporting bias in randomized controlled trials. Twenty studies were eligible, of which four were newly identified in this update. Only two followed the cohort all the way through from protocol approval to information regarding the publication of outcomes. Fifteen of the studies investigated study publication bias and five investigated outcome reporting bias. Three studies have found that statistically significant outcomes had higher odds of being fully reported as compared to nonsignificant outcomes (range of odds ratios: 2.2–4.7). In comparing trial publications to protocols, it was found that 40–62% of studies had at least one primary outcome that was changed, introduced, or omitted. It was decided not to undertake meta-analysis because of the differences between studies. This update does not change the conclusions of the review in which 16 studies were included. Direct empirical evidence for the existence of study publica ...
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
Revista de Asisten] Social, anul X, nr. 12011, 25-33 25.docxmalbert5
Revista de Asisten]\ Social\, anul X, nr. 1/2011, 25-33 25
Measuring Effectiveness
in Direct Social Work Practice
Bradford W. Sheafor*
Abstract. In many parts of the world social workers are increasingly expected to
provide documentation of the effectiveness of their services. One useful approach to
such documentation is to measure the amount of change clients experience relative to
the issues in their lives being addressed with the social worker. This is one expression
of the popular demand for evidence-based practice: evidence-based evaluation. While
it is not possible to prove that a social worker�s intervention caused the change,
empirical documentation of change can be shown to be associated with the intervention
and the work of the social worker. This trend is somewhat controversial in social work
and, indeed, there are advantages and disadvantages to efforts to quantify client
change. In this article a process is described for conducting an evidence-based evalu-
ation of client change when working in a direct service capacity, i.e., face-to-face
intervention with individuals, families, and groups. In addition to the usual process
followed in assessing and intervening to help change the client situation, additional
steps in the process are to: 1) generate researchable questions that will inform the
social worker�s actions with this client (formative research) or provide summary infor-
mation about the practice outcomes (summative research) to inform future practice
activities; 2) quantitatively measure change in the important variables related to the
issue(s) being addressed; 3) organize the resulting data in a format that helps to
interpret the client outcomes.
Keywords: direct practice evaluation, evidence-based practice, measurement, single-
-subject designs, empirical practice evaluation
Introduction
As social work has evolved, at least in industrialized nations, simply asserting that we are
doing good when serving our clients is increasingly viewed with suspicion. When called upon
to prove that our interventions make a difference for clients, social workers are often
hard-pressed to uphold their claims of success-or defend against others� claims of our failures.
How can we accurately determine if we are truly helping our clients? One approach is
to ask the opinions of the clients who clearly have an important perspective on our work.
However, there are serious limitations to client assessments of the social worker�s perfor-
mance. Clients may not have an accurate basis of comparison to other service providers,
* School of Social Work, Colorado State University, 119 Education Building, Fort Collins, CO
80523, USA, Tel.: (970) 4915654, E-mail: [email protected]
B.W. Sheafor / Measuring Effectiveness in Direct Social Work Practice26
may base their judgments or disliking the social worker as opposed to assessing his or her
competence in addressing the issues, and the client�s assessment may be subject to manipu-
lation as s.
Similar to Assignment WK 9Assessing a Healthcare ProgramPolicy Evaluation.docx (20)
Be prepared to answer the following questionsWhat are the thr.docxjesuslightbody
Be prepared to answer the following questions:
What are the three components of the DRI?
Describe how RDA, AI, and UL influence health?
After reviewing your results on the Interactive DRI, how well are you meeting the RDAs suggested?
What two changes can you make to improve?
.
Based upon our readings concerning the work of Pierre Bourdieu, ple.docxjesuslightbody
Based upon our readings concerning the work of Pierre Bourdieu, please address the following: a) define his concept of "habitus," specifically citing your reading material, and give at least ONE example of this important concept; b) explain the role that habitus plays in creating inequality (economic, political, social, etc.) between people in society; c) give one example recently covered in the news media (within the last year or so), that demonstrates how the accumulation of "cultural capital" can be used to benefit a person, OR, how a lack of cultural capital can harm a person.
.
Based on the documentary and the article, please answer the followin.docxjesuslightbody
Based on the documentary and the article, please answer the following in 2-4 sentences each:
1. Why did blackface develop in the 19th Century?
2. What are the characters described in the documentary and how did they perpetuate specific stereotypes?
3. How did images influence public perceptions of African-Americans?
4. How was the stereotypical characteristics been maintained into the 20th century?
5. How do media representations impact the broader public understanding of African-Americans?
LINK:
https://vt2013group9.wordpress.com/2013/05/02/blackface-how-stereotypes-influenced-the-perception-of-race/
https://www.manhoodraceculture.com/classes/history-4382/ethnic-notions/
.
Based on Case Study Fetal Abnormality and the required topic Reso.docxjesuslightbody
Based on "Case Study: Fetal Abnormality" and the required topic Resources, write a 750-1,000-word reflection that answers the following questions:
What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
How does the theory determine or influence each of their recommendations for action?
What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?
Remember to support your re
.
Bad time to be humble! When andwhy leaders should not be hum.docxjesuslightbody
Bad time to be humble! When and
why leaders should not be humble
Jiang Xu
Guanghua School of Management, Peking University, Beijing, China
Jih-Yu Mao
School of Business Administration, Faculty of Business Administration,
Southwestern University of Finance and Economics, Chengdu, China, and
Ye Zhang
Guanghua School of Management, Peking University, Beijing, China
Abstract
Purpose –Although leader humility is generally considered a positive leadership behavior, this study aims to
examine when the positive influences of leader humility are likely weakened.
Design/methodology/approach – Data were collected from a two-wave survey. Ordinary least squares
regression analyses were conducted to test the hypotheses.
Findings – Although leader humility is positively related to perceived leader support, this relationship is
weakened when the environment is uncertain, resulting in comparatively lower follower performance.
Practical implications – Leaders should be aware that environmental constraints may weaken the desired
outcomes of humility and therefore adapt leadership to situational needs.
Originality/value – Contrasting to predominant research on leader humility, this study examines a critical
boundary condition bywhich its positive influences are compromised. In light of the disruption caused by the
ongoing COVID-19, this study suggests that what usually are considered positive characteristics of leader
humility are likely perceived as little leader support when the environment is uncertain. Findings of this
study echo contingency leadership theories, which suggest that effective leadership should be context-
dependent.
Keywords Leader humility, Environmental uncertainty, Perceived leader support, Follower performance
Paper type Research paper
In the wake of several corporate scandals, managers and scholars have begun to reflect upon
the dark side of leaders’ grandiose characteristics, such as narcissism, hubris, and sense of
entitlement (Boje et al., 2004; Chang and Diddams, 2009; Li and Tang, 2010; Rosenthal and
Pittinsky, 2006). By contrast, virtues such as humility are important managerial
characteristics (Owens et al., 2013). In light of the appeal for “more humility and less
hubris” (Weick, 2001, p. 93), leader humility has received increased attention across various
organizational settings in recent years (e.g. Ou et al., 2018; Swain and Korenman, 2018; Wang
et al., 2018; Wolfteich et al., 2021).
Leader humility is generally viewed as a positive virtue that leads to desirable outcomes for
followers (Wang et al., 2018), teams (Owens and Hekman, 2016), and organizations (Ou et al.,
2018). However, since organizations are embedded in a dynamic, uncertain, and unpredictable
environment, there is no omnipotent leadership: Leadership is not universal and contextual
influences bound its effectiveness. Similarly, leader humility may have its limits. For instance,
Pfeffer (2015) argued that humility might be an overrated leader characterist.
be 3-5 sentences per answerDescribe what is meant by Maslo.docxjesuslightbody
be 3-5 sentences per answer
Describe what is meant by Maslow's self actualization?
List and explain the characteristics of a person who is self-actualized.
What are peak experiences, and discuss the types of people who experience them?
What is intrinsic motivation, and share some examples.
What are your thoughts about Buddhist Psychology?
.
Be sure to complete the topic Physical Development before particip.docxjesuslightbody
Be sure to complete the topic "Physical Development" before participating in this discussion.
Take a moment to review the physical development milestones that occur in infancy and complete the following:
Reflect on the physical milestones.
Select one of the milestones and state the timeframe when it is expected to occur.
Describe why you chose that milestone
What changes in motor and sensory organs occur with that milestone?
What do you feel might be complications of failure to achieve that milestone?
Describe a personal experience that relates to this milestone.
Using an external source, describe what advice should be offered to parents of children for whom this milestone is delayed.
Please be sure to validate your opinions and ideas with citations and references in APA format.
.
BCO 117 IT Software for Business Lecture Reference Notes.docxjesuslightbody
BCO 117 IT Software for Business
Lecture Reference Notes
Cloud
computing
Eras in IT infrastructure evolution
Chapter 5. IT Infrastructure and EmergingTechnologies
Management Information Systems (Kenneth P. Laudon, Jane C. Laudon)
An information technology (IT) paradigm, a model for enabling ubiquitous access to shared pools of configurable resources (such as computer networks, servers, storage, applications and services), which
can be rapidly provisioned with minimal management effort, often over the Internet.
