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Using Research to Select, Adapt and Improve Programs A One-Day Training for Adolescent

Using Research to Select, Adapt and Improve Programs A One-Day Training for Adolescent Reproductive Health Professionals

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Using Research to Select, Adapt and Improve Programs A One-Day Training for Adolescent

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  1. Using Research to Select, Adapt and Improve Programs A One-Day Training for Adolescent Reproductive Health Professionals This slide presentation has been adapted from a training developed and delivered by ETR and NOAPPP for the Adolescent Pregnancy Prevention Coalition of North Carolina (APPCNC) in July 2004. Funding for this training was provided CDC Division of Reproductive Health. ETR Associates 2004

  2. Research & Reproductive Health Opening Discussion Questions: • What feelings or thoughts come to mind when you hear the word "research?“ • How have you used research in your work over the past six months? • Where did you find this research? ETR Associates 2004

  3. Why is research important to ARH professionals? 1. Research helps us to prioritize public health problems and the populations most in need. For example, CDC has identified the leading causes of mortality for 15-24 year olds (see next slide). This data helps us decide how to best spend limited energy and resources. ETR Associates 2004

  4. Leading Cause of MortalityAll Races, Both Sexes, 15-24 Years of Age, 2001 • Unintentional injury • Homicide • Suicide • Malignant neoplasms • Heart disease • Congenital anomalies • HIV • Cerbro-vascular • Influenza & pneumonia • Chronic low respiratory disease http://www.cdc.gov/health/causes.htm ETR Associates 2004

  5. Why is research important to ARH professionals? 2. Research helps us to better understand the needs of the populations we plan to help. ETR Associates 2004

  6. African American and Latino Teens For example, the resources below will help you better understand the reproductive health needs of African American and Hispanic Teens. • Joint Center for Political and Economic Studies: Fact Sheets on the Reproductive Health of African American Adolescents http://www.jointcenter.org/publications/details/health/n-rhaaa.html • UCSF: Fact Sheets on the Reproductive Health of Latino Adolescents http://reprohealth.ucsf.edu/publications/internal.html#FactSheets • ReCAPP: Disparities in Adolescent Reproductive Health http://www.etr.org/recapp/research/disparitiesmain.htm ETR Associates 2004

  7. Why is research important to ARH professionals? 3. Research helps us to select, adapt and/or develop interventions in a purposeful and strategic way. ETR Associates 2004

  8. Effective Programs The resources listed below provide descriptions of rigorously evaluated programs that have shown to change adolescent sexual risk taking behavior • Emerging Answers(Douglas Kirby) • ReCAPP’s “Evidence-based Programs” Column (www.etr.org/recapp) • Advocates for Youth’sScience and Success ETR Associates 2004

  9. Why is research important to ARH professionals? 4. Research helps us in defending intervention strategies and activities to funders, policymakers, participants, and other stakeholders. ETR Associates 2004

  10. Why is research important to ARH professionals? 5. Research guides us in our quest to do the most effective job possible with available resources! ETR Associates 2004

  11. What do we mean by “research?” Categories • Demographic/Descriptive data • Studies that try to explain why a problem exists. • Studies that examine the consequences of a problem. • Studies that examine whether or not an intervention is effective ETR Associates 2004

  12. What do we mean by “research?” Demographic/Descriptive data often counts and/or describes a population. For example ETR Associates 2004

  13. What do we mean by “research?” In 2000, there were 821,810 pregnancies among women 15-19 years of age in the US. In 2000, the overall pregnancy rate for women in the US aged 15-19 was 84 per 1,000. In 2000, the pregnancy rate for Hispanic women in the US aged 15-19 was 138 per 1,000. US Teenage Pregnancy Statistics: Overall Trends, Trends by Race and Ethnicity and State by State Information. (2004). New York: Alan Guttmacher Institute. ETR Associates 2004

  14. What do we mean by “research?” Studies that try to explain why a problem exists. These studies look at the behaviors, and the risk and protective factors associated with a particular health problem. ETR Associates 2004

