BACKGROUND: India—one of the most significant antibiotic users in the world with a high burden of antibiotic resistance—does not have a formal antibiotic surveillance system. No formal studies exist on the sub-national differences in antibiotic use in India except for small hospital or community-based studies. Informed by the WHO Global Action Plan, India developed a national action plan; however only two states have state action plans so far. This suggests that it is important to understand existing antibiotic consumption patterns, sub- national differences and trends over time, and the determinants of antibiotic use so that evidence-informed action plans and programs can be developed in India. AIM: To understand the changing landscape of antibiotic use in India and contribute to relevant policy and programmatic interventions that can improve the appropriate use of antibiotics in the country. Specific objectives included examining the use of systemic antibiotic consumption at the national level, analyzing geographical and temporal variations across states between 2011 and 2019, and understanding the determinants of antibiotic consumption. Additionally, we examined Kerala as a case study to understand the use and availability of data in designing, implementing, and monitoring the state antibiotic action plan. METHODOLOGY: First, we conducted a cross-sectional analysis of antibiotic use in 2019 using the WHO Access-Watch-Reserve (AWaRe) and Defined Daily Doses (DDD) matrices at the national level across product type (Fixed-Dose Combinations [FDCs]; and single formulations [SF]), essentiality (listed in the national list of essential medicines [NLEM]; and not listed), and central regulatory approval status (approved and unapproved). Second, we analyzed trends in consumption rates and patterns at the national, state, and groups of states at different levels of health achievements (‘high focus’ [HF]; and ‘non-high focus’ [nHF]) and compared the appropriateness of use between states and state groups. Third, using a cross-sectional, time series (panel) dataset on antibiotic use, per-capita GDP, per-capita government spending on health, girls' tertiary education enrollment ratio, measles vaccination coverage, and lower respiratory tract infection incidence for the period 2011- 2019, we conducted a quasi- experimental fixed-effects analysis to understand the critical determinants of antibiotic use. Finally, we conducted key-informant interviews and document analysis to understand the use of data in policy formulation, implementation, monitoring, and evaluation of the Kerala state action plan. RESULTS: India's per-capita private-sector antibiotic consumption rate was lower than global rates, but the country has a high consumption rate of broad-spectrum antibiotics, FDCs discouraged by WHO, formulations outside NLEM in FDCs, and unapproved formulations. The overall rate increased from 2011 to 2016 and decreased between 2016 and 2019, registering a net decrease of 3.6%. State consumption rates varied widely— with HF states reporting lower rates. The inappropriate use increased over the years, the share of Access antibiotics decreased (13.1%), and the access-to-watch ratio declined (from 0.59 to 0.49). HF and nHF states showed convergence in the share of the Access and the Access-Watch ratio, while they showed divergence in the use of WHO Discouraged FDCs. The most critical independent determinant of antibiotic use was government spending on health—for every US$12.9 increase in per-capita government spending on health, antibiotic use decreased by 461.4 doses per 1000 population per year after adjusting for other factors. Economic progress (increase in per-capita GDP) and social progress (increase in girls' higher education) were also found to reduce antibiotic use independently. The qualitative case study showed that stakeholders understand and express interest in generating and using data for decision- making, and the action plan document mentions some basic monitoring plans. However, a monitoring and evaluation framework is missing, there is a lack of engagement with the private sector, and there is a lack of understanding among key government policymakers on the importance of using data for surveillance and policy implementation. CONCLUSION AND IMPLICATIONS: There is significant and increasing inappropriate antibiotic use in India's private sector, accounting for 85-90% of total antibiotic use. Increased government spending on health is critical in reducing private-sector antibiotic use. The dearth of data on public sector use is a significant challenge in understanding the total consumption rate. Developing a monitoring and evaluation system through stakeholder engagement is necessary for Indian States to inform, monitor, and evaluate effective antibiotic action plans. We need global efforts to improve the science and methods to measure antibiotic use. / 2023-08-30T00:00:00Z