· Computing as a service
· Computing on the Internet
· Business line for computing corporations
Hassan, Qusay (2011).
"Demystifying Cloud Computing"(PDF).
The Journal of Defense Software Engineering.
Cloud computing
Cloud computing
Cloud computing
Cloud computing
www.euruni.edu
Cloud computing examples
Software as a Service
Platform as a Service
Insfrastructure as a Service
Cloud computing examples
Cloud computing examples
https://aws.amazon.com/products/?hp=tile&so-exp=below
Cloud computing examples
Cloud computing examples
Cloud computing examples
www.euruni.edu
Cloud computing examples
Cloud computing examples
Cloud computing examples
www.euruni.edu
Cloud computing success
Key concepts
·
Reliability – reliability of the system, measured in Mean Time Between Failures (MTBF)
·
Availability – uptime of the system or application, measured in parts per million (PPM) of downtime
·
Serviceability – easily restoring the system after a failure, measured in Mean Time To Repair (MTTR)
·
Manageability – the ease with which the entire system can be managed, measured in systems per headcount.
·
Scalability - the ability of an information system to be used or produced in a range of capabilities
·
“Updatability”– a key factor linked to performance, integration with other IS and security
https://software.intel.com/en-us/articles/total-cost-of-ownership-factors-to-consider
Top Benefits of Cloud Computing
http://www.mushibhuiyan.com/category/cloud/
Debate
https://www.forbes.com/sites/louiscolumbus/2013/08/13/idg-cloud-computing-survey-security-integration-challenge-growth/#268d6d3755cb
Debate
https://www.forbes.com/sites/louiscolumbus/2013/08/13/idg-cloud-computing-survey-security-integration-challenge-growth/#268d6d3755cbCloud Computing strategy
https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=WUW12350USEN
www.euruni.edu
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i.
Authors Anna, Alisa, David & PreslavaThis article is desi.docxjesuslightbody
Authors: Anna, Alisa, David & Preslava
This article is designed to analyze the cryptocurrency market from an economical perspective during the period from 2018 to 2022 with several
instances from other timelines.
Economics & Public Policy
Equilibrium
Supply Shifts
While bitcoin supply is extremely transparent, bitcoin demand is rather
opaque. That said, there are a few quantifiable items that we do know
about bitcoin demand. First, we have a pretty good idea of the number
of bitcoin transactions performed each day. Secondly, and more
importantly, it appears that fluctuations in bitcoin transaction costs
play a major role in determining price corrections. For example, the
number of transactions stopped growing in 2012, about one year
before bitcoin’s 2013 peak and bear market. It began to rise again in
2014 before bitcoin prices began to recover in earnest but have been
stagnating since the end of 2016, perhaps foreshadowing the recent
correction.
Bitcoin’s demand and supply are both considered perfectly inelastic.
The reason is very simple but before that, it is very important to
understand how bitcoin price moves and how bitcoin mining
works.
First thing first, bitcoin has its ultimate quantity of supply which is
known by every buyer/trader/investor, which is only 21 million of
bitcoin. Meanwhile, there are around 18 million bitcoins in
circulation. How then does the quantity of circulation go up? It
depends on the bitcoin miners, as bitcoin miners contribute their
computers’ GPU and electricity to verify the transaction among the
decentralized network, in return, they will be rewarded with bitcoin
from the quantity that is not in circulation (hence the quantity of
the circulating bitcoin goes up). In the long term, the rewards
decrease, while each block is formulated the less the miners can earn.
Published on: 22nd of March 2022 Publisher: Olga Larina
Demand Shifts
The supply inelasticity explains in large part why bitcoin is so volatile. Items with inelastic supply show a greater
response to demand shifts than items with elastic supply. The same is true of demand: the more inelastic the demand, the
greater the price changes in response to small fluctuations in either supply or demand. Bitcoin’s limited and highly
inelastic supply is also a major factor driving its price appreciation, a rise so spectacular that it can only be appreciated
when seen on a log scale. In bitcoin’s first four years, supply grew by roughly 2.5 million coins per year. Even then prices
were rising as the user community grew. Since then supply has continued to grow but the pace has slowed substantially
while demand has occasionally dipped, even on a year-on-year basis. Bitcoin’s limited supply and soaring price make it
difficult to be used as a medium of exchange outside of the cryptocurrency space.
Cryptocurrencys' Impact on the Global Economy
The relationship between bitcoin prices and transaction
costs is even more compelling. This third spike in
t.
Authoritarianism, Populism, and the GlobalRetreat of Democra.docxjesuslightbody
Authoritarianism, Populism, and the Global
Retreat of Democracy: A Curated Discussion
Paul S. Adler1, Amr Adly2, Daniel Erian Armanios3 ,
Julie Battilana4, Zlatko Bodrožić5, Stewart Clegg6,7, Gerald F. Davis8,
Claudine Gartenberg9, Mary Ann Glynn10, Ali Aslan Gümüsay11,12,
Heather A. Haveman13, Paul Leonardi14, Michael Lounsbury15,
Anita M. McGahan16, Renate Meyer17, Nelson Phillips14
and Kara Sheppard-Jones10
Abstract
To the surprise of many in the West, the fall of the USSR in 1991 did not lead to the adoption of liberal democratic govern-
ment around the world and the much anticipated “end of history.” In fact, authoritarianism has made a comeback, and liberal
democracy has been on the retreat for at least the last 15 years culminating in the unthinkable: the invasion of a democratic
European country by an authoritarian regime. But why does authoritarianism continue to spread, not only as an alternative to
liberal democracy, but also within many liberal democracies where authoritarian leaders continue to gain strength and pop-
ularity? In this curated piece, contributors discuss some of the potential contributions of management scholarship to under-
standing authoritarianism, as well as highlight a number of directions for management research in this area.
Keywords
institutional theory, business & society, ethics
Introduction
Michael Lounsbury and Nelson Phillips
Over the past decade, there have been increased calls for man-
agement scholars to do more research that is societally relevant
and important—to, for example, address grand challenges (e.g.,
George et al., 2016) and to examine the role of organizations
and institutions in the production and maintenance of economic
inequality and systemic power imbalances (e.g., Amis et al.,
2020). While historically “such topics have been difficult to
publish in our leading journals,” more recently “business
schools are becoming more oriented to making research and
education more relevant to their broader societies, which will
in turn encourage scholars to pursue under researched topics
of critical importance” (Tihanyi et al., 2022, p. 712). We
believe that recent events in Ukraine demand that management
scholars once again look beyond more traditional management
themes and focus their attention on a topic that is highly socie-
tally relevant and globally important: the rise of authoritarianism
and the threat this poses to democratic governments and the
international rule of law.
When Russia invaded Ukraine in February of this year,
the Western world reacted with shock and disbelief, and as
days, weeks, and now months have passed, this shock has
evolved into a mixture of anger and fear as it has become
apparent that there is seemingly little the West can (or at
least will) do to stop Russian aggression and the growing
humanitarian crisis that has followed the invasion. While
1University of Southern California, Los Angeles, CA, USA
2American University of Cairo, New Cairo, Egypt
3Un.
ASSOCIATE SCIENCE IN NURSINGCLINICAL WORKSHEET MATERNITY NU.docxjesuslightbody
ASSOCIATE SCIENCE IN NURSING
CLINICAL WORKSHEET: MATERNITY NURSING PROCESS CARE PLAN
STUDENT NAME
DATE
Client Initials
Culture/Ethnicity
Support System
Unit
Room/Bed
Religion
Age
Sex
Language
Pre-preg Wt
Pre-preg Ht
Marital Status
Children & Ages
Current Wt
Current Ht
Occupation
G
T
P
A
L
Health Insurance
Current Work Status
Current Medical Diagnosis
Name of Significant Other/Primary Caregiver
Highest Grade Completed
Pain
Rating, Quality & Location
Infant Feeding
Date/Time of Delivery
Delivery Type (Vaginal, Cesarean**, Forceps, Vacuum)
**Reason for Cesarean
Diagnostic procedures
Surgical procedures
Pathophysiology/Psychopathology (List Reference)
Reference
Today’s Assessment
M
Admissions Vital Signs
A
T
Frequency
B
P
U
R
BB
B/P
L
Allergies/Side Effects
E
H
Brief Health History
Diet with Rationale
Time
Flowsheet Notes
Activity Order
Limitations/Prosthetic Device
PERTINENT LABORATORY DATA
Lab Test # 1
Lab Test # 2
Lab Test # 3
Lab Test # 4
Hgb/Hct #1
Hgb/Hct #2
Results
Results
Results
Hgb/Hct #3
.
Rationale for abnormal results
Rationale for abnormal results
Rationale for abnormal results
Rationale for abnormal results
(
2
)
.
INTRAVENOUS SOLUTION #1
INTRAVENOUS SOLUTION #2
Type
Lactate Ringers’ (main IV)
Type
500 ml NS (piggyback)
cc/hr
125
gtts/min
cc/hr
gtts/min
2 milliunits/minute via pump
Additives
Additives
30 U Oxytocin
Rationale for solution
Rationale for solution
.
