evaluation*of*fasd preventionand fasdsupport … · ! 2! healthandwell!being!ofwomen! introduction*...
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EVALUATION OF FASD PREVENTION AND FASD SUPPORT PROGRAMS Participant Outcomes: Health and Well Being of Women www.fasd-evaluation.ca
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Health and Well Being of Women
Introduction Presented below is a chart containing examples of outcomes, indicators, outputs, and data collection methods and tools related to Health and Well-‐being. Following this chart are examples of tools and/or survey/questionnaire items that have been used in evaluations to assess these participant outcomes, as well as references for the evaluation-‐related resources used to create the chart below. We recognize that every program and every program evaluation is unique -‐ differing as a function of a program’s specific goals, setting and resources, as well as the community’s context, history, and so forth. Thus, every program evaluation will have its own ideas about the outcomes, indicators, data collection methods and tools that are most appropriate and feasible – and you need to decide what is best for you.
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Health and Well-being– Participant Outcomes and Indicators Examples of program activities related to this outcome: o Providing 1-‐1 support, advocacy, role modeling and skill development o Group activities including peer support, outings, cultural activities o Workshops and orientation to community resources o Collaborative planning, follow up and ongoing communication between participants, program team and service partners
Participant Outcomes
Early positive response
(participation, increased knowledge)
Intermediate active engagement, attitude change, behaviour change
Long term desired outcome
Outputs/Indicators Data Collection Methods and tools
Participants identify their strengths, needs and goals Participants develop trusting relationships with staff Participants learn about and learn how to access services and resources addressing: • social/relationship skills • physical health • mental health • sexual health • dental health • substance use • safety, how to avoid
unsafe situations • connection to culture/
spiritual wellness • food security
Participants take steps to have: • improved physical,
mental, dental, sexual health/wellness
• healthy social/sexual relationships
• healthy physical and recreational activities
• connection to culture/spiritual wellness
• sense of balance in life There is collaborative planning, follow up and support/ advocacy if needed, re: addressing wellness needs Participants access
Participants have improved health and well-‐being Participants achieve their self-‐identified goals Participants have balance in their life and in their interactions Participants are connected to other people and to resources in their community Participants have
# partics receiving (1-‐1) support # hours service/support per participant # participants attending per group # visits to community resources/services/organizations as part of group or 1-‐1 programming
amount of physical activity per week per participant #/freq. of team meetings
Pre/Post Participant self-‐ratings/Questionnaire, e.g.: • Self-‐reported
health survey • WHO QOL • COOP Scales • Well-‐being scale • General Self-‐
efficacy Scale • Assessment Wheel
(Awo Taan) (Pre/Post) Interviews/Focus groups with: Participants; Families/caregivers; Program staff;
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Participant Outcomes Early
positive response (participation, increased
knowledge)
Intermediate active engagement, attitude change, behaviour change
Long term desired outcome
Outputs/Indicators Data Collection Methods and tools
• exercise and recreation Participants are supported to get to appointments and to access needed resources
comprehensive primary health care for themselves and their children Participants take part meaningfully in decision-‐making re: wellness care Participants can identify people whom they can call on for support Participants feel supported Participants feel as though their health/wellness needs are being met Participants develop/increase their sense of control and efficacy over their own lives
enhanced capacity to control elements of their lives Participants get regular exercise
Community partners Output data
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Possible Data Collection Tools and Sample Survey/Questionnaire Items 1) Health Survey Questionnaire
Source: Bent, K. (2004). Anishinaabe Ik-‐We Mino-‐Aie-‐Win. Aboriginal Women’s Health Issues: A Holistic Perspective on Wellness. University of Athabasca. http://www.pwhce.ca/pdf/abWoHealthBentFull.pdf
Section II. Health Issues These next questions are going to ask you to describe your health. The questions have been divided into four sections asking about physical, emotional, intellectual and spiritual health. a) Physical health Do you consider yourself physically well? ! Yes ! No Have you been diagnosed with a major illness in the last 3 years? ! Yes ! No If yes, please check the appropriate box: ! Heart attack/disease ! Diabetes ! Cancer ! Pneumonia ! Liver problems ! Kidney problems ! Lung problems ! Bone and joint problems ! Eyes, nose, throat problems ! Accident that required hospitalization
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Have you had any other physical health problems in the last 3 years? ! Yes ! No If yes, what kind? __________________________________________________ Do you smoke? ! Yes ! No Do you exercise on a regular basis? ! Yes ! No Are your nutritional requirements being met? ! Yes ! No What would you say is your biggest physical health concern? ______________________________________________________________________________ b) Emotional Health Do you consider yourself emotionally well? ! Yes ! No Have you had a mental health illness in the last 3 years? ! Yes ! No I If yes what is the illness/diagnosis: ______________________________________________________________________________ Are you addicted to drugs, alcohol, or other substances? ! Yes ! No What would you say is your biggest emotional health concern? ______________________________________________________________________________
