Current models of hospital-to-home transitions for older adults do not typically include a rehabilitation perspective, which led to the endeavor of this thesis. Chapter 2 (Paper 1) is a scoping review that summarized current literature related to slow-stream rehabilitation (SSR) for older adults. Chapter 3 (Paper 2) was a descriptive prospective cohort study that examined frequency, intensity, type and time (FITT) parameters for cardiovascular and resistance exercises completed by older adult participants in a community-based, SSR, hospital-to-home transition program; and to compare FITT parameters of completed exercises to established guidelines. Chapter 4 (Paper 3) was a qualitative study that examined perspectives of those working in or referring to the community-based, SSR, hospital-to-home transition program to identify factors that act as barriers or facilitators to successful implementation and function of an enhanced, community-based, SSR, hospital-to-home transition program. The scoping review found that SSR programs in single payer healthcare systems improved physical and functional outcomes, decreased hospital readmission and institutionalization for older adults with complex healthcare needs. SSR programs were multidisciplinary, ranged in program and session length, and only took place in institutional settings. The prospective cohort study found that older adults with complex healthcare needs participating in a community-based, SSR, hospital-to-home transition program were able to meet many of the cardiovascular and resistance frequency, intensity, and time (FIT) guideline parameters for community-dwelling older adults. Exercise interventions should be tailored to older adult needs and preferences, at the appropriate FIT to allow for functional gains. The qualitative study found the current program’s services e.g., rehabilitation, education, and nursing care were of benefit. Most of the stated barriers were at a macro or meso level and were out of the study participants’ control, while all the facilitators were at a micro level. Community-based, SSR, hospital-to-home transition programs can serve as a holistic model of care that address identified gaps in the literature. / Dissertation / Doctor of Philosophy (PhD) / Hospital-to-home transition care models do not often include a rehabilitation ‘lens’ which led to this thesis. Chapter 2 was a scoping review of slow-stream rehabilitation (SSR) for older adults; Chapter 3 looked at exercises older adults completed during an SSR hospital-to-home program; and, Chapter 4 studied facilitators and barriers to enhancing a current community-based, SSR, hospital-to-home program. These studies found: 1) SSR programs in healthcare systems like Canada were geared towards older adults with many health problems, only took place in hospital or long-term care settings, and were of benefit; 2) Older adults participating in a SSR hospital-to-home program should exercise at the appropriate intensity, time and frequency to see gains in function; 3) The current program’s services e.g., rehabilitation, education, and nursing care were beneficial, but barriers to enhancing the program were out of the participants’ control. Community-based, SSR, hospital-to-home transition models of care that include rehabilitation are very important for older adults.

Indiana University-Purdue University Indianapolis (IUPUI) / The increasing call for accountability combined with increasing competition for resources has given program evaluation more importance, prominence and attention within the United States nonprofit sector. It has become a major focus for nonprofit leaders, funders, accrediting organizations, board members, individual donors, the media and scholars. Within this focus however there is emerging attention and literature on the concept of evaluation capacity building to discover what organizations require to be able to effectively and efficiently evaluate their programs. This study examines this topic within the environment and stakeholder relationship dynamics of nonprofit human service organizations. A multi-stakeholder research approach using qualitative interviews of executive directors, board chairs, program staff, funders and evaluators, as well as two case studies, is employed to provide insight into the factors that determine an organization’s evaluation capacity. The overarching goal of this research is to impart this information to stakeholders interested in program evaluation, by analyzing elements for capacity beyond the more common, narrow scope of financial resources and evaluation skills. This purposeful approach intends to broaden our understanding of evaluation capacity building to encompass developing the necessary resources, culture, leadership and environments in which meaningful evaluations can be conducted for nonprofit human service programs. Results indicated that effective evaluation capacity building requires more than just funds, personnel and expertise. Some of the important factors that impacted this process included leadership; value orientations; congruence among stakeholders for their perceptions of evaluation terms and concepts; resource dependency; quality signaling; stakeholder involvement and understanding of their role in program evaluation; organizational culture; organizational learning; personal preferences; and the utilization of available evaluation tools. This study suggests that stakeholders interested in effectively building capacity to evaluate programs should be cognizant of these political, financial, social, intellectual, practical, structural, cultural and contextual implications.