Medication Name Generic/Trade
Classification
Major Actions
(why taking meds)
Dose/ Route Safe Range
Adverse Effects
Nursing Implications
Assessment Data Subjective/Objective
Nursing Diagnosis
Plan Outcome Criteria (Client Centered)
Interventions (Nurse Centered)
Rationale for Interventions (REFERENCED)
Evaluation
Assessment Data Subjective/Objective
Nursing Diagnosis
Plan Outcome Criteria (Client Centered)
Interventions (Nurse Centered)
Rationale for Interventions (REFERENCED)
Evaluation
Have you received a push notification like this?
Real Message: I just want your $$$
@DrWendyGuess
Hi John. Your order should be arriving on Thursday. Would you like to set up a date & time to install it? Just reply with your preferences. Wendy
Real Message: You care about the customer)
Or …. Has a note like this one
arrived just at the perfect moment?
@DrWendyGuess
Which Would YOU Rather Read?
Welcome. Wondering about the MyTalk.Rocks?
Link -
http://mytalk.rocks
Rock The Speaker
Send A Photo
Share Feedback
Ask Questions?
@DrWendyGuess
What’s better for your LTV/ROI?
@DrWendyGuess
How would it be for your clients
to feel like you’re a mind reader?
@DrWendyGuess
@DrWendyGuess
Part 1: Design Campaign
What am I really delivering?
My guiding principles
Beyond the product…
For Support
To build Community
Improve Productivity.
Assume that you are a Healthcare Quality Specialist at a healthcare .docxjesuslightbody
Assume that you are a Healthcare Quality Specialist at a healthcare facility/organization preparing for an initial Joint Commission International accreditation visit in one year.
Discuss the value that accreditation brings to an organization.
Describe the steps and processes you will initiate and implement over a one-year period in preparation.
Include any key personnel and the risk prevention procedures you would be sure to put in place as well as your performance and quality improvement plans.
Embed course material concepts, principles, and theories (which require supporting citations) in your initial response along with at least three scholarly, peer-reviewed journal articles. Use academic writing standards and APA style guidelines.
.
Assignment
Your healthcare organization’s strategic plan includes the replacement of the information system currently in place for the electronic health record in the hospital and associated provider offices.
Please note: Life cycle of a system and NOT life cycle of a software. Be careful you do not focus on software.
You will prepare an audiovisual (You must use Kaltura) with a transcript (Word file) or PowerPoint presentation (12-20 slides) with speaker notes that address:
Title slide
Include an introduction. What is your topic and what are you going to address in the presentation.
The system life cycle process and the role of employees in each stage of the process.
Identify the process- use a visual or table (if you get it already made then make sure there is appropriate credit on the slide). In the speaker’s notes explain the process steps and how employees are engaged in each step. Key is what is the employee role in each step. The role will change by each step. Be specific.
There is an announcement with directions
How to use Kaltura
How to prepare the transcript from Kaltura
Note: The transcript must be a readable, Word file that matches the narrative or your speaker notes .
The presentation continued
The identification and roles of at least five internal stakeholders employed by the practice.
Identify the stakeholders by role and define how that role contributes to the life cycle process- why are they important to the process. A table is good for this. Note: Patients are not employed by the practice.
Identify the major stakeholders and why their role is important to the project
Once you identified the stakeholders there will be some that have more sway in the project than others- they are the major or power stakeholders. Identify which stakeholders are your major stakeholders and in the speaker note/narration, define why. Do not include the government nor insurance companies.
Project Management Tools
Explain the purpose of a minimum of four key project management tools planned for the project. (See the hints for project tools link.) Word, Excel, Power Point, Teams are not examples of Project management tools.
Consider the following tools (not exclusive):
Scope
Metrics to determine project success
Gantt charts
Budget
Critical pathway
Risks
Develop a Communication Plan for the Project.
Provide a specific, detailed plan with identified tasks and answer the “who, what, when, where, why, and how”. (A table is good for this. Review the information above on the how and what to include.) Do not define what a communication plan is but develop the actual communication plan. You want a specific, detailed plan, not definitions and vague concepts. You need to include in your communication plan:
Identified tasks
Think Who, what, when, why and how.
Communication Plan continued
Think of it as a table with specific details.
Who is doing what, when
Ex. Once a month the man.
ASSIGNMENT Planning an Effective Press ReleaseSelect a topic an.docxjesuslightbody
ASSIGNMENT: Planning an Effective Press Release
Select a topic and company for a mock press release and press conference. Choose one of the following:
1. Tesla
2. Uber
3. Pepsi
4. Instagram
5. Twitter
6. Netflix
7. A current US Senator announcing their bid for the US Presidency
Choose a newsworthy topic for your selected company.
What is new? Newsworthy?
(You can make something up or use real news.)
Prepare a press release to make the announcement and issue to the press.
Audience:
Who will you issue the press release to?
Who is your target audience?
.
Assume an African American character and write from the perspective .docxjesuslightbody
Assume an African American character and write from the perspective of the character. What would be the obstacles faced by people of color during the Great Depression or the war years? Explain the issues in your letter and ask for specific help on those matters. Also in a separate paragraph below your letter, explain why you chose to write what you did. What inspired you to write on the topics, situations or events that were discussed in your letter?
.
Assignment WK 8 Advocating for the Nursing Role in Program Design .docxjesuslightbody
Assignment WK 8 Advocating for the Nursing Role in Program Design and Implementation
As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.
Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.
In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.
To Prepare:
· Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
· Select a healthcare program within your practice and consider the design and implementation of this program.
· Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.
The Assignment: (2–4 pages)
In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:
·
Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
·
Who is your target population?
·
What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
·
What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
·
What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
·
Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed..
Assignment Title
Students Name
Course Title
Professors Name
Date of Submission
Introduction
Add Presentation Notes and Sources
2
Problem Statement
Analyze and define the problem to include possible political conflicts.
Add Presentation Notes and Sources
3
Risks and Challenges
Identify risks and challenges.
Add Presentation Notes and Sources
4
Alternatives and
Solution
s
Identify and construct policy alternatives and solutions.
Add Presentation Notes and Sources
5
Stakeholders and Key Roles
Identify stakeholders and key roles.
Add Presentation Notes and Sources
6
Identify funding opportunities, challenges, and budget cost factors, to include saving measures.
Funding and Budget
Add Presentation Notes and Sources
7
Criteria
Choose supportive and evaluative criteria.
Add Presentation Notes and Sources
8
Policy Benefits
Identify incentives, subsidies, and potential benefits.
Add Presentation Notes and Sources
9
Conclusion
Draw conclusions in a thorough summary, with lessons learned.
Add Presentation Notes and Sources
10
Sources
Follow the Credit to Authors and Sources Guidelines found in the Strayer Writing Standards (SWS).
.
Assignment OverviewYou and a few of your fellow learners have be.docxjesuslightbody
Assignment Overview
You and a few of your fellow learners have been assigned to construct a presentation on one of the following groups:
Working with ableism or disability and lookism.
Each person working on the presentation is researching and contributing specific slides that analyze issues of power, privilege, and oppression as they pertain to the chosen group, as well as strategies and approaches for practice when working with these issues. This assignment will ask you to submit the presentation slides that you contributed to the presentation for an individual grade.
By successfully completing this assignment, you will demonstrate your proficiency in the following EPAs and specialized practice behaviors:
EPA Competency 1: Demonstrate Ethical and Professional Behavior.
C1.SP.B: Articulate and provide leadership in the application of the core values and ethical standards of the social work profession through an ethical problem solving model to aid in critical thinking and ethical decision making related to individuals, families, organizations, and communities to guide and inform ethical advanced generalist social work practice.
Related Assignment Criteria:
3. Discuss challenges that may arise from clients' cultures and from differences among people and cultural groups.
EPA Competency 1: Demonstrate Ethical and Professional Behavior.
C1.SP.C: Integrate the ethical and effective use of technology at all levels of advanced generalist social work practice with individuals, families, groups, organizations, and communities.
Related Assignment Criteria:
1. Create slides that address chosen theme(s) related to culturally relevant practice.
EPA Competency 2: Engage Diversity and Difference in Practice.
C2.SP.A: Analyze dimensions and differentiation in diversity and apply the influence of relationships, intervention techniques, and technologies with diverse clients, families, groups, organizations, and communities.
Related Assignment Criteria:
2. Discuss theory applicable to the selected group.
4. Discuss techniques and best practices applicable to the selected group.
Assignment Description
Each learner creates 2–4 slides that discusses the selected group around one or more of the following themes:
Religion and spirituality.
Assignment Instructions
Complete the following:
Create 2–4 slides that address chosen theme (or themes) related to culturally relevant practice.
Discuss theory applicable to the selected group.
Discuss challenges to practice with the selected group.
Discuss techniques and best practices applicable to the selected group.
.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Assignment WK 9Assessing a Healthcare ProgramPolicy Evaluation.docx
1. Assignment: WK 9Assessing a Healthcare Program/Policy
Evaluation
Program/policy evaluation is a valuable tool that can help
strengthen the quality of programs/policies and improve
outcomes for the populations they serve. Program/policy
evaluation answers basic questions about program/policy
effectiveness. It involves collecting and analyzing information
about program/policy activities, characteristics, and outcomes.
