Template: Making Effective Presentation about Your Evidence-based Health Promotion Program This template is intended for you to adapt to your own program and presentation needs. This version of the template includes examples of the slides that were used in the online educational module.

Title of Presentation Your Name and Organization (include logos if desired)

Texas Healthy Lifestyles: Bringing Chronic Disease-Self Management, EnhanceFitness and Matter of Balance Programs to Communities Marcia G. Ory, PhD, MPH John D. Prochaska, MPH Angie F. Wade, MPH Evaluation Center EXAMPLE

Funded by List your funders Include grant numbers, funding amounts, or logos is desired

Funded by EXAMPLE Administration on Aging (AoA) Atlantic Philanthropies/National Council on Aging California Wellness Foundation Catholic Healthcare West Centers for Disease Control (CDC) Good Hope Medical Foundation Green Foundation Health Trust Foundation Jewish Community Foundation Kaiser Permanente

Program Partners List your program partners Describe their roles as partners

Our Program Partners and Their Roles EXAMPLE PartnerStateLocal/ Reg. Role UNC School of Public Health Evaluation; conceptualization Dept of Public Health Materials; workshop referrals Local Health Department Sites; workshop implementation Dept of Health and Human Services Marketing AARP Marketing; problem-solving (potential funding)

Our Program Partners and Their Roles Action for Boston Community Development (ABCD) A Matter of Balance Department of Public Health Program management, coordination with partners at local, state and national level, technical assistance, planning and reporting. Elder Services of the Merrimack Valley (ESMV) My Life, My Health, a CDSMP program Executive Office of Elder Affairs Grant administration and reports, program promotion, fidelity and sustainability Hebrew Senior Life (HSL) Healthy Eating for Successful Living in Older Adults EXAMPLE

Our Program Partners and Their Roles EXAMPLE Action for Boston Community Development Department of Public Health Executive Office of Elder Affairs Elder Services of the Merrimack Valley Hebrew Senior Life

Program Purpose Describe the scope of the health issue your program addresses National level data State level data Local level data

Chronic disease: An epidemic of unparalleled proportions EXAMPLE Mensah, CDC National Center for Chronic Disease Prevention and Health Promotion: State of Aging and Health in America 2007: 80% of older adults have at least one chronic condition Greater prevalence among minority populations 1.7 million Americans die of a chronic disease each year 1/3 of U.S. deaths attributed to modifiable behaviors

Prevalence of chronic diseases among older North Carolinians is increasing EXAMPLE 50% have arthritis 23% have diabetes mellitus 22% have heart disease/stroke 45% with chronic conditions are disabled Minorities at greater risk for having chronic conditions and dying from them Source: Behavioral Risk Factor Surveillance System (BRFSS)

Health Disparities in Chronic Disease **p <.001 Philadelphia Health Management Corporation 2004 Household Health Survey (a representative sample of 10,000 people in the greater Philadelphia region) EXAMPLE

Target Population Describe your target population Racial/ethnic composition Geographic distribution Demographic data Include maps if desired

Target Population EXAMPLE State of California: (2006) Highly populated (36 million) 11% age 65+ Racially/ethnically diverse Geographically varied Population We Aim to Reach: Older adults with: Multiple health conditions All income levels, but especially lower income Representative of the diversity of California

Target Population and Their Settings EXAMPLE Older Adults (ages 60+) served by the following areas: Bexar Area Agency on Aging (San Antonio area) Brazos Valley Area Agency on Aging Harris County Neighborhood Centers, Inc. (Greater Houston area) Areas serviced by Area Agencies on Aging affiliated with the Texas Falls Prevention Coalition

Program Description Impact What impact or effect does your program have? Why is it effective? Purpose What is the overall purpose of your program? Key Elements What are the key components of how your program works? What strategies and techniques are used? How is the program structured? What do participants do in your program? Research Outcomes What are the research questions or outcomes that your program addresses?

Evidence that CDSMP Works! EXAMPLE Improvements in health: Increased self-rated health and energy Reduced fatigue, social and role activity limitations, distress with health state Fewer days in hospital in past six months Trend for fewer outpatient and ER visits Cost-effective and long-lasting

CDSMP Purpose and Key Components EXAMPLE CDSMP builds self-confidence to manage chronic health conditions Strategies: goal setting feedback behavior modeling problem-solving techniques Techniques: Relaxation Changing diet Managing sleep and fatigue Using medications correctly Exercise Communication with health providers

CDSMP Program Meetings 2.5 hour weekly sessions 6 weeks Standardized manual Multi-tiered system: T-Trainers, Master Trainers, Lay Leaders Lay Leaders have chronic conditions Class size: participants EXAMPLE

Research Questions 1. Do state-wide evidence-based programs improve measures of: quality of life perceived pain and fatigue functional abilities health care utilization rates 2. Is it possible to build capacity using existing organizations and partnerships? EXAMPLE

Participant Recruitment Describe how you recruit participants to the program Where do advertise? Who does the recruiting? Corresponds to the REACH component of RE-AIM

How We Recruited Participants Went where older adults live, work, play, or pray Used class leaders as recruiters Used class participants as recruiters Used RSVP volunteers EXAMPLE

