HED 730 – Program Evaluation in Health Promotion; Fall 2010
Julia Ferry
12/6/2010
Introduction
Alzheimer’s disease (AD) is the most common form of dementia. It is a brain disorder that affects people’s daily life. This form of dementia is due to amyloid plaques and neurofibrillary tangles (FCARF 2010). Plaques consist of a combination of protein and cellular material outside and around the brain's nerve cells, while tangles are twisted fibers that build up on the inside of those nerve cells (FCARF 2010).
As many as five million people suffer from Alzheimer’s disease in the United States (Alzheimer’s Association, 2009). This number indicates a 10% increase in the incident rate when compared to previous years (Alzheimer’s Association, 2009). If this growth continues, we could see the number rise to over seven million by 2030 (Alzheimer’s Association, 2009). In Clark County the death rate of Alzheimer’s disease has increased by over one percent (Southern Nevada Health District, 2007).
Program
Goal
To prolong the quality of life for people aged 55 and older who are at risk for developing Alzheimer’s disease.
Behavioral Objective:
By the end of the program 70% of participants will graduate from the program, signing an intention to eat fish and partake in mind stimulators weekly.
Environmental Objective:
By the end of the program all participants will be able to identify Alzheimer's disease and understand how to prevent/prolong their current mental health.
Intervention:
The target audience are those members of the Suncity community 55 years and older. Suncity retirement community in Summerlin Las Vegas Nevada will be host to an Alzheimer’s awareness and prevention program that will last three months and be free for anyone 55 years and older. The program will be a bi-weekly (six session) program that is both educational and supportive. Initial sessions will dispel myths of aging and clarify early symptoms of Alzheimer’s in comparison to natural signs of aging. These initial sessions (two) will be designed to be fun and interactive while also remaining informative and factual. The next two sessions (session three and four) will teach the participants the potential value of fish in their diet. The first session will be informative, while the second session will be examples of ways to serve and incorporate fish into a weekly diet. Participants will be encouraged to exchange recipes and cooking tips. The last set of sessions (session five and six) will encourage mind games like Sudoku or crossword puzzles as well as reading. These last two sessions will make suggestions and help participants find the mind game they most enjoy and can use once a week. Studies indicate, individually, a diet that introduces fish weekly and regular mental stimulation can help prevent full onset of Alzheimer’s disease. This program will combine both in hopes of prolonging the quality of life for those 55 and older at risk for developing Alzheimer’s disease. Graduation of the program will conclude with participants signing a letter of intent to make fish a weekly part of their diet and to use mind stimulating games or reading once a week as well. This intention letter is in line with the program plan based around the Transtheoretical Model. The Transtheoretical Model describes individuals’ motivation and readiness to change a behavior. There are five stages of change in this model in which a person may enter the change process at any stage, relapse to an earlier stage, and begin the process once more; they may cycle through this process repeatedly, and the process can shorten at any point. The stages are as follows: (National Cancer Institute)
· Precontemplation – Has no intention of taking action within the next six months
· Contemplation – Intends to take action in the next six months
· Preparation – Intends to take action within the next thirty days and has taken some behavioral steps in this direction
· Action – Has changed behavior for less than six months
· Maintenance – Has changed behavior for more than six months
A letter of intention upon graduation would indicate the participant moving from precontemplation to preparation. Intention statements at this stage are a high indicator of action.
Note the intervention is completely revised from the original format to make for a more targeted program with a clear plan of execution. Some objectives from the original program plan were adjusted for the new intervention.
Logic Model
Logic model Outcome / Evaluation question / Smart objective / Indicator / Source of evidenceGraduation of the Suncity Alzheimer’s program. / Will the behaviors be adopted? / By the end of the program 70% of participants will graduate from the program, signing an intention to eat fish weekly and play mind stimulating games. / Number of letters of intent upon graduation and the number of graduates / Report the number of participants who signed intent to make fish a part of a weekly diet and utilize mind stimulating games weekly.
Base line indicator is the value of indicator prior to implementation of the program, in this case that would be the number of participants who eat fish and play mind stimulating games or read weekly (TR 2010). The method used to observe the indicator would be the number of graduates and the number of letters of intent. Target indicator is the expected values of an indicator at a specific point in time, or in this case 70% graduation of the three month program (TR 2010). The method of indicator in this case would be template intention letters for signing at the graduation and number of graduates in attendance of the last session.
Stake Holders
Stakeholders are individuals with vested interests in the success of the program (TR 2010).
· Members of Suncity community living of the age of 55 years or older.
o These are the participants of the program and their interest is a personal investment based on the risk factors for AD.
· Suncity community leaders
o These are the leaders of the community that have a vested interest in the program because the program’s intention is to prolong the quality of life, prolonging their residents in the independent living community instead of a nursing home or assisted living community.
· Local Alzheimer’s disease association
o These members are a commitment to the education and prevention of AD.
The program will involve the stake holders during different lesson sessions. The local Alzheimer’s association will be invited to observe the sessions and will be solicited for advice on sessions one and two. An invitation for a member to act as a guest speaker during these initial disease information sessions will be extended to them. Suncity leaders will be encouraged to observe the sessions and invited to participate in the activity portion of the program – both building fish recipe books and discovering mind stimulating games. Members of Suncity will be encouraged to participate in the program, which has opportunities through-out to encourage them to participate.