This information can be used to ultimately improve program
services or policy initiatives.
Nurses can play a very important role assessing program/policy
evaluation for the same reasons that they can be so important to
program/policy design. Nurses bring expertise and patient
advocacy that can add significant insight and impact. In this
Assignment, you will practice applying this expertise and
insight by selecting an existing healthcare program or policy
evaluation and reflecting on the criteria used to measure the
effectiveness of the program/policy.
To Prepare:
· Review the Healthcare Program/Policy Evaluation Analysis
Template provided in the Resources.
· Select an existing healthcare program or policy evaluation or
choose one of interest to you.
· Review community, state, or federal policy evaluation and
reflect on the criteria used to measure the effectiveness of the
program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected,
complete the Healthcare Program/Policy Evaluation Analysis
Template. Be sure to address the following:
· Describe the healthcare program or policy outcomes.
· How was the success of the program or policy measured?
· How many people were reached by the program or policy
selected?
2. · How much of an impact was realized with the program or
policy selected?
· At what point in program implementation was the program or
policy evaluation conducted?
· What data was used to conduct the program or policy
evaluation?
· What specific information on unintended consequences was
identified?
· What stakeholders were identified in the evaluation of the
program or policy? Who would benefit most from the results
and reporting of the program or policy evaluation? Be specific
and provide examples.
· Did the program or policy meet the original intent and
objectives? Why or why not?
· Would you recommend implementing this program or policy in
your place of work? Why or why not?
· Identify at least two ways that you, as a nurse advocate, could
become involved in evaluating a program or policy after 1 year
of implementation.
By Day 7 of Week 10
Submit your completed healthcare program/policy evaluation
analysis.
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.).
Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation”
(pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/science/article/pii/S0029655418
300617
3. i J LUUU^S
Why Don't We See More Translation
of Health Promotion Research to Practice?
Rethinking the Efficacy-to-Effectiveness Transition
I Russell E. Glasgow, PhD, Edward Lichtenstein, PhD, and
Alfred C, Marcus, PhD
The gap between research and practice is well documented. We
address one of the
underlying reasons for this gap: the assumption that
effectiveness research naturally
and logically follows from successful efficacy research. These 2
research traditions
have evolved different methods and values; consequently, there
are inherent differ-
ences between the characteristics of a successful efficacy
intervention versus those of
an effectiveness one. Moderating factors that limit robustness
across settings, popu-
lations, and intervention staff need to be addressed in efficacy
studies, as well as in
effectiveness trials. Greater attention needs to be paid to
documenting intervention
reach, adoption, implementation, and maintenance.
Recommendations are offered to
help close the gap between efficacy and effectiveness research
and to guide evaluation
and possible adoption of new programs. (Am J Public Health.
2003;93:1261-1267)
4. Despite a growing literature documenting pre-
vention and health promotion interventions
that have proven successful in well-controlled
research, few of these interventions are consis-
tently implemented in applied settings. This is
true across preventive counseling services for
numerous target behaviors, including tobacco
use, dietary change, physical activity, and
behavioral heailth issues (e.g., alcohol use, de-
pression). Several recent reviews and meta-
analyses have documented this gap,''^ and the
task forces on both clinical preventive services
and community preventive services have noted
that in several areas there is insufSdent ap-
pUed evidence available to make recommenda-
tions at present ̂ "̂ Most of the Healthy People
2000 objectives^ were not met, and the even
more ambitious goals in Healthy People 2010
are similarly unlikely to be met without signifi-
cant changes in the status quo.̂ '* To meet these
challenges, we will need to have substantially
more demonstrations of how to effectively im-
plement recommendations in typical settings
and in locations serving minority, low-income,
and rural populations facing health disparities.
This situation is not unique to preventive in-
terventions, as strikingly documented in the re-
cent Institute of Medicine report Crossing the
Chasm^ which summarizes the similar state of
affairs regarding many medical and disease
management interventions. For example, there
is increasing consensus on evidence-based
diabetes management practices to prevent
complications and on the importance and cost-
5. effectiveness of these practices.'" However,
these recommendations—and especially those
related to lifestyle counseling and behavioral
issues—are poorly implemented in practice."^''*
This gap between research and practice is
the result of several interacting factors, includ-
ing limited time and resources of practition-
ers, insufficient training,'' lack of feedback
and incentives for use of evidence-based
practices, and inadequate infrastructure and
systems organization to support translation.®'̂
In this article, we focus on another reason for
the slow and incomplete translation of re-
search findings into practice: the logic and as-
sumptions behind the design of efficacy and
effectiveness research trials.
EFFICACY AND EFFECTIVENESS
TRIALS
Many of the methods used in current pre-
vention science are based on 2 influential pa-
pers published in the 1980s: Greenwald and
Cullen's'^ description of the phases of cancer
control research and Flay's analysis of efficacy
and effectiveness research.'^ Both papers ar-
gued for a logical progression of research de-
signs through which promising intervention
ideas should proceed. These papers had many
positive effects in helping to establish preven-
tion research and enhancing acceptability
among other disciplines. However, they may
also have had an important and inadvertent
negative consequence that derives from the
6. assumption that the best candidates for effec-
tiveness studies—and later dissemination—are
interventions that prove successful in certain
types of efficacy research. We argue that this
assumption, or at least the way in which it has
been operationalized over the past 15 years,
has often led to interventions that have low
probability of success in real-world settings.
To understand this point, it is necessary first
to briefly review the seminal papers by Flay'̂
and Greenwald and Cullen.'̂ Efficacy trials are
defined by Flay as a test of whether a "pro-
gram does more good than harm when deliv-
ered under optimum conditions."'*''''"" Effi-
cacy trials are characterized by strong control
in that a standardized program is delivered in
a uniform fashion to a specific, often narrowly
defined, homogeneous target audience. Owing
to the strict standardization of efficacy trials,
any positive (or negative) effect can be directly
attributed to the intervention being studied.
Effectiveness trials are defined as a test of
whether a "program does more good than
harm when delivered under real-wOrld condi-
tions."'*"'"''̂ " They typically standardize avail-
ability and access among a defined popula-
tion while allowing implementation and levels
of participation to vary on the basis of real-
world conditions. The primary goal of an ef-
fectiveness tried is to detennine whether an
intervention works among a broadly defined
population. Effectiveness trials that result in
no change may be the result of a lack of
proper implementation or weak acceptance or
7. adherence by participants.'*'^
Greenwald and Cullen'̂ proposed 5 phases
of intervention research presumed to unfold in
August 2003 , Vol 93 , No. 8 | American Journal of Public
Health Glasgow et al. | Peer Reviewed | Public Health Matters |
1 2 6 1
ME
a sequential fashion. This continuum begins
with Phase I research to formtiJate and develop
intervention Jiypotheses for future study. Phase
II studies develop methodologies that can be
used in future efBcacy or effectiveness studies.
Phase III (efficacy) studies test intervention hy-
potheses, using methods that have been tested
in Phase Jl. TJius, Phase III studies are de-
signed to test interventions for efBcacy, vnth an
emphasis on internal validity, tJie purpose of
wJiich is to establish a eausal link between the
intervention and outcomes. Given this empha-
sis on internal control, Greenwald and Cullen
note that Phase III studies can be conducted in
settings and witb stimples that will "optimize in-
terpretation of efBcacy," including study sam-
ples tbat may be more homogeneous tban tbe
ultimate target population, and settings tbat will
maximize management of and control over tbe
researcb process.
Tbe main objective of Phase fV (effective-
ness) studies is to measure tbe impact of an in-
8. tervention when it is tested witbin a population
tbat is representative of tbe intended target au-
dienee. Given that Pbase JV studies should
yield results tbat are generalizable, there is also
tbe presumption tbat tbe context and setting
for delivering tbe intervention should likewise
be generalizable to tbe intended program
users. Jn Pbase V studies, effective Pbase JV in-
terventions are translated into large-scale dem-
onstration projects. Tbe major concern is im-
plementation fidelity of an intervention tbat
will now be introduced witbin even broader
populations, including entire communities. Tbis
final pbase (dissemination researeb), wbere col-
laboration and coordination witb various com-
munity partners is likely to receive even
greater attention, is intended to provide tbe
necessary data and experience to move inter-
ventions into public bealth service programs at
tbe national, regional, state, and local levels.
Greenwald and Cullen spedficaUy advocated
tbat intervention researcb unfold in a system-
atic fasbion, building on and extending tbe
body of science acctimulated in previous
pbases. By explicitly defining tbe difference be-
tween Pbase JJJ and Pbase IV researcb as being
an empbasis on internal control versus repre-
sentativeness, botb Flay and Greenwald and
CuUen assumed tbat successful Pbase III trials
would lead naturally to Pbase fV trials. Unfor-
tunately, tbis bas not ocaured.''"'^" Instead, we
currently find ourselves in a situation in wbicb
we bave many small-scale efBcacy studies of
unJoiown generalizability and few suceessiuJ ef-
9. fectiveness trials.̂ ''̂ ^ In particular, we know
very little about tbe representativeness of par-
ticipants, settings, or intervention agents partici-
pating in bealtb promotion research.''^'
Altbougb tbe National Gancer Institute no
longer empbasizes tJiis linear "pbases of re-
searcb" model,^'''^'' tbe model was extremely
influential in guiding an entire generation of
researeb; many researcbers, reviewers, and
editors still use tbis framework wben design-
ing, ftmding, and evaluating research—and in
deciding wbat types of studies are needed to
advance a given area. Similar pbase models
are influential in evaluating prevention effec-
tiveness^^ and in developing drug therapies.