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Do you need help determining appropriate measures and feasible data collection methods for program evaluations within integrated primary care? In this 3-hour preconference workshop, leaders from CFHA’s Research & Evaluation Committee and Families, Systems, & Health journal will provide practical training in conducting rigorous program evaluations. This workshop will help you identify appropriate measures to answer your key questions as well as data collection methods that balance quality and feasibility. This workshop is designed for those who are planning, conducting, or revising a program evaluation, as attendees will apply the material to their own personal projects within interactive small groups.

Amongst the breathtaking and mountainous landscapes of the Western Highlands is a highly indigenous Mayan population stricken with challenges of food insecurity and extreme poverty. Despite efforts by governmental and non-governmental organizations alike to combat these challenges, the results of chronic malnutrition have led to some of the highest child stunting rates in all of Guatemala, particularly in the department of Totonicapán, where this study took place. To date, information is limited regarding agricultural programs that utilize the rabbit as a model to reduce food insecurity in Guatemala. Thus, a novel agricultural education program, Guatemala Rabbit Project (GRP), was developed using a farm-to-fork and hands-on training approach to provide women with knowledge and skills needed to successfully raise rabbits for household consumption. The overarching purpose of this study is to evaluate the GRP as an agricultural intervention among women in three Western Highlands communities. The REAIM evaluation framework, developed for and widely utilized to evaluate public health interventions, was used to assess reach, effectiveness, adoption, implementation, and maintenance of the GRP among participants. The first aim of this study was to conduct a process evaluation utilizing reach, adoption, and implementation dimensions of RE-AIM. Findings suggest that the target population was reached, and adoption rates (84%) were promising. In general, GRP adopters adhered to the best management practices taught during the training, as reflected by observational scores across a variety of management topics indicating successful implementation. The second study aimed to evaluate the outcomes of the GRP utilizing effectiveness and maintenance dimensions of RE-AIM. Findings suggest that the GRP could serve as a household agricultural intervention based on the reported benefits and positive unintended outcomes discovered. Participants provided feedback about challenges that will be used to expand training content. Overall, findings provide evidence that the GRP could be a sustainable agricultural intervention, increasing access to animal protein while also providing households with an additional source of income.

In the past few decades, several meta-analytic studies have attempted to answer the question: Is marriage education effective (Carroll & Doherty, 2003; Halford, Markman, Kline & Stanley, 2003; Reardon-Anderson, Stagner, Macomber, & Murray, 2004)? However, previous meta-analytic studies have been somewhat limited in their conclusions because they have reviewed a narrow portion of the marriage education spectrum (e.g. premarital education only, Carroll & Doherty, 2003), because they focused only on one particular program (e.g, Couples Communication, Butler & Wampler, 1999), because they failed to differentiate marital therapy from marital education programs (Reardon-Anderson et al., 2005), or because they excluded much of the mainstream of marriage education due to methodological restrictions (e.g, random assignment studies only, Reardon-Anderson et al., 2005). The current meta-analysis is uniquely qualified to better answer whether marriage education is effective. It examines the full range of marital education from marriage preparation to early marriage and across the marital life span. It excludes studies that evaluate therapy programs and interventions, thus providing a more focused test of marriage education rather than a broader test of marriage intervention. It also allows for analysis of programs more representative of the mainstream of marriage education as it is currently practiced. Finally, this work employed more rigorous statistical techniques than had been done with previous meta-analyses. Sixty-nine marriage education evaluation reports were included in this meta analysis; fifteen additional articles were not code-able, but were analyzed conceptually. Articles were coded by design and results are reported according to study design. Quantitative results showed that across methodology, sample and program type, marriage education has moderate positive effects on marital satisfaction/quality and communication. These effects remain at follow-up evaluations. Effects were strongest for couples married longer than five years and for communication-training programs. Subgroups of studies generally were too small to examine many moderator variables. In addition, study samples were predominately White, well-educated, middle-class couples. Although this meta analysis provides the strongest answer to date on the effectiveness of marriage education, increased exploration and evaluation of moderator variables are needed before we will know which types of interventions are most effective for which couples.

