The process evaluation of it's your move!, an Australian adolescent community-based obesity prevention project

Background
Evidence on interventions for preventing unhealthy weight gain in adolescents is urgently needed. The aim of this paper is to describe the process evaluation for a three-year (2005-2008) project conducted in five secondary schools in the East Geelong/Bellarine region of Victoria, Australia. The project, 'It's Your Move!' aimed to reduce unhealthy weight gain by promoting healthy eating patterns, regular physical activity, healthy body weight, and body size perception amongst youth; and improve the capacity of families, schools, and community organisations to sustain the promotion of healthy eating and physical activity in the region.

Methods
The project was supported by Deakin University (training and evaluation), a Reference Committee (strategic direction, budgetary approval and monitoring) and a Project Management Committee (project delivery). A workshop of students, teachers and other stakeholders formulated a 10-point action plan, which was then translated into strategies and initiatives specific to each school by the School Project Officers (staff members released from teaching duties one day per week) and trained Student Ambassadors. Baseline surveys informed intervention development. Process data were collected on all intervention activities and these were collated and enumerated, where possible, into a set of mutually exclusive tables to demonstrate the types of strategies and the dose, frequency and reach of intervention activities.

Results
The action plan included three guiding objectives, four on nutrition, two on physical activity and one on body image. The process evaluation data showed that a mix of intervention strategies were implemented, including social marketing, one-off events, lunch time and curriculum programs, improvements in infrastructure, and healthy school food policies. The majority of the interventions were implemented in schools and focused on capacity building and healthy eating strategies as physical activity practices were seen by the teachers as already meeting students' needs.

Conclusions
While substantial health-promoting activities were conducted (especially related to healthy eating), there remain further opportunities for secondary schools to use a whole-of-school approach through the school curriculum, environment, policies and ethos to improve healthy eating, physical activity and healthy body perceptions in youth. To achieve this, significant, sustained leadership will be required within the education sector generally and within schools specifically.

Does multidisciplinary care enhance the management of advanced breast cancer? : evaluation of advanced breast cancer multidisciplinary team meetings

Purpose: To assess the contribution of the advanced breast cancer (ABC) multidisciplinary team meetings (MDMs) to patient care and clinical outcomes.

Methods: Members of ABC MDMs at two health services completed questionnaires in November 2007. The questionnaire asked about the performance of the MDMs and their contribution to improvement in patient care in five domains: medical management, psychosocial care, palliative care, care in the community, and benefits for team members. A final section covered the perceived value and importance of the MDM in patient management. Descriptive statistics (frequencies, mean, and standard deviation) were used to summarize the performance, improvement, and importance scores.

Results: A total of 27 multidisciplinary team members (73%) completed the questionnaire. The MDM performed best in medical management (mean performance score out of 5 [M] = 3.78) and palliative care (M = 3.77). These were also the areas that were most improved through the MDM. Benefits to team members and care in the community (both M = 3.05) ranked lowest by both measures. The MDM provided the most benefit for patient management in the areas of "awareness of services available" (M = 4.32), "efficiency of referrals" (M = 4.27) and "supportive care for patients" (M=4.27). "Awareness of services available," "psychological care for patients," and "continuity of care" were considered the most important (M = 4.64).

Conclusion: The study provides evidence that MDMs make an important contribution to the logistical and medical management of patients with advanced breast cancer.

Impact of alcohol harm reduction strategies in community sports clubs : pilot evaluation of the good sports program

Objective: Approximately 4.5 million Australians are involved in community sports clubs. A high level of alcohol consumption tends to be commonplace in this setting. The only program of its type in the world, the Good Sports program was designed to reduce harmful alcohol consumption in these Australian community sports clubs. The program offers a staged accreditation process to encourage the implementation of alcohol harm-reduction strategies.