In tbe remainder of tbis article, we discuss
bow tbis well-intentioned and logical pbase of
researcb paradigm may bave fallen sbort of
its intended goal, and propose approacbes to
remedy tbe present situation.
Our primary thesis is tbat tbis "triekle-
down" model of bow to translate researcb
into practice—namely, tbat tbe optimal way to
develop disseminable interventions is to
progress from efBcacy studies to effectiveness
trials to dissemination projects—is inherently
flawed, or at least incomplete. We posit that
given tbe respective cultures, values, and
methodological traditions tbat bave devel-
oped witbin efBcacy versus population-based
effectiveness researcb, it is bigbly unlikely
tbat interventions tbat are successful in efB-
cacy studies will do well in effectiveness stud-
10. ies, or in real-world applications.
Table 1 summarizes tbe key cbaracteristics
of well-designed efficacy and effectiveness tri-
als, using tbe RE-AIM evaluation frame-
work.̂ '̂̂ ^ Tbis model for evaluating interven-
tions is intended to refoctis priorities on
public bealtb issues, and it gives balanced em-
pbasis to internal and external validity (see
bttp://www.re-aim.org). RE-AIM is an acro-
nym for Reach, Efficacy or Effectiveness (de-
pending on tbe stage of researcb). Adoption,
Implementation, and Maintenance.
Reach refers to tbe participation rate among
tbose approacbed and tbe representativeness
of participants. Factors determining reaeb are
tbe size and cbaracteristics of tbe potential au-
dience and tbe barriers to participation (e.g.,
cost, sodaJ and environmental context, neces-
sary referrals, transportation, and inconven-
ience). Efficacy or effectiveness pertains to tbe
impact of an intervention on specified out-
come criteria and includes measures of poten-
tial negative outcomes as well as intended re-
sults (as recommended by Flay,'* but seldom
eolJected)̂ ®'̂ ^ (D.A. Dzewaltowski et al., un-
publisbed data, 2002). Adoption operates at
the setting level and concerns the percentage
and representativeness of organizations or set-
tings tbat wifl conduct a given program.
Rogers^" bas written extensively on adoption
and dissemination issues. Factors associated
witb adoption include political and cultural fit.
TABLE 1-Distinctive Characteristics of Efficacy and
11. Effectiveness intervention Studies,
Using RE-AIM^^'" Dimensions for Program Evaluation
RE-AIM Issue Efficacy Studies Effectiveness Studies
Reacli
Efficacy or
effectiveness
Adoption
Implementation
Maintenance and
cost
Homogeneous, highly motivated sample;
exclude those with complications.
other comorbid problems
Intensive, specialized interventions that
attempt to maximize effect size; very
standardized; randomized designs
Usually 1 setting to reduce variability; settings
with many resources and expert staff
Implemented by research staff closely
12. following specific protocol
Few or no issues; focus on individual level.
Broad, heterogeneous, representative sample;
often use a defined population
Brief, feasible interventions not requiring great
expertise; adaptable to setting; randomized,
time series, or quasi-experimental designs
Appeal to and work in multiple settings; able
to be adapted to fit setting
Implemented by variety of different staff with
competing demands, using adapted protocol
Major issues; setting-level maintenance is as
Important as Individual-level maintenance
1262 I Public Health Matters | Peer Reviewed | Glasgow et al.
American Journal of Public Health | August 2003, Vol 93, No. 8
cost, level of resources and expertise required,
and how similar a proposed service is to cur-
rent practices of an organization. Implementa-
tion refers to intervention integrity, or the
13. quality and consistency of delivery. Finally,
maintenance operates at both the individual
and the setting or organizational level. At the
individual level, maintenance refers to how
well hehavior changes hold up in the long
term. At the setting level, it refers to the ex-
tent to which a treatment or practice becomes
institutionalized in an organization.
Table 1 summarizes how the RE-AIM di-
mensions apply to the efiicacy-efTectiveness
distinction. Efficacy trials typically limit reach
by seeking motivated, homogeneous partici-
pants with minimal or no complications or co-
morbidities. The considerable degree of initial
screening for eligibility inherently limits the
reach of an eflicacy trial. Adoption is often
treated as a nonissue for efficacy trials so long
as at least one or, in some tdeds, a few set-
tings are willing to participate. For effective-
ness trials, reach is usually higher because
participants are drawn from a broad and "de-
fined" population. Adoption is critical because
the settings need to commit their own re-
sources and expect the intervention to "fit"
with existing procedures.
Implementation in an efficacy trial is usually
accomplished by research staff following a
standardized protocol, whereas in an effective-
ness trial, regular stciff with many competing
demands on their time must implement the in-
tervention. While such staff are also guided by
a protocol, adherence is likely to be more vari-
able.' Because they are implemented by re-
search staff, efficacy interventions are often
14. more complex and intensive than effectiveness
interventions. Maintenance is usually a nonis-
sue for efficacy trials at the setting level; it is
expected that the intervention will cease when
final assessments are completed and research
staff depart Since effectiveness trials are in-
tended to represent typical setting conditions, it
is hoped that the intervention will be main-
tained, assuming there are positive results.
WHY THE DISCONNECT?
We conclude that the characteristics that
cause an intervention to be successful in effi-
cacy research (e.g., intensive, complex, highly
standardized) are fundamentally different
from, and often at odds with, programs that
succeed in population-based effectiveness set-
tings (e.g., having broad appeal, being adapt-
able for both participants and intervention
agents). If this is the case, then the "system" of
moving from research to usual service pro-
grtims, to which we have subscribed, may be
broken and may need to be substantially
modified.
Why does this linear progression of re-
search, which is analogous to the steps used
successfully to evaluate emd bring pharma-
ceuticals to market, seem to fail with behav-
ioral and health promotion research? One
contextual factor is that, before trials, phar-
maceutical companies invest considerable
time and money establishing that the drug af-
fects relevant biological mediators to a much
15. greater extent than behavioral researchers in-
vest in showing that their interventions affect
psychosocial mediators. Granted, industry
has vastly more resources. But we suggest
that key differences also reside in the nature
of the interventions.
Standard medical interventions (e.g., drugs
or surgery) are presumed to be robust, readily
transferable from setting to setting, and to
work approximately equally across broad cate-
gories of patients. Clinicians exercise discretion
about dosage and surgeons vary in experience,
but it is still presumed that the pill is the same
whoever administers it Medicinal and surgical
protocols can be relatively precisely defined,
and adherence to them can be more easily
monitored relative to behavioral interventions.
Behavioral interventions are more difficult to
define and standardize in part because of the
inherent interactivity with client characteristics,
preferences, and behaviors. This is exacer-
bated when behavioral interventions are deliv-
ered by staff whose training and expertise fall
outside of behavioral science. In efficacy trials,
research st£iff usually bring expertise in behav-
ioral intervention and ensure that it is imple-
mented consistently. This level of quality con-
trol and standardization is typically absent
among regular health care staff implementing
interventions for effectiveness trials.
Tbere are 2 underl}Tng differences between
efficacy and effectiveness approaches that we
feel are responsible for the current state of af-
fairs. Tbe first is that in an effort to enhance
16. internal validity and control extraneous fac-
tors, the tradition in efficacy studies has been
to simplify and narrow settings, conditions,
participants, and a variety of other factors.
There is nothing inherently wrong with this
methodological approach, and the tradition of
reductionism (e.g., understanding effects by
isolating them and removing or controlling
other factors) has contributed much to the ad-
vancement of science and theory.^' The prob-
lem is that usually the longer-range intent is to
generalize beyond the narrow conditions of
the efficacy trial. In effectiveness trials, an in-
tervention must be robust across a variety of
different participants, settings, conditions, and
other less controlled factors. Equally impor-
tant, it must appeal to a broad "defined popu-
lation" or target audience.
A dassic example of the typical differences
between a health care efficacy study and an ef-
fectiveness trial concerns subject selection. In a
tightly controlled efficacy trial, only highly mo-
tivated, homogenous self-selected volunteers
who do not have any complications or other
comorbid conditions are eligible (to control for
potential confounding factors). Then, following
success in such an efficacy study, we expect
the same intervention to appeal to and be ef-
fective in a much broader cross-section of par-
ticipants, many of whom have comorbid condi-
tions and may not volunteer for treatment
The second key difference between effi-
cacy and effectiveness trials concerns how
17. settings and contextual factors are treated. In
efficacy studies, the usual approach is to con-
trol variance by restricting the setting to one
set of circumstances—for example, one partic-
ular clinic (which often includes intervention
experts). In contrast, a key characteristic of ef-
fectiveness trials is to produce robust effects
and to understand variation in outcomes
across heterogeneous settings and delivery
agents. Therefore, it should not be surprising
when the results of an intervention are effica-
cious under a highly specific set of circum-
stances but fail to replicate across a vkide vari-
ety of settings, conditions, and intervention
agents in effectiveness research.