Site Recruitment Describe how you recruit sites for the program Coordination sites Implementation sites Corresponds to the ADOPTION component of RE- AIM

Recruitment of Sites: Coordination sites: Previous experience delivering programs Diverse target populations Potential capacity to continue offering programs post-funding Implementation sites: Sites requested the class Direct recruitment Advertisements EXAMPLE

Program Leaders Describe how you recruit program leaders Where do you advertise? Strategies used to retain leaders? Corresponds to the ADOPTION component of RE- AIM

Recruitment and Retention of Program Leaders Recruitment Through existing instructors (50%) Through community partners (25%) Senior Centers, RSVP (10%) Newspapers (10%) Retention Leader Agreement Regular phone calls and meetings Buddy system Quarterly s Recognition events and mementos EXAMPLE

Program Implementation Describe your strategies to assure fidelity to the program design Strategies used across sites (class monitoring, evaluations, etc.) Strategies used within sites (progress reports, etc.) Corresponds to the IMPLEMENTATION component of RE-AIM

Strategies Used To Assure Fidelity To The Program Session observation by Master Trainer Stanford observation checklist On-going technical support provided to workshop leaders Participant evaluations Fidelity Update in quarterly EXAMPLE

Adaptations Describe any adaptations you made to the original program Describe why the adaptation was needed Describe how you decided on the adaptation Describe the actual adaptation Did you clear your adaptation with the program developers?

Adaptations Made to Our Program Moment of silence to address preference for spiritual recognition Avoid sweets & salt Discussed communicating with health care provider of a different race Added initial group session for orientation and completion of baseline evaluation Adaptations developed by Jean Goeppinger, RN, PhD, University of North Carolina; pilot tested by Molly Rose, RN, PhD & Christine Arenson, MD, TJU, 2001) EXAMPLE

Adaptations to the Original Program EXAMPLE PROBLEM Initial session length not enough to enroll participants and collect data PROCESS Conducted interviews with program instructors and agency staff ADAPTATION added session 0 at beginning of program for registration and data collection

If you have data about your program to present, continue on to the next slide. If you do NOT have data to present, skip to slide 64 in this template.

Participant Enrollment and Retention Enrollees Number interested Year by year Baseline surveys Percent completing survey Successful completion Percent successful completion Year by year Post-program survey

Enrollment, Attendance and Retention (as of September 2004) 267 enrolled 100% completed baseline survey 88% (235/267) completed course (4/6 sessions) 78% (212/267) completed 4 month post-test survey EXAMPLE

Description of Participants: General Characteristics Participant characteristics Demographic data Geographic data

Description of Program Participants: , n=230 Demographic CharacteristicMean Age (yrs)76.3 Percent Female69 % Living Alone41 % Non-White, Non-Hispanic65 % HS Graduate66 % Covered by Medicaid18 % Income <=$25,00082 % EXAMPLE

Description of Program Participants: Years , Demographic Characteristic (n=230) Mean (n=301) Mean Age (yrs) Percent Female6977* Living Alone4151* Non-White, Non-Hispanic6567 HS Graduate6665 Covered by Medicaid1826* Income <=$25, * *p =.05 EXAMPLE

Description of Program Participants: Years , Demographic Characteristic (n=230) Mean (n=301) Mean Age (yrs) Percent % Female6877 % Living Alone4151 % Non-White, Non-Hispanic6567 % HS Graduate6665 % Covered by Medicaid1826 % Income <=$25, EXAMPLE

Description of the Participants: Health Status (REACH) Percent with health issue being addressed General health status Health care utilization

Participants Health Characteristics: Frequent use of medical care High rates of chronic conditions 2 of 5 rate their health poor/fair EXAMPLE

Attrition Number non-completers Compare non-completers to completers Demographic data Health status data Health care utilization If any, describe differences

Attrition: Significant Differences between Completers and Non-Completers ( ) Completers (n=561) Non-completers (n=82) Age (yrs) Female85%35%* Race91% white80% white* Chronic Conditions2.2 conditions3.8 conditions *p =.05 EXAMPLE

Research Design, Data Collection and Analysis Research Design Analysis Methods quantitative data qualitative data

Research Design, Data Collection and Analysis (EFFECTIVENESS) Pre-post evaluation: Group baseline interview conducted during orientation session. Four month follow-up phone interview Data analysis: paired Wilcoxon tests on data for individuals with pre-post evaluations EXAMPLE

Data Collection: Tools, Methods, Timeframe Types of tools Data collection methods Data collection timeframe and data collection points

Program Quality (Process) Measures Participant Demographic Form Participant Satisfaction Survey Attendance Sheet Fidelity Checklist Individual Benefits (Outcome) Measures CDSMP Pre/Post Survey Data Collection Tools (EFFECTIVENESS) EXAMPLE

Participant Outcomes General presentation Simply state improved, did not change, worsened Use tables or charts Research presentation Use statistics - include percents means, confidence intervals, change scores, p values