The purpose of this research study was to investigate perceptions and activities of disability support program administrators in Florida community colleges regarding program administration and evaluation. The study further sought to document if any relationships existed between selected organizational and staffing characteristics and the program's ability to follow an established set of standards for program administration and evaluation. A total of 25 disability support administrators (89.3% response rate) completed a phone survey designed for this study. The study revealed that there were many inconsistencies among the higher education disability support programs in regard to programming, staffing and data collecting activities. The common denominator for determining the extent of data collection being performed within the responding community colleges appeared to be the Florida Department of Education, specifically the criteria requested annually by the Division of Community Colleges and Workforce Education. At all of the institutions surveyed, data collection activities were concentrated on numerical student data and did not consistently include program evaluation information. Finally, administrator training in program evaluation was positively associated with the responding disability support program's ability to participate in program evaluation activities. This study concluded with discussion of proposed recommendations for disability support administrators in the Florida community colleges.

Alcohol use among college students has maintained its place as a major issue in American higher education since its inception. Although dangerous drinking has always proliferated among college students, institutions have only provided alcohol and other drug (AOD) education and interventions encouraging students to adapt less harmful habits for a much shorter period of time. During this relatively short history of postsecondary alcohol interventions, colleges and universities have shifted away from abstinence-only, education-based methods. Instead, institutions have begun to adapt cognitive behavior-centric, motivational enhancement-based strategies emphasizing harm reduction through the use of protective behaviors. In order to reach a greater number of students, alcohol intervention programs have been developed combining the harm reduction ideology with internet-based dispersion at a population level. This research study addressed the behavioral changes that occurred among an entire class of first-time-in-college freshmen at a large public university before and after mandatory participation in AlcoholEdu for College, an online, population-level, harm reduction-based alcohol intervention. The study expanded upon previous evaluations of the program, which addressed program efficacy among the population as a whole but did not further explore differences in effect upon students engaging in different levels of drinking. Other demographic factors, such as gender, ethnicity, family history of alcohol issues, and age of first consumption, were also taken into account. Pre-test surveys taken by students prior to the intervention at the beginning of the academic year were matched to follow-up surveys taken four to six weeks after program completion, providing the necessary data for conducting a quantitative study. The specific areas of interest within the study included (a) willingness to complete the program in a timely and complete fashion, (b) levels of consumption, (c) use of protective behavioral strategies (PBS), and (d) incurrence of negative alcohol-related consequences. A combination of analytical procedures was utilized, including descriptive statistics, chi-square tests for independence, exploratory factor analysis, repeated measures ANCOVA, and nonparametric inferential tests. Results were described within the framework of social cognitive theory (Bandura, 2004) as well as the CIPP program evaluation framework (Stufflebeam & Shinkfield, 2007). The analysis uncovered that three major factors determined willingness to complete the mandatory program in a timely and complete fashion: gender, age of first alcohol consumption, and drinker group. Specifically, students who were male, started drinking prior to high school, or were identified as heavy episodic drinkers were less likely than peers to complete all portions of the AlcoholEdu program. Both moderate and heavy episodic drinkers reduced their levels of consumption between pre-test and follow-up. A large percentage of abstaining students maintained this status later in the semester. Light and moderate drinkers either maintained or slightly reduced their use of PBS, while heavy episodic drinkers showed increases in use of most types of PBS over time. All students indicated low levels of incurrence of negative consequences in both the pre-test and follow-up periods. However, while students experienced an increased number of most of these consequences between the pre-test and follow-up surveys, heavy drinkers cited a decreased rate of drinking and driving-related consequences as of the follow-up. Throughout all of the analyses, important controlling factors included gender, ethnicity, and age of first alcohol consumption. The results of this study can guide future development and refinement of the AlcoholEdu program, as well as provide higher education administrators and AOD education program staff with additional baseline knowledge of the change process first-time-in-college freshmen undergo when engaged in the program.