SHALL THE TWAIN EVER MEET?
From the above discussion, it may seem
hopeless to expect congruence across findings
August 2003, Vol 93, No. 8 | American Journal of Public Health
Glasgow et al. Peer Reviewed | Public Health Matters | 1263
fi'om efficacy and effectiveness studies. Some
might go so far as to suggest, as one reviewer
of this manuscript did, that perhaps efficacy
studies should be abandoned altogether. We
are optimistic, however, that there are solu-
tions to the present disconnect. In brief, we
need to embrace and study the complexity of
the world, rather than attempting to ignore
or reduce it by studying only isolated (and
often unrepresentative) situations.''^ What is
18. needed is a "science of larger social units"''''
that takes into account and analyzes the so-
cial context(s) in which experiments are con-
ducted. To advance our present state of sci-
ence, the question that we need to ask of
both efficacy and effectiveness studies is
"What are the characteristics of interventions
that can (a) reach large numbers of people,
especially those who can most benefit, (b) he
broadly adopted by different settings (work-
site, school, health, or community), (c) be con-
sistently implemented by different staff mem-
bers with moderate levels of training and
expertise, and (d) produce replicable and
long-lasting effects (and minimal negative im-
pacts) at a reasonable cost?"
This suggested focus has important implica-
tions. It implies that we need to consider not
only individual participants but also the set-
tings within which they reside and receive
treatment This move to a multilevel ap-
proach is consistent with developments in
several fields, and methodologies for how to
handle such factors are available. There is not
only a rich conceptual history to the study of
generalization"*"* and of representative or pur-
poseful sampling,''̂ '̂ ^ but also statistical meth-
ods for handling these contextual factors.''̂
This comes down to an issue of generaliza-
tion.̂ * The prevailing view seems to be that
efficacy studies should focus only on interned
validity and theoretical process mechanisms,
and that issues of external validity should be
left until later effectiveness studies. In con-
19. trast, we argue that issues of moderating vari-
ables (external validity) need to be addressed
in both efficacy cind effectiveness studies.
Brewer''* conceptualizes such sodal context
factors as moderating variables that infiuence
the conclusions that can be drawn about the
efficacy of an intervention. Moderating vari-
ahles (e.g., race/ethnicity, socioeconomic sta-
tus, type of setting or intervention agent) are
relatively stable factors that interact with the
intervention or change the effect of the pro-
gram. Researchers should consider elevating
hypotheses related to moderator variables to
primary aims.
WHAT CAN BE DONE? DISCUSSION
AND RECOMMENDATIONS
It is difficult to change established practice
patterns, regardless of whether they be of cli-
nidans, researchers, or funding agendes. It
cannot reasonably be expected that many sd-
entists will quickly discontinue practices in
which they have been trained and become
comfortable. It is also more efficient, and
much more under one's control, to continue
to conduct efficacy studies without consider-
ing moderating variables or external validity
because "the purpose is to study interventions
under ideal conditions." However, as illus-
trated above,, this is only true if one does not
intend to generalize one's conclusions beyond
the very limited sample and conditions of a
given study,'•^' which is hardly ever the case
in health promotion research.
20. There is an increasingly well-documented
disparity hetween the large amount of infor-
mation on efficacy and the very small amount
of information on effectiveness and represen-
tativeness.^''^^'"' To produce significant im-
provement in the current state of affairs,
changes will be necessary on the part of re-
searchers, funding organizations, joumal re-
viewers, cind grant review panels. We propose
4 spedfic changes—2 of which focus on re-
searchers, 1 on joumal editors, and 1 on
funding organizations.
1. Researchers should pay increased attention to
moderating factors in both efficaqj and effective-
ness research. Table 2 outlines how data col-
lection and information about moderating fac-
tors, such as participant characteristics (reach)
and setting characteristics (adoption), can be
incorporated into both efficacy and effective-
ness research in a manner appropriate to that
phase. Using the RE-AIM framework, we sug-
gest that researchers consider the types of set-
tings, intervention agents, and individuals that
they wish their program to be used by when
designing and evaluating interventions. Dur-
ing efficacy studies, purposeful or oversam-
pling strategies can be used to include both
spedfic end-user groups (e.g., minorities, less
educated) and settings of interest A critical
concem for broader application—and an inte-
gral part of Flay's original description'*—was
measurement of potential harmful outcomes.
This part of his definition has seldom been
21. addressed, but it needs to be.
Participatory research methods, including
developing one's intervention ideas collabora-
tively with members of the intended audi-
ence (individuals, intervention agents, and or-
ganization decisionmakers) should not be left
for later phases of research but built into effi-
cacy studies. More formal measures of adop-
tion and setting level maintenance may need
to wait until later effectiveness studies
(Table 2), but both qualitative and quantita-
tive "proxy measures" of these factors can
and should be addressed in efficacy studies.
Such infonnation can lead to better tailoring
of interventions to organizational culture in
the same way that tailoring of intervention at
the individual level has led to increased suc-
cess."*''*̂ A final recommendation for both ef-
ficacy and effectiveness studies is to include a
variety of intervention agents, to describe
their backgrounds emd levels of experience/
expertise with regard to the target behavior,
and to report on potential differences in im-
plementation and outcomes associated with
these differences.'*''
As illustrated in Table 2, issues pertaining
to moderating factors—and eventual transla-
tion into practice—are best addressed during
the p/anning phases of research. RE-AIM, or
other evaluation models,'^'^can be used to
help plan and select samples, interventions,
settings, and agents in ways that make it more
likely that results will be replicated in later
studies.
22. 2. Realize that public health impact involves
more than just efficacy. Our training and cur-
rent review criteria all emphasize producing
large effect sizes under tightly controlled con-
ditions. To make a real-world impact, several
other criteria are also necessary.
a. At the individual level, several research
groups have proposed that Impact=Reach
(R) X Efficacy (E)."̂ ""*̂ It is not enough to
produce a highly efficadous intervention. To
have broad public health impact, an interven-
1264 I Public Heaith Matters | Peer Reviewed | Glasgow et al.
American Journal of Public Heaith | August 2003, Voi 93, No. 8
TABLE 2-Ways to Address RE-AIM^°'" Issues in Efficacy and
Effectiveness Studies
Efficacy trials
(Phase III
research)
Effectiveness trials
in defined
populations
(Phase IV
research)
23. Reach
Have specified inclusion
criteria or purposeful
selection, but participants
will be volunteers in a
specific research setting.
Report exclusions,
participation rates.
dropouts, and
representativeness on
key characteristics.
Include all relevant members
of a defined population.
Report exclusions.
participation rates.
dropouts, and
representativeness.
Efficacy or Effectiveness
24. Measure outcomes using
intent to treat
assumptions or
imputation of missing
values and a high level
of rigor.
Assess both positive
(anticipated) and
negative (unintended)
outcomes.
Report effects of moderator
variables.
Address as above, though
measures are usually
more limited.
Include economic
outcomes.
Adoption
25. Have potential adoptees
assess fit of prototype
intervention to their
setting.
Include "proxy measures" of
adoption, such as
participation among
those staff members of
a system who v»ill
participate in the study.
Assess willingness of
stakeholders from multiple
settings to adopt and
adapt the program.
Report on representativeness
of settings, participation
rate, and reasons for
declining.
26. Implementation
Collect data on likely
treatment demands.
Evaluate delivery of
intervention protocol
by different intervention
agents (usually research
staff).
Assess staff ability to
implement key
components of the
intervention in routine
practice.
Evaluate consistency of
intervention delivery
by agency staff who
are not part of
research team.
27. Maintenance
Assess recidivism among
participants.
Engage potential community
settings in strategic
planning efforts from
the outset.
Document extent to which
research protocol is
retained by setting/agency
once the formal study is
completed.
Assess continuation of
program over time.
and especially after
research phase
concludes.
Systematically program
28. for and evaluate the
level of institutionalization
ofthe program elements
after formal study
assistance is terminated.
don must also have high reach. To the Im-
paet=R X E formula, we would add a third
eomponent: implementation (I). As diseussed
by Basch et al.,'̂ a program cannot be effee-
dve if it is not implemented. Thus, we pro-
pose that individual-level Impaet=R x E x I.
b. An individual-level foeus is, however, not
suffieient An intervention also has to be ae-
eeptable to and adopted by a variety of inter-
vention settings, and to be implemented rela-
tively consistently by different intervention
agents. In other words, the parallel setting or
organizational-level impaet formula should be
Organizational Impact (01)=Adoption (A) x
Implementation (I). Several authors have
diseussed issues of nesting and setting fac-
tors'''''^ and how to adjust individual-level
effects for issues of nonindependenee. How-
ever, to otir knowledge, the A x 1=01 for-
mula for estimating the impaet of an interven-
tion across settings has not been diseussed,
with the exception of an early related pro-
posal by Kolbe^^ that Impact=Effectiveness x
Dissemination x Maintenance. It is important
29. to emphasize that in terms of overall public
health effect, adoption and implementation
are as important as reach and effieaey, and
that we need more emphasis on studies of or-
ganizational- and system-level faetors.