All stake holders will be given an opportunity to express views of how the program went, with personal observation of the graduation session; this will be the extent of their participation in evaluation.
Evaluation
Since this is a new initiative (a program not previously tested) the focus of this evaluation will be on process monitoring and process evaluation. The program’s resources are a ballroom in the Suncity community center, which includes a projector and microphone, tables and chairs, and refreshments for the group. The administrators of the program will include several members of the creation team – Shawnta Jackson, and Alexis Adams. Shawnta Jackson has a background in public relations and Alexis Adams has a background in physiology. Guests will range from Alzheimer’s disease experts to local culinary students. Evaluators will include Julia Ferry and Danish Jalil and the Suncity leaders. Julia Ferry has a background in health science and Danish Jalil has a background in exercise science. Shawnta Jackson will be arranging the guest speakers and Alexis Adams will be in charge of set up of the room for each program session. Julia Ferry and Danish Jalil will encourage participation in the program as well as advertising it. The direct outcome of the program will include knowledge of Alzheimer’s disease, dishes that include fish, and what consists of a mind stimulating games. The overall goal of the program is to create routine health behavior in those who participate that includes weekly intake of fish as well as mind stimulating time weekly to help prolong the quality of life in those at risk for Alzheimer’s disease.
Process Monitoring and Evaluation
Process goal:
By 4/29 Shawnta Jackson will secure guest speakers for all lesson sessions of the program – an Alzheimer’s expert from the local foundation, as well as local physician, and a local culinary student to teach the group a recipe involving fish.
Process Monitoring
Process monitoring is the documentation of data that describes the characteristics of the population served, the services provided, and the resources used to deliver those services (CDC 2002)
Evaluation Question / Indicator / Source of EvidenceWhere the guest speakers secured? / # of guest speakers
# of volunteers / # of volunteer contracts
# of guest speaker contracts
# of affiliation links
# of memorandum of agreement (MOA) with guest speakers
Were the participants considered high risk for Alzheimer’s disease? / # of participants 55 years and older
# of participants with prior head trauma
# of participants with first-degree family member who had AD / Pre-test survey
Attendance log
We will measure if we were able to gain the interest of guest speakers by recording our contacts, affiliation links, and create memorandum of agreement with those who agree to guest speak. We will also pass out a pre-test survey to gather insight on our participants’ demographics and base-line. Questions about age, prior head trauma, and family members with Alzheimer’s disease will be included to measure our participant’s risk for the disease.
Process Evaluation
Process evaluation is the collection of information on what the program consists of, activities in the program, and the results, as well as the program’s context and other key characteristics (CDC 2008).
Evaluation Question / Indicator / Source of EvidenceWere the guest speakers (an Alzheimer’s expert and a culinary student) for the project secured? / # of staff and/or volunteers with a special certification
Educational background of staff and/or volunteers / Verification of employment history
Notes from interview
To volunteer or guest speak with our program, we will do a verification of employment history and a short interview to ascertain current skill level. We are looking for guest speakers who are proficient in speaking to Alzheimer’s and speakers who are familiar with preparation of a variety of fish dishes.
Outcome Goal:
By the end of the three month program, 70% of participants will intend to eat fish weekly in their diet (1) as well as participate in mind stimulating games (2).
At the end of the three month program, all graduates will be able to identify the signs and symptoms of Alzheimer’s disease.
Outcome Monitoring
Outcome Monitoring is the tracking through measures of the progress a program has and ascertains the outcomes of the intervention on a client (CDC1999)
Evaluation Question / Indicator / Source of EvidenceBy the end of the program, how many participants reported not intending to eat fish and participate in mentally stimulating games? / # of participants who do not sign a letter of intention
# of participants who did not graduate from the program. / Attendance list
Letters of intention
By the end of the program, the number of participants who cannot identify the symptoms of Alzheimer’s disease. / # of participants who do not recognize the symptoms of AD / Pre-test and post-test that asks participants to match symptoms with natural aging or AD
Prior to the program start, participants will be asked to complete a questionnaire to determine their current base-line of knowledge of Alzheimer’s disease, followed by a post-test at the completion of the program. The tests will be administered by our evaluators at the first and last program session. Attendance will also be taken daily by our program administers. A blank letter of intent to eat fish and partake in mental stimulation once a week will be passed out at the last session to be signed.
Outcome Evaluation
Outcome evaluation is the assentation through various methods to determine if the program’s results match the intended goals of the program.
Evaluation Question / Indicator / Source of EvidenceAt the end of the program, did 70% sign a letter of intent to add fish to their weekly diet and participate in a weekly brain stimulating game? / # of letters of intent to add fish and brain stimulating games weekly / # of letters of intent signed at the end of the program
# of participants who graduate the program
Were all graduates of the program able to distinguish the signs and symptoms of Alzheimer’s verse those of natural aging. / # of participants who got the answers correct / Pre-test and post-test results for those matching questions about the symptoms of Alzheimer’s disease and natural ageing.
The evaluation will be a quasi-experimental design because randomization is just not possible for participation in this intervention. We will administer a pre-test and post-test to our control and experimental group; the experimental group will be those 55 years and older who are members of the Suncity community and the control group will be a pre-test and post-test administered to another Summerlin elderly community. The post-test on the control group will be administered three months following the pre-test, however, it will not follow administration of the program.