Evaluation & the Health Professions recent issues

Introduction to the Second International Translation Special Issue

Bausell, R. B., Sussman, S. — 2008-07-28

Translating an Adolescent Smoking Cessation Program Into Policy and Practice in an Australian Context

Cross, D., Hearn, L., Hamilton, G., Resnicow, K., Hall, M. — 2008-07-28

Although Australia's restrictive tobacco control policies have made it an international leader in reducing smoking prevalence, and only 7% of teens smoke weekly, cessation efforts are still needed among adolescents. Of the campaigns and programs implemented in Australia to reduce this problem among adolescents, most have provided only abstinence messages and few have been effectively evaluated and translated into policy and practice. This article describes the translation of a harm minimization cessation program for teens, the Smoking Cessation for Youth Project (SCYP), derived from an approach developed with adults. In addition, the article describes the unique sociopolitical context of Australia in which the SCYP program was developed and the significant conceptual, contextual, and methodological factors that enabled and limited this program's effective implementation and translation.

The Establishment and Promotion of the First Youth Quitline in Hong Kong Challenges and Opportunities

2008-07-28

This study describes the establishment, promotion, and preliminary findings of a peer-led smoking cessation quitline for Chinese youth smokers in Hong Kong. The Youth Quitline targeted Chinese smokers aged 12 to 25, who smoked at least one cigarette in the past 30 days and were willing to leave telephone numbers for follow up. The protocol was translated from the California Smoker's Helpline and we provided toll-free telephone counseling based on motivational intervention with multiple follow-up sessions for smokers who called the service. By intention-to-treat analysis, 55% reported at least one quit attempt, and the quit rate was 22.1% (self-reported 7-day point prevalence) or 17.5% (self-reported 30-day point prevalence). The Hong Kong Youth Quitline, along with enforcement of the antismoking legislation for both youth and adults, advocacy to de-normalize smoking in the society, and appropriate publicity, could help to promote quitting among youth smokers in Hong Kong.

Potential for Alcohol Policy to Decrease the Mortality Crisis in Russia

Khaltourina, D. A., Korotayev, A. V. — 2008-07-28

Post-Soviet Russia experiences among the world's highest prevalence of alcohol-related problems, which contributes to high mortality rates in this region. Reduction in alcohol-related problems in Russia can have strong effects on mortality decline. This article considers the plausibility of application of general principles of alcohol policy translated in the Russian Federation. We conclude that alcohol policy approaches could be implemented in the same ways as they have been in other countries. In addition, there should be special attention to decreasing distilled spirits consumption, illegal alcohol production, nonbeverage alcohol consumption, and enforcement of current governmental regulations.

Need and Possibilities for Seat Belt Use Promotion in Bashkortostan, Russia

2008-07-28

Bashkortostan is a republic in the Russian Federation with a population of 4.1 million. As with other health behaviors, the prevalence of seat belt use is low, which may account in part for the very high rate of motor-vehicle-related mortality in this republic. The authors discuss the need and potential for translating seat belt promotion programming from other Russian regions and other countries to Bashkortostan. The authors conclude that current policies developed in other countries could work well in the republic, if they are enforced. Meanwhile, initiatives such as the Sakhalin Road Safety Partnership offer great potential for translation in Bashkortostan as well as in other regions with similarly low seat belt use prevalence.

Adapting Smoking Cessation Programming to the Bulgarian Context

Andreeva, V. A., Sakuma, K.-L. K. — 2008-07-28

Tobacco control efforts are among Bulgaria's leading health priorities, although enforcement of policies translated from other regions is challenging due to the high national smoking prevalence, especially among health professionals and school personnel. This article reviews the sociocultural and economic background relevant to health policy change and smoking cessation initiatives. Recommendations are made for effective Bulgarian tobacco control.

Translation of Evidence-Based Tobacco Use Prevention Programming in Croatia

Skara, S., Kovacic, L., Civljak, M., Voncina, L. — 2008-07-28

Croatia faces a major threat of smoking-related health burdens given the monumental changes this newly formed country has undergone in the past 15 years because of its postcommunist democratic and economic transitions and the destructive 1991-1995 war with Serbia. This article provides information on Croatia's general background, current smoking prevalence and attitudes, and current evidence-based smoking prevention efforts. Furthermore, various cultural and contextual conditions within Croatia that facilitate or impede smoking prevention research utilization are discussed. Finally, it is concluded that new research is needed that continues to build on comprehensive research-tested multicomponent prevention initiatives utilizing school-, family-, community-, and mass media—based delivery modalities, which specifically focus on the social influences of smoking.