3. Include external validity reporting criteria in
author guidelines. Within medieine, a widely
agreed upon set of criteria for reporting the
results of randomized clinical trials has been
developed. Known as the CONSORT crite-
ria,^" these reporting standards have been
widely adopted by leading medieal journals
and have helped to increase the quality of
published research. As helpftil as the
CONSORT criteria are, they are almost exclu-
sively concerned with issues of internal valid-
ity. Only 1 out of 22 reeommendations di-
rectly addresses external validity issues^'; in
contrast to the other very specific and con-
crete criteria, it simply states "Generalizability
(external validity) of the trial findings" and
provides no guidance as to how this issue
should be reported.
We propose the following 7 additions to
the existing CONSORT criteria, whieh would
help greatly to increase awareness of and re-
porting on extemcil validity. If sueh criteria
were widely adopted, it would greatly en-
hance the quality and information value not
only of individual studies but also of evi-
dence-based reviews and meta-analyses. The
current state of health promotion research is
so biased toward reporting on internal valid-
ity issues that it is difficult to draw any eon-
30. elusions about generalization. In particular,
there has been a serious lack of attention to
issues of representativeness, especially at the
level of settings and intervention agents.̂ ''̂ *'̂ ^
This becomes even more problematic when
the evidence upon which meta-analyses and
practice reeommendations are based eonsists
largely or solely of effieaey studies of un-
known genendizabiUty.
The 7 items that we propose below
should apply to both effieacy and effective-
ness studies. They would not require a great
deal of additional joumal space and are de-
August 2003, Vol 93, No. 8 | American Journal of Public Health
Glasgow et al. | Peer Revievi/ed | Public Health Matters | 1265
scribed below in the same format as existing
CONSORT items. These criteria were re-
cently added by the Evidence-Based Behav-
ioral Medicine Committee of the Society of
Behavioral Medicine^^ to their recommenda-
tions for reporting on behavioral interven-
tion studies.
a. State the target population to which the
study intends to generalize.
b. Report the rate of exclusions, the participa-
tion rate among those eligible, and the repre-
sentativeness oi participants.
c. Report on methods of recruiting study set-
tings, including exclusion rate, pariicipation
rate among those approached, and represen-
31. tativeness of settings studied.
d. Describe the pariicipation rate and charac-
teristics of those delivering the intervention.
State the population of intervention agents
that one wotild see eventually implementing
the program and how the study intervention-
ists compcire with those who will eventually
deliver the intervention.
e. Report the extent to which different com-
ponents of the intervention are delivered (by
different intervention agents) as intended in
the protocol.
f Report the specific time, and costs required
to deliver the intervention,
g. Report on organizational level of continu-
ance, discontinuance or adaptation in modi-
fied form of the intervention once the trial is
completed, and individual-level maintenance
of results.
We think that such infonnation should be
of relevance not only to researchers but also
to clinicians, health directors, and decision-
makers responsible for selecting prevention
and health promotion programs. In fact, we
think that these parties already make implicit
tise of these dimensions. Making them explicit
should aid reading of the literature and guide
more informed program selections.
4. Increase funding for research focused on
moderating variables, external validity, and ro-
bustness. The large imbalance between the ex-
tent to which health promotion investigations
focus on internal validity emd the extent to
which they foeus on external validity will not
be remedied without substantial ehanges in
32. fiinding priorities. Table 3 lists several reeom-
TABLE 3-Recommendations for
Funding Organizations to Acceierate
Transfer of Researcii to Practice
• Solicit proposals that investigate interventions in
multiple settings and especially settings that are
representative of those to which the program is
intended to generalize.
• Fund innovative investigations of ways to enhance
reach, adoption, implementation, and
maintenance (which have all been
de-emphasized relative to efficacy).
• Require standard and comprehensive reporting of
exclusions, participation rates, and
representativeness of both participants and
settings.
• Fund cross-over designs, sequential program
changes, replications, multiple baseline, and
other designs in addition to randomized
33. controlled trials that can efficiently and
practically address key issues in translation.
• Invite programs that investigate and can
demonstrate quality implementation and
outcomes across a wide range of intervention
agents similar to those present in applied
settings.
• Require a maintenance/sustainability phase in
research projects and implementation of plans to
enhance institutionalization once the original
research has been completed.
• Fund competitive proposals to investigate long-term
effects and sustalnability of initially successful
interventions.
• Encourage innovation in intervention design and
standardization in reporting on process and
outcome measures at both individual and
setting/intervention agent levels.
34. • Request more cost-effectiveness studies and other
economic evaluations that are of interest to
program administrators and policymakers.
mendations for fiinding organizations that
would help correct this imbalance.
These reeommendations would have 2 ef-
feets. The first would be to increase the small
number of well-eonducted effectiveness stud-
ies now available. The second would be to
increase the relevance of efficacy studies for
practice by focusing attention on moderating
variables and the range of conditions, set-
tings, intervention agents, and partidpants to
whieh the results apply. Such refocused fund-
ing priorities should also increase tmder-
standing of health disparities and help reduce
them, since more research would be con-
ducted involving minorities and low-income
settings. Finally, fiinding organizations might
explicitly have reviewers rate proposals on
their likely robustness or potential for wide-
spread application and impact. This could be
done by methods described in the Gtiide to
Community Preventive Services.'^
CONCLUSIONS
In summary, at least part of the reason for
the slow and uneven translation of research
findings into practice in the health promotion
sciences is lack of attention to issues of gen-
35. eralization and extemal validity (moderating
factors that potentially limit the robustness of
interventions). There also needs to be a
greater understanding of, and research on,
setting-level social contextual faetors.'̂ '̂ '̂̂ ^ If
these issues were addressed in the design
and reporting of efficacy as well as effective-
ness studies, it would greatly advance the
current quality of research Eind our knowl-
edge base. These issues are to a large extent
under the control of researchers, reviewers,
and fiinding organizations, and we have
listed actions that each of these parties can
take to facilitate better transfer from efficacy
to effectiveness research. •
About the Authors
Russell E. Glasgow and Alfred C. Marcus are with Kaiser
Permanente Colorado and AMC Cancer Research Center,
Denver. Edward Lichtenstein is with the Oregon Research
Institute, Eugene.
Requests for reprints should be sent to Russell E. Glas-
gow. PhD, PO Box 349, Canon City, CO 81215 (e-mail:
[email protected]).
This article was accepted October 24, 2002.
Contributors
All authors produced original drafts of sections of the
manuscript, extensively edited each other's contribu-
tions, and made substantive contributions to the ideas
expressed in the manuscript
Acknowledgmeuts
This project was supported by The Robert Wood John-
36. son Foundation (grant 030102) and the Agency for
Healthcare Research and Quality (grant HS 10123).
We acknowledge the contributions of Allan Best,
PhD, Brian Flay, PhD, Lisa Klesges, PhD, and Thomas
M. Vogt, MD, MPH, for their helpful comments on an
earlier draft of the manuscript
1266 I Public Health Matters | Peer Reviewed | Glasgow et al.
American Journal of Public Health 1 August 2003, Vol 93, No.
8
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and public health programs. Psychol Addict Behav.
1997;11:142-151.
48. Elboume DR, Campbell MK. Extending the
CONSORT statement to cluster randomized trials:
for discussion. Stat Med 2001;20:489-496.
49. Kolbe LJ. Increasing the impact of school health
promotion programs: emerging researeh perspectives.
Health Educ. 1986;17:49-52.
50. Moher D, Schulz KF, Altman D. The CONSORT
statement: revised recommendations for improving the
quality of reports./>1M4. 2001;285:1987-1991.
51. Zaza S, Lawrenee RS, Mahan CS, Fullilove M, et
al. Scope and organization of the Guide to Community
Preventive Services. Task Foree on Community Preven-
tive Services. Amf Prev Med, 2000;18(suppl l):27-34.
52. Bull SS, Gillette C, Glasgow RE, Estabrooks P.
Worksite health promotion research: to what extent
can we generalize the resulte and what is needed to
translate researeh to practice? Health Educ Behav, In
press.
53. Davidson K, Goldstein M, Kaplan R, et al. Evi-
dence-based behavioral medieine: what is it and how
do we get there? Ann Behav Med. In press.
54. Green LW, Kreuter MW. Commentary on the
emerging Guide to Community Preventive Services
from a health promotion perspective. AmJ Prev Med.
2000;18:7-9.
43. 55. Institute of Medidne. Promoting Health: Interven-
tion Strategies From Social and Behavioral Research.
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Mountain View, Calif: Mayfield Publishing Co; 1999.
August 2003, Vol 93, No. 8 | American Journal of Public Health
Glasgow et al. Peer Reviewed | Public Healtfi Matters | 1267
Healthcare Program/Policy Evaluation Analysis Template
Use this document to complete the Module 5 Assessment
Assessing a Healthcare Program/Policy Evaluation
Healthcare Program/Policy Evaluation
Description
How was the success of the program or policy measured?