Introduction: Health service organizations and their partners are increasingly under pressure to collaborate to deliver integrated patient care. The Collective Impact framework aligns well with respectful engagement and decision making between an organization and its partners, ensuring long-term change at the systems level. Shared vision, mutually reinforcing activities, and continuous communication are key components of a collective impact effort. Communication, in particular, plays an important role in all aspects of an organization, both internally and externally. Thoughtful feedback from partners and collaborative efforts can achieve collective impact and improved patient and population outcomes. Choose Well (CW), a statewide contraceptive access initiative in South Carolina, was developed using Collective Impact principles. CW launched in 2017 and continued through 2022. CW aimed to implement best practices for contraceptive access and provision. This study examined the perceptions of CW staff towards shared vision for contraceptive access, mutually reinforced activities, and communication strategies between CW and its partners. Methods: Data were collected in 2022 via exit key-informant interviews with CW staff to reflect across-all-years of their involvement with the initiative. A semi-structured interview guide was used, and the interviews were recorded, transcribed, and coded. A codebook was developed based on the interview guide. Data from questions related to 1) shared vision, 2) communication, and 3) mutually reinforcing activities between CW staff and partners were analyzed for this study. Coding was conducted with NVivo software version 1.7. Results: A total of eight CW staff participated in the interviews. Findings indicate that participants were very satisfied with the shared vision for contraceptive access between CW and its partners. The most prevalent facilitators for shared vision were constant and ongoing communication, collaboration with partners, and CW changes in framing for the initiative. Regarding communication, most participants perceived that the level of communication and coordination among various CW partners was consistent and streamlined. Integration of communication into daily processes, open communication with partners, and use of an online communication tool were mentioned as strategies that facilitated communication. Lack of administrative and partner buy-in among some partners, staff turnover, and pandemic-related challenges were commonly mentioned by participants as barriers to communication. Most participants perceived mutually reinforcing activities to be adaptability to partner needs, funding for the full range of contraceptive methods, collaboration efforts, and feedback from the partners. Conclusion: While lack of buy-in among some partners and the pandemic posed challenges, most participants perceived that constant and consistent communication facilitated a shared vision among the CW partners. Through adaptability, collaboration, and open communication with partners, CW adjusted its work to align with their partners’ goals. The findings of this study indicate that CW has coordinated their efforts around a common goal that aligns with their partners. CW maintained effective and consistent communication and integrated partner feedback as a Collective Impact approach towards improving contraceptive access and provision in SC. Shared vision and understanding of the health issue between the organization and partners can lead to a collective impact towards solving community health problems such as contraceptive access.

This applied dissertation paper introduced a program evaluation of a secure laptop-based testing (SLBT) program, which was implemented from 2009 to 2014 in an undergraduate nursing program at a private institution in the southeastern region of the United States (US). Computerized testing is an old topic in the educational research field, but the instructor-made, laptop-based secure testing that utilizes learning management systems (LMS) for undergraduate nursing programs is a fairly new topic in the US. Traditionally, testing has been administered with paper and pencil in the undergraduate nursing programs in the US for security reasons. Recently, with different robust LMSs, together with availability of affordable laptops, SLBT has become a reality on many campuses. The undergraduate nursing program at the Adventist University of Health Sciences (ADU) began to implement the SLBT program in 2009, which allowed students to use their newly purchased laptops to take secure quizzes and tests in their classrooms. After nearly five years' SLBT program implementation, a formative evaluation was conducted to seek constructive feedback from students, faculty, and technology support personnel to improve the program. Evaluation data show that, overall, students believed the SLBT program help them get hands-on experience of taking exams on the computer and get them prepared for their National Council Licensure Examination for Registered Nurses (NCLEX-RN) which is also computerized. Students, however, had a lot of concerns on laptop glitches and campus wireless network glitches they experienced during testing. Faculty and technology support personnel, on the other hand, were very satisfied with the SLBT program. Another goal of this evaluation study was to determine if students' first-time passing rate of NCLEX-RN has been improved significantly after the implementation of the SLBT program. NCLEX-RN first-time passing rate data were analyzed using the Chi-Square test and it revealed that there was no significant association between the two types of testing method (paper-and-pencil testing and the secure laptop-based testing) and whether or not students would pass NCLEX-RN the first time X2(1) = 3.53, p > .05. Based on the odds ratio, however, the odds of students passed NCLEX-RN the first time were 1.37 times higher if they were taught with the SLBT testing method than if taught with the traditional paper-and-pencil testing method in nursing school.