  15. What do we mean by “research?” Examples from Emerging Answers: Two vs. One Parent is a protective factor for the initiation of sex according to at least 28 studies (1980-2000). • Sexually active peers is a risk factor for the initiation of sex according to at least 14 studies (1992 -2000). ETR Associates 2004

  16. What do we mean by “research?” Studies that examine the consequences of a problem. For example ETR Associates 2004

  17. What do we mean by “research?” Teenage pregnancy costs an estimated $6.9 billion each year in the U.S. Teenage mothers less likely to complete school. Children of teenage mothers more likely to have poorer health and poorer academic outcomes. Kirby, D. (2001). Emerging Answers. Washington DC: National Campaign to Prevent Teen Pregnancy. ETR Associates 2004

  18. What do we mean by “research?” Studies that examine whether or not an intervention is effective ETR Associates 2004

  19. Effective Programs • Descriptions of studies completed on programs to reduce adolescent sexual risk taking can be found in Emerging Answers. • To order Emerging Answers, click here. ETR Associates 2004

  20. How is data gathered? Quantitative data collection methods emphasize precise, objective and generalizable findings. These methods require the use of standardized measures so that varying perspectives and experiences can fit into a limited number of predetermined response categories. ETR Associates 2004

  21. Quantitative Methods • Surveys/polls • Performance tests • Clinical tests (e.g., urine, blood) ETR Associates 2004

  22. How is data gathered? Qualitativedata collection methods emphasize deep and detailed understandings of human experience. Issues are explored openly without the constraint of predetermined categories. ETR Associates 2004

  23. Qualitative Methods • Open-ended questions on surveys • Interviews • Focus Groups • Observations/Field Notes ETR Associates 2004

  24. How is data presented? • Raw numbers • Mean, Median, Mode • Percentages • Rates • Prevalence/Incidence • Ratio • Trend • Qualitative Data ETR Associates 2004

  25. How is data presented? • Raw numbers (count, frequency) In 2002, there were 72,894,483 children under the age of 18 living in the US. Kids Count 2004 Data Book Online http://www.aecf.org/cgi-bin/kc.cgi?action=profile&area=United+States ETR Associates 2004

  26. How is data presented? • Mean = totaling a list of numbers and dividing by the number of numbers in the list (an average). • Median = the value of the middle case in an rank-order set of numbers. • Mode = The most frequently occurring number in a group of numbers. ETR Associates 2004

  27. How is data presented? For example, let’s say that the youth in an after-school program are aged: 14, 14, 15, 15, 15, 15, 16, 17, 17 Mean: 15.3 (138/9) Median: 15 Mode: 15 ETR Associates 2004

  28. How is data presented? Percentage: The number of units with a certain characteristic divided by the total number of units in the sample and multiplied by 100. • If there are 35,305,818 Hispanic people living in the US with a total of 281,421,906 people, we say that Hispanics make up 12.55% of the US. • Calculation: (35,305,818/281,421,906) x 100 = 12.55% • US Census 2000. http://factfinder.census.gov/servlet/AdvSearchByKeywordServlet?_lang=en ETR Associates 2004

  29. How is data presented? Rate: A rate is a measure of some event, disease, or condition in relation to a unit of population, along with some specification of time.  In 2000, the adolescent pregnancy rate per 1,000 women aged 15-19 in the US was 84. ETR Associates 2004

  30. How is data presented? Prevalence: The total number of cases of a defined condition present in a specific population at a given time - often expressed as a rate. Incidence: The number of new cases of a defined condition that occur during a specified period of time in a defined population - often expressed as a rate. ETR Associates 2004

  31. How is data presented? The CDC has estimated that about 800,000-900,000 people in the U.S. are infected with HIV. The CDC has estimated that 40,000 new HIV infections occur each year. Karon, JM et al. (2001). HIV and the United States at the turn of the century: An epidemic of transition. American Journal of Public Health, 91(7), 1060-1068. ETR Associates 2004

  32. How is data presented? Ratio: Numerical expression which indicates the relationship in quantity, amount or size between two things. • 4 in 10 teen girls get pregnant at • least once before age 20. • Emerging Answers ETR Associates 2004