Sexuality and intimacy occupations are often considered valued life occupations by individuals and communities and can contribute to quality of life and relationship satisfaction (Diamond & Huebner, 2012; McGrath & Lynch, 2014; Sakellariou & Algado, 2006; Smith et al., 2011). Sexuality and intimacy occupations have the potential to play either enriching or detrimental roles in individuals lived experiences, which supports the notion that healthcare providers must be prepared to address these topics in practice (Collins et al., 2017; Deering et al., 2014; Diamond & Huebner, 2012; Espelage, Basile, Rue, & Hamburger, 2015; Papp, Erchull, Liss, Waaland-Kreutzer, & Godfrey, 2017; Smith et al., 2011). Despite the potentially powerful impact of sexuality and intimacy occupations on quality of life, there is a lackluster response to prioritize these occupations among occupational therapy (OT) clinicians and in OT curricula (Dyer & Nair, 2013; Hattjar, Parker, & Lappa, 2008; McGrath & Lynch, 2014; McGrath & Sakellariou, 2015). This doctoral project (1) identifies restrictive factors which enable OT professionals’ hesitancy to include sexuality and intimacy into scholarly, academic, and clinical practices, (2) identifies solutions informed by dissemination and implementation sciences to dismantle institutional and clinician level restrictions and enable clinical adoption, (3) analyzes available literature related to best practices in marketing, dissemination and implementation, and sexuality education for healthcare providers and (4) conducts a program evaluation of the Institute for Sex, Intimacy and Occupational TherapyLLC. Summative and formative results suggest that ISIOTLLC was successful in (1) generating enthusiasm for the brand and learning products, (2) conducting webinars which influenced clinical adoption, (3) building a coalition of advocates to promote institutional change, and (4) building credibility of the author as a subject matter expert on sexuality and intimacy within the OT profession. The project results will contribute to the profession by equipping OT professionals with a guide for including sexuality and intimacy into their academic or clinical practice. Enhancing clinical adoption of sexuality and intimacy into OT practice will improve the quality of life of the individuals, communities, and populations the profession serves. / 2020-06-18T00:00:00Z

The purpose of this case study was to answer 5 primary questions in order to determine the impact (efficacy, efficiency, and value) of the educational intervention known as the mental skills training program (MSTP) as implemented with an NCAA Division I volleyball team. The primary evaluation questions are (1) Was individual and/or team performance enhanced during the season? (2) How did the intervention of the MSTP impact individual and team mental toughness? (3) How did the intervention of the MSTP impact team communication and team chemistry? (4) How did the coaches and student-athletes view the investment of time and effort (value/worth)? (5) Was the program delivered effectively and efficiently? The core mental skills that comprise the MSTP are goal setting, visualization, feelazation, energy management, and effective thinking which when integrated encourage mental toughness. The program evaluation contains an instructional design (ID) that incorporated a flexible curriculum to meet the weekly needs of the team. A modified Gerlach and Ely (1980) ID model is utilized to direct the design process and also as a prescriptive evaluation guide. The evaluation utilized quantitative instruments including surveys, questionnaires, and assessments of the effectiveness and efficiency of delivery by the mental skills trainer. Qualitative data includes interviews and field notes consisting of observations, member checks, and peer debriefing. The results of the data indicate individual performance and mental toughness were enhanced; team performance and mental toughness may have been improved. Team chemistry was enhanced while team communication was not. The program was considered valuable and worthwhile and was delivered effectively and efficiently. The decision components of the program yielded an 84.69% positive program evaluation rating. In discussion of these results, team communication may be improved with a greater emphasis on teambuilding early in the program. Gains in mental toughness exceeded expectations, and a foothold has been established for future research in this area. Regarding team performance, expanding categories in survey instruments may yield a more positive evaluation. Finally, program evaluation may provide a viable research vehicle for applied sport psychology to demonstrate the efficacy of mental skills training for performance enhancement. / Ph. D.