Toward an Understanding of and Response to Tobacco Use Among High-Risk Israeli and Palestinian Youth

Isralowitz, R., Afifi, M., Sussman, S. — 2008-07-28

Little has been done to bring Israeli and Palestinian people together to address common health problems. Because Jewish and Arab people have been in a declared and/or de facto state of war since the establishment of Israel as a nation in 1948, the possibility of Israelis and Palestinians working together to deal with a mutual problem has been bleak. This article describes efforts to link people together to address tobacco use cessation among Israeli and Palestinian high-risk youth and provides an overview of a current initiative to demonstrate a smoking cessation model, Project EX, which may contribute to the health of those involved and to societal change in the region.

Linguistic Translation of Psychological Assessment Tools: A Case Study of the MMPI-2

Nezami, E., Zamani, R., DeFrank, G. — 2008-07-28

This article examines the effect of cultural differences on translation accuracy outcomes for the translation of the Minnesota Multiphasic Personality Inventory—2 (S. R. Hathaway & J. C. McKinley, 1940) into Farsi for use in Iran.

Sociocultural Barriers and Malaria Health Care in Tanzania

Nsimba, S. E. D., Kayombo, E. J. — 2008-07-28

In Tanzania, since the time of its ancestors, cultural beliefs have existed which influence the treatment and management of diseases. This article focuses on malaria as a current major cause of morbidity and mortality in Tanzania. Patients and caretakers have tended to rely on traditional sociocultural practices as a means of treating the convulsions associated with severe malaria in children and often do not seek care at health facilities, therefore, delaying prompt management of the disease.

Reflections on International Translation of Evidence-Based Health Behavior Programs

Sussman, S., Palinkas, L. A. — 2008-07-28

In this concluding article, the authors describe factors that influence the international translation of programs. These include language, control over the translation process, local normative challenges to translation, program adaptation, and globalization. The authors suggest that systematic efforts at language translation, program adaptation partnership, and compromise are general principals needed to surmount these challenges.

Introduction to the Special Issue

Sussman, S., Bausell, R. B. — 2008-04-30

Country Prototypes and Translation of Health Programs

Sussman, S., Unger, J. B., Palinkas, L. A. — 2008-04-30

This article introduces the topic of international translation of health programs. Different perspectives toward the study of national-level variables that are relevant to translation of evidence-based programming developed outside of or in a country are discussed. Concepts including national prototypes, national stereotypes, country clusters, knowledge incompatibility, and absorptive capacity are introduced. The ideas expressed in this article serve to provide direction when considering developing a health behavior program for a country, using previous programmatic knowledge from elsewhere.

Translation of Health Programs for American Indians in the United States

Unger, J. B., Soto, C., Thomas, N. — 2008-04-30

American Indian and Alaska Native (AI/AN) cultures in the United States include a diverse group of indigenous cultures that have been affected by their contact with European Americans and have suffered adverse psychological, physical, and economic consequences. AI/AN adolescents have the highest prevalence of cigarette smoking of all U.S. ethnic groups. Culturally competent health promotion programs are needed to enhance their resiliency and help them avoid recreational, addictive use of commercial tobacco. The authors describe the diverse AI/AN populations and their unique health and social issues, including adolescent smoking. They present examples of smoking prevention programs tailored or adapted for AI/AN adolescents and make recommendations for implementation and evaluation of prototype programs. Recommendations include involving the community, respecting tribes' wishes for confidentiality, being aware of IRB issues, beginning with formative and qualitative research, using culturally appropriate measures, understanding the diversity of AI/AN cultures, and involving multiple generations of the family.

Promoting the Effective Translation of the Framework Convention on Tobacco Control: A Case Study of Challenges and Opportunities for Strategic Communications in Mexico

2008-04-30

The World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) promotes the implementation of best-practices tobacco control policies at a global scale. This article describes features of the sociocultural and political-economic context of Mexico that pose challenges and opportunities to the effective translation of WHO-FCTC policies there. It also considers how strategic communication efforts may advance these policies by framing their arguments in ways that resonate with prevalent values, understandings, and concerns. A focus on a smoke-free policy illustrates barriers to policy compliance, including how similar issues have been overcome among Latino populations in California. Overall, this article aims to lay the foundation for comparative research from policy uptake to impact so that the scientific evidence base on tobacco control policies includes examination of how context moderates this process.