Method: We conducted a postintervention adoption study to evaluate whether community sports club accreditation through the Good Sports program was associated with lower rates of alcohol consumption. We examined alcohol consumption rates in 113 clubs (N = 1,968 participants) and compared these to consumption rates in the general community. We hypothesized that members of clubs with more advanced implementation of the Good Sports accreditation program (Stage Two) would consume less alcohol than those with less advanced implementation (Stage One).

Results: Multilevel modeling (MLM) indicated that on days when teams competed, Stage Two club members consumed 19% less alcohol than Stage One club members. MLM also indicated that the length of time a club had been in the Good Sports program was associated with reduced rates of weekly drinking that exceeded Australian short-term risky drinking guidelines. However consumption rates for all clubs were still higher than the general community. Higher accreditation stage also predicted reduced long-term risky drinking by club members.

Conclusion: Our findings suggest that community sports clubs show evidence of higher levels of alcohol consumption and higher rates of risky consumption than the general community. Implementation of the Good Sports accreditation strategy was associated with lower alcohol consumption in these settings.

Field evaluation of a suite of biomarkers in an Australian Tropical Reef Species, Stripey Seaperch (Lutjanus carponotatus) : Assessment of Produced Formation water from the Harriet A Platform

There is paucity of data regarding hydrocarbon exposure of tropical fish species inhabiting the waters near oil and gas platforms on the Northwest Shelf of Australia. A comprehensive field study assessed the exposure and potential effects associated with the produced water (PW) plume from the Harriet A production platform on the northwest shelf in a local reef species, Stripey seaperch (Lutjanus carponotatus). This field study was a continuation of an earlier pilot study which concluded that there were “warning signs” of potential biological effects on fish populations exposed to PW. A 10-day field caging study was conducted deploying 15 individual fish into 6 separate steel cages set 1-m subsurface at 3 stations in a concentration gradient moving away from the platform. A battery of biomarkers were evaluated including hepatosomatic index (HSI), total cytochrome P450, bile metabolites, CYP1A-, CYP2K- and CYP2M-like proteins, cholinesterase (ChE) activity, and histopathology of liver and gill tissues. Water column and PW effluent samples was also collected. Results confirmed that PAH metabolites in bile, CYP1A-, CYP2K-, and CYP2M-like proteins and liver histopathology provided evidence of significant exposure and effects after 10 days at the near-field site (~200 m off the Harriet A platform). Hepatosomatic index, total cytochrome P450, and ChE did not provide site-specific differences by day 10 of exposure to PW. CYP proteins were shown by principal component analysis (PCA) to be the best diagnostic tool for determining exposure and associated biological effects of PW on L. carponotatus. Using a suite of biomarkers has been widely advocated as a vital component in environmental risk assessments worldwide. This study demonstrates the usefulness of biomarkers for assessing the Harriet A PW discharge into Australian waters with broader applications for other PW discharges. This approach has merit as a valuable addition to environmental management strategies for protecting Australia’s tropical environment and its rich biodiversity.

Moving beyond the restrictions : the evaluation of the Alice Springs alcohol management plan

There have been a number of evaluations of alcohol management in the Alice Springs region. Interestingly, an evaluation in 1975 emphasised the need for government and other agencies to view the issues holistically and to address them accordingly. The outcomes of this evaluation point to a similar situation with comparable recommendations.

The situation in Alice Springs is unique in some respects but has parallel characteristics to other towns and communities in Australia. Alice Springs is an important regional supply, service-orientated, and tourism town. Its people have diverse backgrounds and appear as durable as the environment they live in. Associated with this is a hard drinking culture that permeates the community with a range of issues regardless of one’s cultural background.

The research group found a community that in many ways is ruptured and fragmented when it comes to the ways and means of how such challenges can be confronted. This situation is exemplified by the perception that alcohol problems are confined to a minority of drinkers that seemingly pervades the dialogue surrounding drinking and its effects in the town.