  33. How is data presented? Trend: The general direction or course of changes based on significant patterns observed from past events. Trends help to forecast the future. ETR Associates 2004

  34. How is data presented? Between 1991 and 2001, the teen birth rate for girls aged 15-19 declined 37% for African Americans, 30% for non-Hispanic Whites, and 27% for Hispanics. ETR Associates 2004

  35. How is data presented? Qualitative Data • Data analyzed for themes/patterns • Data presented in a narrative by using quotes, interpretation and summary ETR Associates 2004

  36. On-line Data Resources There are many websites where you can find public health data specific to your state. Click here for a listing of those sites. ETR Associates 2004

  37. What does “Science-based” mean? • Science-based strategies are ones that research has shown to be effective in preventing teen pregnancy. • Effective strategies delay sexual onset, reduce frequency of intercourse, reduce number of sexual partners, and/or increase contraceptive use. • The evaluation of the strategy must have been rigorous enough to be accepted by a peer-review journal or panel of independent experts conducting an objective review. ETR Associates 2004

  38. Science-based Databases • Emerging Answers(Douglas Kirby) • ReCAPP’s “Evidence-based Programs” Column (www.etr.org/recapp) • Advocates for Youth’sScience and Success • Sociometrics PASHA database (www.socio.com) • National Campaign’s Making the List ETR Associates 2004

  39. What do you mean by “rigorous?” • The study uses an experimental or quasi-experimental design. • The study uses a sample size that is appropriate (or adequate). • The study measures knowledge, attitudes and behaviors. ETR Associates 2004

  40. What do you mean by “rigorous?” • The study measures program effects over time. • The study uses sound research methods and processes. • The study was replicated and similar evaluation results were found. ETR Associates 2004

  41. What does "program fidelity" mean? The degree of fit between the developer defined components of a program and the actual implementation of that program. In other words, how well are we following the program developer's “recipe?” Similar terms: adherence, integrity, compliance ETR Associates 2004

  42. What does "program adaptation" mean? Deliberate or accidental modification of the program, including: • deletions or additions to program components; • modifications to components; • changes in teaching methods or administration; and/or • cultural or other modifications. ETR Associates 2004

  43. What are “core components”? • Elements of the program that fundamentally define its nature and are most likely to account for its main effects. • Based on analysis of the program’s underlying theories, logic models and/or empirical evidence. • Examples: - 10 Characteristics of Effective Programs -Practice Profiles ETR Associates 2004

  44. Fidelity/Adaptation Guidelines • Understand the Target Population • Who do you intend to serve with the program (i.e., gender, age, culture, economic status, etc.)? • What are their needs and assets? • What are your goals and objectives for working with this group? ETR Associates 2004

  45. Fidelity/Adaptation Guidelines • Understand the Program • What is the theory base/logic model behind the program? • What are core components of the program (fundamental elements of the program needed for it to be effective)? ETR Associates 2004

  46. Fidelity/Adaptation Guidelines • Assess Adaptation Concerns • What adaptations do you think are necessary given the characteristics of your target population, community, funding, staffing, politics, etc. • How will these adaptations affect the core components of the program? ETR Associates 2004

  47. Fidelity/Adaptation Guidelines • Assess Adaptation Concerns (continued) • Are there alternatives to adaptation (e.g., staff training, building support for the program amongst key stakeholders)? • Ultimately, will your adaptations affect the core components of the program to the point at which you have compromised fidelity and likelihood of program success? If yes, is there another program that is a better fit? ETR Associates 2004

  48. Fidelity/Adaptation Guidelines • Implementation • Process evaluation that examines fidelity and adaptation • Outcome evaluation • Use what you learn from evaluation efforts ETR Associates 2004

  49. 10 Characteristics of Effective Programs • Douglas Kirby and ETR Associates beginning in 1993 • A qualitative analysis of programs and their developers • Have held up remarkably well over time • Click here to review the 10 Characteristics ETR Associates 2004

  50. Effective Programs: Characteristic #1 1. Focus on reducing one or more sexual behaviors that lead to unintended pregnancy or HIV/STD infection; ETR Associates 2004

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