Prevention of Alcohol Problems in Dutch Youth: Missed Opportunities and New Developments

van de Luitgaarden, J., Thush, C., Wiers, R. W., Knibbe, R. A. — 2008-04-30

Binge drinking among young people is a problem in the Netherlands. This article outlines the current Dutch approach to alcohol prevention in this target group. It is argued that well-enforced evidence-based control measures are lacking despite renewed political interest in them. Politicians often favor alcohol education, but to increase the effectiveness of alcohol prevention, a combined approach of policy measures, enforcement, and education is needed. Translation of education and policy-based measures is discussed.

Applying Drug Dependence Research to Prevention Interventions in Spain

Espada, J. P., Lloret, D., Garcia del Castillo, J. A. — 2008-04-30

This article examines the status of evidence-based interventions for preventing drug dependence in Spain. The evolution of the perception that the Spanish have of the problem and how this has influenced prevention efforts is described. An analysis is made of how programs designed to prevent drug use have been translated from the field of experimental research to implementation. The characteristics of evidence-based programs developed in Spain are outlined, analyzing their efficacy and the adaptations of programs from other countries to the Spanish context. Most have been school based, although some family and leisure-time based programs also have been developed. The processes for translation and cultural adaptation of evidence-based programs are described. Finally, pending aspects of the adaptation of research in drug dependence within Spain are discussed.

HIV/AIDS Prevention in the Nepalese Context

Pokhrel, P., Regmi, S., Piedade, E. — 2008-04-30

With their numbers now approaching almost 30 million, Nepalese feature importantly in the South Asian demography. Yet, it has been only 60 years since Nepal gained international recognition as a nation-state. Nepal at present is one of the world's poorest countries and is in dire need of development, especially in the area of health. Given the current civil instability coupled with rapid modernization, the health and well-being of the Nepalese people have been increasingly affected by newer threats, such as HIV/AIDS. The present study discusses the uniqueness of the Nepalese context in relation to HIV/AIDS prevention. The authors suggest that HIV/AIDS prevention programs in Nepal should now focus more on adolescents from rural regions. The authors also suggest the ways one may approach the task of developing a prevention program targeting rural youths.

The International Implementation of Multisystemic Therapy

Schoenwald, S. K., Heiblum, N., Saldana, L., Henggeler, S. W. — 2008-04-30

The purpose of this article is to consider, through the lenses of theory and research on technology transfer and the adoption and implementation of innovation, the international transport of evidence-based psychosocial treatments for youth, using Multisystemic Therapy (MST) as an example. MST is a well-validated family and community-based approach originally developed in the United States to treat serious juvenile offenders. This article describes challenges to MST transport internationally by virtue of the political, legal, economic, and cultural contexts in different nations. Modifications used to address these challenges and facilitate the international implementation of MST are described and pertain to pre-implementation processes, clinical staff, training materials and procedures, and clinical service delivery.

Cultural Adaptation Process for International Dissemination of the Strengthening Families Program

Kumpfer, K. L., Pinyuchon, M., de Melo, A. T., Whiteside, H. O. — 2008-04-30

The Strengthening Families Program (SFP) is an evidence-based family skills training intervention developed and found efficacious for substance abuse prevention by U.S researchers in the 1980s. In the 1990s, a cultural adaptation process was developed to transport SFP for effectiveness trials with diverse populations (African, Hispanic, Asian, Pacific Islander, and Native American). Since 2003, SFP has been culturally adapted for use in 17 countries. This article reviews the SFP theory and research and a recommended cultural adaptation process. Challenges in international dissemination of evidence-based programs (EBPs) are discussed based on the results of U.N. and U.S. governmental initiatives to transport EBP family interventions to developing countries. The technology transfer and quality assurance system are described, including the language translation and cultural adaptation process for materials development, staff training, and on-site and online Web-based supervision and technical assistance and evaluation services to assure quality implementation and process evaluation feedback for improvements.