This study addressed the complex issue of data collection in program evaluation. The researcher sought to understand the influences affecting the quality and utility of data in program evaluation. The data collection process was examined through a single case study of a bilingual education program located in California. Information for this study was obtained through open-ended interviews with project staff, classroom teachers, and external evaluators. Other sources of information included records, documents, a computer database, and electronic mail correspondence with program officers. The researcher used Non-numerical Unstructured Indexing Searching and Theory Building (NUD*IST) computer software to manipulate interview transcriptions, records and documents. Emerging from the data were key categories and themes that were presented in narrative form. The researcher found that data collection was grounded in the context in which it occurs and was therefore, highly dependent on program staff. Data collection requires willing, qualified staff with an understanding of technology, assessment, and evaluation methodology.

Higher education is facing new expectations and demands for accountability. This is especially true in categorically-funded programs that expand the scope of mission for an institution. The Economic Development Program of the California Community Colleges is such a program. An evaluation of program outcomes was required by the California legislature in 1998 for the Economic Development Program. This evaluation was conducted in a high-stakes environment in a six-month time frame. The intent of this study is to provide a cohesive case history of this evaluation effort, and to examine tools that may prove helpful for the program in future evaluation studies. Interviews with government officials, program administrators and managers, the evaluation contractor, and project directors revealed a consistent lack of understanding of how to construct program evaluations. The evaluation report studied attempted to evaluate program outcomes before assessments of program need, program theory and design, and program implementation had been adequately addressed.

School-Wide Positive Behavior Support (SWPBS) is a plan based on broad assessments of schools and their climate that can be implemented to create classrooms and schools that are focused on community and positive behavior (Horner, Sugai, Todd, & Lewis-Palmer, 2005). SWPBS involves creating and explicitly stating expectations, teaching those expectations, encouraging appropriate behavior, and defining ways to handle inappropriate behavior. Current tools that are suggested for use in conducting an assessment of school climate are: the Best Behavior School Discipline Assessment (BBSDA) also known as the Best Behavior Self-Assessment Survey (BBSAS), the School-Wide Evaluation Tool (SET), the Oregon School Safety Survey, and the Effective Behavior Support Self-Assessment (EBS Self Assessment) (Horner, et al., 2005; Sprague & Walker, 2005). All of these indicators and evaluation tools are helpful in planning SWPBS programs as well as assessing the integrity of implementation and changes in behavior patterns; however, they gather limited information from students. Collecting and examining student attitudes and perceptions about their school and safety is an important aspect of the evaluation process. The current study examined information from student surveys concerning the behavioral expectations at school as well as places in the school they felt safe and unsafe. Information gathered from these surveys was used to create an intervention that targeted a specific area identified as being the least safe and most unsafe, the bathroom, in the school to improve students' sense of safety. Based on the results of student survey information, an intervention was designed and implemented for six weeks. Compared to pre-intervention surveys, the treatment group reported feeling safer in the bathroom after the implementation of the intervention as compared to the control group, which reported no change.

The purpose of this study, a formative program evaluation, was to provide an overview of treatment integrity rates, attitudes, and assessment methods within a specialized school for children and adolescents with Autism Spectrum Disorder. The study utilized a partnership model whereby the evaluators worked collaboratively with primary stakeholders (school administrators) to determine areas of focus for the evaluation. The program evaluation was conducted between August 2009 and August 2010, spanning one school year. The evaluation participants were the school's teachers. The evaluation was based on an exploratory case study design and included both quantitative and qualitative data. Quantitative data consisted of direct observations of treatment adherence to behavior plans in classrooms, teacher knowledge of treatment content assessed in quizzes, and observations of teacher engagement with students at recess. Qualitative data consisted of teacher surveys and focus groups. The evaluation yielded an in-depth assessment of treatment integrity within the school; an intervention to define and enhance teacher engagement during recess was also developed and implemented.

No description available.