Significant Outcomes at 4 Months (N = 212) Outcome CategoryOutcome SubcategoryOutcome Status Physical ActivityStrengthening/stretchingImproved Other exercise activities (walking, swimming) Improved Health StatusSocial role functionImproved Health distressImproved Self EfficacyImproved Physical well-being and diet Improved Work and financesImproved Health care utilization(# of MD visits past 4 months)Not improved - # visit increased rather than decreased EXAMPLE

OutcomeMean (SD)Zp value PretestPosttest Health care utilization.77 (1.3).85 (1.0) Doctor visits2.8 (2.9)3.4 (3.0) Self-efficacy7.1 (2.2)7.6 (2.0) Physical well-being and diet3.9 (2.7)3.0 (2.7) Work and finances3.7 (2.9)3.2 (2.9) Significant Outcomes at 4 Months Compared to Baseline for (N = 212) EXAMPLE

Participant Outcomes at Follow-up After the Program (EFFECTIVENESS) Indicate time points Findings Compare post-program assessment and follow-up assessment Textual description: maintained, not maintained Statistical comparison

Long-term Outcomes at 12 months Compared to Post-program Assessment: Year Outcome CategoryPost-assessment (4 mos) N = 212 Follow-up (12 mos) N = 190 Physical ActivityImprovedNot maintained* Health StatusImprovedMaintained Self EfficacyImprovedMaintained Physical well-being and diet ImprovedMaintained Work and financesImprovedMaintained Health care utilization Not improved - # visit increased rather than decreased Improved - # visit decreased* * Results in green statistically significant EXAMPLE

Comparing Our Outcomes with the Original Research Outcomes (EFFECTIVENESS) Compare populations Compare outcomes Textual description: comparable nearly comparable better not significant Statistical comparison

Comparative Participant Characteristics: *Lorig KR, Sobel DS, Stewart LA et. al (1999) Medical Care, 37 (1) Original CDSMP* (n=561) Harvest Health CDSMP (n=212) Average Age66 yrs72.5 yrs Female65%85% Race91% white100% African American Average # Health Conditions2.2 conditions2.8 conditions EXAMPLE

Comparison of Post-Assessment Outcomes at 4 Months: Outcome CategoryCDSMP original study* N = 561 Our Program N = 212 Physical ActivityImproved Health StatusImproved Self EfficacyImproved Physical well-being and diet Improved Work and financesImproved Health care utilization ImprovedNot Improved *Lorig KR, Sobel DS, Stewart LA et. al (1999) Medical Care, 37 (1) EXAMPLE

Data Collection Methods and Timeframe Data collection methods All tools are self-administered Baseline completed at the beginning of first session Follow-up outcomes data are collected via mail-out survey Self-addressed, postage-paid envelopes Reminder postcards & second mailing Data collection timeframe Baseline 6 ms, 12 ms, 18 ms, 24 ms after program completion EXAMPLE

Participant Testimonials (EFFECTIVENESS) What to Include: Comments about the program Changes in a participants life Things participant is proud of Changes others have noted Refer someone else to the program?

Testimony: The Story of Doris and CDSMP Doris (age 75), completed the CDSMP program in 2007 I now have a new sense of being in control. CDSMP has really helped me put life back in my life. EXAMPLE

Instructor Testimonials What to Include: What its like to lead Participant changes observed Benefits of leading the program Encourage others to become program leaders?

Testimony: Being a Lay Leader for CDSMP Delia (age 67), Leader of the Orange Senior Center CDSMP Program Were really more like coaches. The answer to someones question is usually in the room. We all learn from each other and thats been fun. EXAMPLE

Summary of Results (EFFECTIVENESS) What to Include: What was expected and/or unexpected Implications of findings for target population partnerships program maintenance policy

Summary of Results We Expected to Find…. Enthusiasm from partners Difficulty reaching rural populations Importance of clear communication channels We Did NOT Expect…. Difficulty scheduling training Need to sell the program to some partners High attrition, particularly in rural areas Need for marketing workshops further in advance Relatively high rates of participation by minorities Level of time and commitment from Regional Coordinators EXAMPLE

Implications of Findings Target populations: Be more strategic about sites Partnerships: Regular updates and openness Program maintenance: Work with local partners on funding Policy: Encourage AAAs to increase funds for evidence-based programs EXAMPLE

Next Steps (MAINTENANCE) What to Include: Continuing the program Program adaptations Participant recruitment Partner and site recruitment Evaluation and data collection Funding Policy

What Do We Do Next? Continue to disseminate program Participant recruitment Partner and site recruitment Leader recruitment Continue data collection and evaluation Seek ongoing funding sources Formulate policy implications EXAMPLE

Whats Next? Continuing the program: Develop more partnerships Participant recruitment: Expanding toolkit, develop referral partners Partner and site recruitment: Building partners at state/regional level Evaluation and data collection: Coordinate with CDC beyond grant period Funding: CDC Arthritis grant (4 yrs), Federal Wellness (Title III-D funds) Policy: Silver Haired Legislators EXAMPLE

For Further Information Provide your contact information in case the audience wants to contact you

For More Information If you are interested in volunteering, contact: Julie Bell If you are interested in partnering with us, contact: Ted Brown EXAMPLE