Erratum

2008-04-30

Provider Selection of Evidence-Based Contraception Guidelines in Service Provision: A Study in India, Peru, and Rwanda

Leon, F. R., Lundgren, R., Jennings, V. — 2008-02-05

Providers underutilize evidence-based practice guidelines as they prescribe contraceptives. To discern biases in guideline utilization by 172 providers of three countries, this study used observations from simulated clients trained to choose oral contraceptives. Providers implemented less than one third of the guideline set, but they addressed, more frequently than other guidelines, items categorized as essential by expert opinion (p < .01). Indian providers emphasized instructions on method use in 9-minute consultations, Rwandan providers emphasized contraindications in 29-minute sessions, and Peruvian providers did not emphasize any single guideline category. Providers should use job aids to improve guideline utilization. Those pressed for time need an evidence-based, rather than arbitrary, selection of essential guidelines that optimizes client outcomes. Practice-based research must be generated to meet this need.

When Is Knowledge Ripe for Primary Care?: An Exploratory Study on the Meaning of Evidence

2008-02-05

The objectives of this study were to explore the meaning of scientific evidence as it is understood by primary care physicians. Individual interviews were conducted with actors chosen for their roles in the production and use of knowledge: 22 family physicians, 13 specialist physicians, and 6 researchers. Two situations served as points of reference for these discussions: screening for genetic breast cancer and treatment of hypertension. The results suggest that there may be a misunderstanding between the producers of knowledge and primary care practitioners with respect to what constitutes "evidence"— knowledge ready for integration into the clinical practice of primary care. These potential differences go beyond the issues of how information is disseminated. Rather, many of the questions raised by family physicians concern how knowledge is developed. In the interests of fostering better dissemination of new knowledge and encouraging its adoption, new links should be created between knowledge "producers" and potential users.

Sentinel Physician Networks as a Technique for Rapid Immunization Policy Surveys

2008-02-05

This study compared the use of mail and Internet surveys of sentinel networks of physicians with traditional random sample mail surveys for three national vaccine policy surveys. Three nationally representative sentinel networks of physicians were established (pediatricians, n = 427; general internists, n = 438; and family physicians, n = 433). Surveys of the sentinel networks were compared with simultaneous surveys conducted with random samples of the American Medical Association (AMA) Physician Masterfile. Response rates were 74% to 78% for sentinel surveys and 29% to 43% for traditional random sample surveys. Respondents to the two methods were generally comparable in demographic characteristics. While there were some differences in responses to survey topic questions, none of the differences were likely to affect policy decisions. Sentinel networks represent the opinions and experiences of physicians in a manner equivalent to traditional mail surveys and may provide a more efficient approach to conducting physician surveys.

Nonresponse Bias and Cost-Effectiveness in a Norwegian Survey of Family Physicians

Bjertnaes, O. A., Garratt, A., Botten, G. — 2008-02-05

Low response rates are a common problem in surveys of family physicians leading to uncertainty about the validity of results. In this study, the authors examined the association between multiple reminders and nonresponse bias, survey estimates and costs in a survey of family physicians in Norway (N = 3,463). After three postal reminders and one telephone follow-up, the response rate was 65.9%. They analyzed differences in nine demographic and practice variables between respondents and nonrespondents, the effect of nonresponse bias on survey estimates, and the cost-effectiveness of each reminder. Statistically significant differences between respondents and nonrespondents were found for six variables. However, demographic and practice variables had little association with the main outcome variables, and the overall survey estimates changed little with additional reminders. In addition, the cost-effectiveness of the final reminders was poor.

Predictors of Enrollees' Satisfaction With a County-Sponsored Indigent Health Care Plan

Boothroyd, R. A., Rocca, T. D., Huey Jen Chen, — 2008-02-05

This article summarizes the findings from a study examining the predictors of satisfaction among individuals enrolled in a county-sponsored indigent health care plan. Mail survey procedures were used to obtain information from enrollees regarding their satisfaction with the health care plan, as well as enrollees' demo-graphics, health care status, and trust in their providers. Results of a stepwise regression model developed using a random half of the respondents revealed enrollees' trust in health care providers was the strongest predictor of general satisfaction, followed by perception of change in health status, and age. The model explained 49% of the variance and demonstrated little shrinkage when cross-validated on the remaining half of the respondents. Trust in health care providers, followed by perception of change in health status also emerged as the strongest predictors of enrollees' satisfaction with freedom of choice.

