Program Evaluation and Continuous Improvement
You are a CHW coordinator for a community-based diabetes prevention program. Your program has been running for one year and has enrolled 80 participants. The program includes 16 weekly group sessions and monthly follow-up calls. You have data showing that 60% of participants attended at least 12 sessions, and 40% completed the program. Participant feedback indicates that the sessions are helpful but that transportation and scheduling conflicts are major barriers. The program's funder requires you to report on reach, effectiveness, adoption, implementation, and maintenance (RE-AIM framework). You have limited resources and need to decide where to focus improvement efforts for the next year. You also have qualitative data from focus groups indicating that participants value the peer support but find the dietary recommendations hard to follow due to cost and cultural food preferences.
1. Using the RE-AIM framework, how would you evaluate the program's current performance and identify priority areas for improvement?
Read the worked answer
I would apply RE-AIM as follows: Reach: 80 enrolled, but we need to know the eligible population size to calculate reach percentage; also assess representativeness of participants. Effectiveness: 40% completed the program; we need to measure outcomes like weight loss, HbA1c changes, and quality of life. Adoption: which organizations referred participants and how many adopted the program? Implementation: fidelity to the 16-session protocol; attendance data shows 60% attended at least 12 sessions, so implementation may be strong but retention is an issue. Maintenance: are participants sustaining behavior changes after program completion? We have limited data on this. Priority areas: improve retention (only 40% completed) by addressing transportation and scheduling barriers; and enhance cultural relevance of dietary recommendations. I would also collect more data on effectiveness and maintenance to inform decisions. Given limited resources, I would focus first on retention because it directly affects outcomes and is a clear gap.
2. What specific strategies would you propose to improve retention and cultural relevance, and how would you evaluate their impact?
Read the worked answer
To improve retention, I would offer sessions at varied times (evenings and weekends) and provide transportation support, such as bus passes or rideshare vouchers. I would also consider a hybrid model with online sessions for those who cannot attend in person. To enhance cultural relevance, I would partner with community members to adapt dietary recommendations to include familiar foods and low-cost options, and invite guest speakers from the community. I would also incorporate more peer-led activities to strengthen social support. To evaluate impact, I would track attendance and completion rates before and after changes, and conduct brief surveys to assess satisfaction and perceived cultural relevance. I would also monitor outcomes like weight and HbA1c at 6 and 12 months. Using a plan-do-study-act (PDSA) cycle, I would pilot changes with a small group, gather feedback, and refine before scaling. I would report these findings to the funder as part of the RE-AIM evaluation.