Nevertheless, a positive outcome of such discourse is the fact that people do care about their community and are very keen to live in a town where there are more responsible attitudes toward drinking. There is some way to go; the first thing that everyone needs to accept is that it is a community problem. Non-Indigenous and Indigenous individuals, groups and organisations all have a responsibility therefore in addressing the challenges and working toward better solutions. Government have an important role of course, however the acceptance by the community that it is a community problem is paramount.

Some of the community and government initiatives are having a positive effect on drinking in the town. However, some of the initiatives, such as certain restrictions, can and should not be considered, on their own, as long-term solutions. Other processes need to be implemented, oversighted and managed in an effective manner. An important component of such processes is data that is well managed, available, and appropriate for those agencies involved.

Evaluation of the fuzzy ARTMAP neural network using off-line and on-line learning strategies

This paper describes an experimental study of the Fuzzy ARTMAP (FAM) neural network as an autonomous learning system for pattern classification tasks. A benchmark database of radar signals from ionosphere has been employed for the system to classify arbitrary sequences of pattern into distinct categories. A number of simulations have been conducted systematically to evaluate the applicability and usefulness of FAM in this context. First, we identify the 'optimum' parameter settings of FAM for the problem at hand, and investigate the effects of different training schemes and learning rules on classification results, using an off-line learning methodology. We then examine a voting strategy to improve classification accuracy by combining results from multiple FAM classifiers. In addition to off-line learning, we evaluate the prospect of using FAM as an autonomously learning pattern classification system for on-line, non-stationary environments. The performance of FAM is comparable with other reported results, but with the added advantage of on-line and incremental learning.

Evaluation of four supervised learning methods for benthic habitat mapping using backscatter from multi-beam sonar

An understanding of the distribution and extent of marine habitats is essential for the implementation of ecosystem-based management strategies. Historically this had been difficult in marine environments until the advancement of acoustic sensors. This study demonstrates the applicability of supervised learning techniques for benthic habitat characterization using angular backscatter response data. With the advancement of multibeam echo-sounder (MBES) technology, full coverage datasets of physical structure over vast regions of the seafloor are now achievable. Supervised learning methods typically applied to terrestrial remote sensing provide a cost-effective approach for habitat characterization in marine systems. However the comparison of the relative performance of different classifiers using acoustic data is limited. Characterization of acoustic backscatter data from MBES using four different supervised learning methods to generate benthic habitat maps is presented. Maximum Likelihood Classifier (MLC), Quick, Unbiased, Efficient Statistical Tree (QUEST), Random Forest (RF) and Support Vector Machine (SVM) were evaluated to classify angular backscatter response into habitat classes using training data acquired from underwater video observations. Results for biota classifications indicated that SVM and RF produced the highest accuracies, followed by QUEST and MLC, respectively. The most important backscatter data were from the moderate incidence angles between 30° and 50°. This study presents initial results for understanding how acoustic backscatter from MBES can be optimized for the characterization of marine benthic biological habitats. © 2012 by the authors.

Adaptation and validation of the Japanese version of the health education impact questionnaire (heiQ-J) for the evaluation of self-management education interventions

Aim:  

Measurement issues in the evaluation of chronic disease self-management programs

Objectives: 

Assessment of proximal outcomes of self-management programs : translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQtm)

Purpose This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs.

Methods The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales.

Results The items of the German heiQ™ were well understood by rehabilitation inpatients. The structure of the eight heiQ™ scales was replicated after minor adjustment. heiQ™ scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ™ scales differentiated between individuals across different levels of depression.

Conclusion The German heiQ™ is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.

An evaluation of the effect of an educational intervention for Australian social workers on competence in delivering brief cognitive behavioural strategies : a randomised controlled trial

Background Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). Methods A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. Results 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency threshold on the Cognitive Therapy Scale whilst the control group remained below. Conclusions Social workers can attain significant improvements in competency in delivering cognitive behavioural strategies from undertaking brief face to face training. This is relevant in the context of health reforms that involve social worker delivery of evidence based psychological care. Further research is required to assess how these improvements in competence translate into performance in practice and clinical outcomes for patients.