Methodologies for Improving Response Rates in Surveys of Physicians: A Systematic Review

VanGeest, J. B., Johnson, T. P., Welch, V. L. — 2007-11-06

Although physician surveys are an important tool in health services and policy research, they are often characterized by low response rates. The authors conducted a systematic review of 66 published reports of efforts to improve response rates to physician surveys. Two general strategies were explored in this literature: incentive and design-based approaches. Even small financial incentives were found to be effective in improving physician response. Token nonmonetary incentives were much less effective. In terms of design strategies, postal and telephone strategies have generally been more successful than have fax or Web-based approaches, with evidence also supporting use of mixed-mode surveys in this population. In addition, use of first-class stamps on return envelopes and questionnaires designed to be brief, personalized, and endorsed by legitimizing professional associations were also more likely to be successful. Researchers should continue to implement design strategies that have been documented to improve the survey response of physicians.

Targeting HIV Clinical Training With Maps: Lessons From the Pacific AIDS Education and Training Center

Myers, J., Bernstein, M., Morin, S. F., Reyes, M. — 2007-11-06

Public health providers are increasingly called on to do more with fewer resources. Aiming to help HIV clinical training providers in 15 local sites to better target their efforts, the Pacific AIDS Education and Training Center (PAETC) implemented a method for integrating disparate information, such as program-level evaluation and publicly available health services data, into one combined and useful format. The resulting local area profiles were distributed to each training site and were updated annually for 2 years. As a result, local training teams adopted data-based approaches to doing their work. Training managers and faculty reported that data presented in spatial formats (i.e., maps) were most helpful for targeting their outreach and training. In addition to achieving the aim of supporting better programs, the project increased capacity for using data to support all aspects of training and education, from grant writing to strategic planning.

Examination of a Clinical Teaching Effectiveness Instrument Used for Summative Faculty Assessment

Bierer, S. B., Hull, A. L. — 2007-11-06

This study explores whether a clinical teaching effectiveness (CTE) instrument provides valid scores for summative faculty assessment. The sample included all CTE instruments (n = 10,087) that learners (N = 1,194) completed to assess clinical teachers (N = 872) during 1 academic year. The authors investigated response processes (e.g., missing data, straight-line responses, level of learner), internal structure (e.g., confirmatory and exploratory factor analysis), teaching ratings by learner group (medical student or resident), and relation to other variables (e.g., correlation with global rating). Response processes identified a high prevalence of straight-line responses (same rating across all items) and differential patterns of missing data by learner group. Medical students rated their teachers higher than residents, and CTE scores had different factor structures depending on learner group. High correlation coefficients of CTE items with a single rating of overall teaching performance suggest that learners consider global performance when assessing clinical teaching performance.

Convergence Between Cluster Analysis and the Angoff Method for Setting Minimum Passing Scores on Credentialing Examinations

Hess, B., Subhiyah, R. G., Giordano, C. — 2007-11-06

Cluster analysis can be a useful statistical technique for setting minimum passing scores on high-stakes examinations by grouping examinees into homogenous clusters based on their responses to test items. It has been most useful for supplementing data or validating minimum passing scores determined from expert judgment approaches, such as the Ebel and Nedelsky methods. However, there is no evidence supporting how well cluster analysis converges with the modified Angoff method, which is frequently used in medical credentialing. Therefore, the purpose of this study is to investigate the efficacy of cluster analysis for validating Angoff-derived minimum passing scores. Data are from 652 examinees who took a national credentialing examination based on a content-by-process test blueprint. Results indicate a high degree of consistency in minimum passing score estimates derived from the modified Angoff and cluster analysis methods. However, the stability of the estimates from cluster analysis across different samples was modest.

Assessment of Family Physicians' Performance Using Patient Charts: Interrater Reliability and Concordance With Chart-Stimulated Recall Interview

Goulet, F., Jacques, A., Gagnon, R., Racette, P., Sieber, W. — 2007-11-06

Peer-assessment processes with chart review have been used for many years to assess the clinical performance of physicians. The Quebec medical licensing authority has been required by provincial law to assess the practicing Quebec physicians on a nonvoluntary basis. During the period from January 2001 to November 2004, 25 family physicians in active practice were randomly selected from a pool of about 300. For each physician, 25 to 40 patients' medical charts were randomly selected to evaluate the interrater reliability of peer-review assessment of medical charts and to compare ratings based on chart review with a chart-stimulated recall interview to those based on chart review alone. The concordance between chart review alone and that of chart review with chart-stimulated recall interview was 75% for chart keeping, 69% for clinical investigation, 81% for diagnostic accuracy, and 74% for treatment plan. Ratings based on chart review alone achieve moderate levels of reliability (Kappa = 0.44 to 0.56). It appears that some important information about quality of care is missed when only chart review is used.