How many people were reached by the program or policy
selected? How much of an impact was realized with the program
or policy selected?
At what point in program implementation was the program or
policy evaluation conducted?
44. What data was used to conduct the program or policy
evaluation?
What specific information on unintended consequences were
identified?
What stakeholders were identified in the evaluation of the
program or policy? Who would benefit most from the results
and reporting of the program or policy evaluation? Be specific
and provide examples.
Did the program or policy meet the original intent and
objectives? Why or why not?
Would you recommend implementing this program or policy in
your place of work? Why or why not?
Identify at least two ways that you, as a nurse advocate, could
become involved in evaluating a program or policy after one
year of implementation.
General Notes/Comments
47. program or
policy
outcomes.
Response
accurately and
clearly explains
how the success
of the program
or policy was
measured.
Response
accurately and
clearly describes
how many
people were
reached by the
program or
policy and
accurately
describes the
impact of the
program or
28 (28%) - 31
(31%)
Using su!cient
evidence,
response
accurately
describes the
healthcare
program or
policy
48. outcomes.
Response
accurately
explains how
the success of
the program or
policy was
measured.
Response
accurately
describes how
many people
were reached
by the program
or policy and
accurately
describes the
impact of the
program or
policy.
25 (25%) - 27
(27%)
Description of
the healthcare
program or
policy
outcomes is
inaccurate or
incomplete.
Explanation of
how the
49. success of the
program or
policy was
measured is
inaccurate or
incomplete.
Description of
how many
people were
reached by the
program or
policy and the
impact is vague
or inaccurate.
Response
vaguely
describes the
point at which
0 (0%) - 24 (24%)
Description of
the healthcare
program or
policy outcomes
is inaccurate
and incomplete
or is missing.
Explanation of
how the success
of the program
or policy was
measured is
50. inaccurate and
incomplete or is
missing.
Description of
how many
people were
reached by the
program or
policy and the
associated
impacts is vague
and inaccurate
or is missing.
Response of the
point at which
time the
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program or
policy selected?
How much of an
impact was
realized with the
program or
policy selected?
· At what point
in time in
program
implementation
was the program
or policy
evaluation
conducted?
policy.
Response
accurately and
clearly indicates
the point at
which time the
program or
policy
evaluation was
conducted.
Response
accurately
indicates the
point at which
time the
52. program or
policy
evaluation was
conducted.
the program or
policy
evaluation was
conducted.
program or
policy was
conducted is
missing.
Reporting of
Program/Policy
Evaluations
· What data was
used to conduct
the program or
policy
evaluation?
· What speci!c
information on
unintended
consequences
was identi!ed?
· What
stakeholders
were identi!ed
in the
evaluation of
53. the program or
policy? Who
would bene!t
the most from
the results and
reporting of the
program or
policy
evaluation? Be
speci!c and
provide
examples.
45 (45%) - 50
(50%)
Response
clearly and
thoroughly
explains in
detail: -speci"c
information on
outcomes and
unintended
consequences
identi"ed
through the
program or
policy
evaluation. -the
stakeholders
involved in the
program or
policy
evaluation. -who
would bene"t
54. most from the
results and
reporting of the
program or
policy
evaluation. -
whether the
program met
the original
intent and
40 (40%) - 44
(44%)
Using su!cient
evidence,
response
accurately
identi"es the
data used to
conduct the
program or
policy
evaluation.
Response
explains in
detail speci"c
information on
outcomes and
unintended
consequences
identi"ed
through the
program or
policy
evaluation.
55. Response
explains in
detail the
stakeholders
involved in the
program or
policy
evaluation.
35 (35%) - 39
(39%)
Response
vaguely or
inaccurately
identi"es the
data used to
conduct the
program or
policy
evaluation.
Explanation of
speci"c
information on
outcomes and
unintended
consequences
identi"ed
through the
program or
policy
evaluation is
vague or
incomplete.
Explanation of
the
56. stakeholders
involved in the
program or
policy
evaluation is
vague or
0 (0%) - 34 (34%)
Identi"cation of
the data used to
conduct the
program or
policy
evaluation is
vague and
inaccurate or is
missing.
Response
includes vague
and incomplete
or is missing
explanation of: -
speci"c
information on
outcomes and
unintended
consequences
identi"ed
through the
program or
policy
evaluation. -the
stakeholders
involved in the
program or
57. policy
evaluation. -who
would bene"t
most from the
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d=_3280054_1
· Did the
program or
policy meet the
original intent
and objectives?
Why or why not?
· Would you
recommend
implementing
this program or
policy in your
place of work?
Why or why not?
· Identify at
least two ways
that you, as a
nurse advocate,
could become
involved in
evaluating a
program or
58. policy after 1
year of
implementation.
outcomes,
including an
accurate and
detailed
explanation of
the reasons
supporting why
or why not. -
whether the
program should
be
implemented,
including an
accurate and
detailed
explanation of
the reasons
supporting why
or why not. -at
least two ways
that the nurse
advocate could
become
involved in the
evaluation of
the program or
policy after 1
year of
implementation.
Response
explains who
59. would bene"t
most from the
results and
reporting of the
program or
policy
evaluation.
Response
includes an
accurate
explanation of
whether the
program met
the original
intent and
outcomes,
including an
accurate
explanation of
the reasons
supporting why
or why not.
Response
includes an
accurate
explanation of
whether the
program should
be
implemented,
including an
accurate
explanation of
the reasons
supporting why
or why not.
60. Response
includes an
accurate
explanation of
two ways that
the nurse
advocate could
become
involved in the
evaluation of
the program or
policy after 1
inaccurate.
Explanation of
who would
bene"t most
from the
results and
reporting of the
program or
policy
evaluation is
vague or
inaccurate.
Explanation of
whether the
program/policy
met the original
intent and
outcomes, and
the reasons
why or why not
is incomplete
or inaccurate.
Explanation of
61. whether the
program or
policy should
be
implemented,
and the
reasons why or
why not, is
incomplete or
inaccurate.
Explanation of
ways that the
nurse advocate
could become
involved in the
evaluation or
policy after 1
year of
implementation
is incomplete
or inaccurate.
results and
reporting of the
program or
policy
evaluation. -
whether the
program or
policy met the
original intent
and outcomes,
and the reasons
why or why not.
-whether the
program or
62. policy should be
implemented,
and the reasons
why or why not.
-ways that the
nurse advocate
could become
involved in the
evaluation or
policy after 1
year of
implementation.
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d=_3280054_1
year of
implementation.
Written
Expression and
Formatting -
Paragraph
Development
and
Organization:
Paragraphs
make clear
points that
support well
63. developed ideas,
low logically,
and
demonstrate
continuity of
ideas.
Sentences are
carefully
focused--
neither long and
rambling nor
short and
lacking
substance. A
clear and
comprehensive
purpose
statement and
introduction is
provided which
delineates all
required
criteria.
5 (5%) - 5 (5%)
Paragraphs and
sentences
follow writing
standards for
#ow, continuity,
and clarity.
A clear and
comprehensive
purpose
64. statement,
introduction,
and conclusion
is provided
which
delineates all
required
criteria.
4 (4%) - 4 (4%)
Paragraphs and
sentences
follow writing
standards for
#ow, continuity,
and clarity 80%
of the time.
Purpose,
introduction,
and conclusion
of the
assignment is
stated, yet is
brief and not
descriptive.
3 (3%) - 3 (3%)
Paragraphs and
sentences
follow writing
standards for
#ow, continuity,
and clarity 60%-
65. 79% of the
time.
Purpose,
introduction,
and conclusion
of the
assignment is
vague or o$
topic.
0 (0%) - 2 (2%)
Paragraphs and
sentences
follow writing
standards for
#ow, continuity,
and clarity <
60% of the time.
Purpose,
introduction,
and conclusion
of the
assignment is
incomplete or
missing.
Written
Expression and
Formatting -
English Writing
Standards:
Correct
66. grammar,
mechanics, and
proper
5 (5%) - 5 (5%)
Uses correct
grammar,
spelling, and
punctuation
with no errors.
4 (4%) - 4 (4%)
Contains a few
(1-2) grammar,
spelling, and
punctuation
errors.
3 (3%) - 3 (3%)
Contains
several (3-4)
grammar,
spelling, and
punctuation
errors.
0 (0%) - 2 (2%)
Contains many
(≥5) grammar,
spelling, and
punctuation
errors that
67. interfere with
the reader’s
understanding.
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punctuation
Written
Expression and
Formatting:
The paper
follows correct
APA format for
title page, font,
spacing,
parenthetical/in-
text citations,
and reference
list).
5 (5%) - 5 (5%)
Uses correct
APA format with
no errors.
4 (4%) - 4 (4%)
68. Contains a few
(1-2) APA format
errors.
3 (3%) - 3 (3%)
Contains
several (3-4)
APA format
errors.
0 (0%) - 2 (2%)
Contains many
(≥5) APA format
errors.
Total Points: 100
Name: NURS_6050_Module05_Week10_Assignment_Rubric
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