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c) Intellectual Health Do you consider yourself intellectually well? ! Yes ! No Do you read on a regular basis? ! Yes ! No Do you possess a library card? ! Yes ! No Do you participate in academic activities and events? ! Yes ! No What would you say is your biggest intellectual health concern? ______________________________________________________________________________ d) Spiritual Health Do you consider yourself spiritually well? ! Yes ! No Do you participate in spiritual activities? ! Yes ! No If yes, which ones? _____________________ Do you speak with an elder on a regular basis? ! Yes ! No Do you participate in Aboriginal cultural traditions? ! Yes ! No What would you say is your biggest spiritual health concern? ______________________________________________________________________________
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Section III. Access and Availability The next set of questions ask you about how often you have used the services of various health care professional in the past 6 months. These questions also ask you to explain, if you needed or wanted more access, why you feel that these services weren’t available to you and to describe what you did instead. In the past 6 months how often have you visited a doctor for your own health concerns? ! Never ! Once ! Twice ! Three – Four times ! More than four times In the past 6 months, were there times that you wanted to visit a doctor for your own health concerns, but were unable to? ! Yes ! No If you answered yes to this question, please explain why you were unable to visit a doctor. ______________________________________________________________________________ What did you do instead of visiting the doctor? ______________________________________________________________________________ In the past 6 months how often have you visited a dentist’s office for your own dental concerns? • ! Never • ! Once • ! Twice • ! Three – Four times • ! More than four times
In the past 6 months, were there times that you wanted to visit a dentist for you own health concerns, but were unable to? ! Yes ! No
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If you answered yes to this question, please explain why you were unable to visit a dentist. ______________________________________________________________________________ What did you do instead of visiting a dentist? ______________________________________________________________________________ In the past 6 months how often have you visited a mental health professional (e.g., counselor, psychologist, psychiatrist) for your own emotional concerns? ! Never ! Once ! Twice ! Three – Four times ! More than four times In the past 6 months, were there times that you wanted to visit a mental health professional for your own health concerns, but were
unable to? ! Yes ! No If you answered yes to this question, please explain why you were unable to visit a mental health professional. ______________________________________________________________________________ What did you do instead of visiting a mental health professional? ______________________________________________________________________________ In the past 6 months how often have you visited an Aboriginal healer for your own health concerns? ! Never ! Once ! Twice ! Three – Four times ! More than four times
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In the past 6 months, were there times that you wanted to visit an Aboriginal healer for your own health concerns, but were unable to? ! Yes ! No If you answered yes to this question, please explain why you were unable to visit an Aboriginal healer. ______________________________________________________________________________ What did you do instead of visiting an Aboriginal healer? ______________________________________________________________________________ In the past 6 months have you used any other health care services (not including doctors, dentists, mental health professionals and Aboriginal healers) for your own health concerns? ! Yes ! No If you have used other health care services, could you please say what they were (e.g., nutritionist, nurse practitioner? ______________________________________________________________________________ If you have used other health care services in the past 6 months how often have you used them? ! Never ! Once ! Twice ! Three – Four times ! More than four times If you have used other health care services in the past 6 months, were there times that you wanted to use them, but were unable to? ! Yes ! No If you answered yes to this question, please explain why you were unable to use the health care services you required. ______________________________________________________________________________ What did you do instead of visiting the health care services you required? ______________________________________________________________________________
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Section IV. General Health and Wellness Issues This next set of questions are asking your opinions about general health and wellness. Overall, what would you say are your top three health concerns? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What would you say are your top three health needs? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What do you do to relieve stress? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What does wellness mean to you? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ How would you define good health? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Thank you for taking the time to fill out this survey.
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2) World Health Organization Quality of Life Scale (WHO QOL-BREF)
Source: World Health Organization, (2004). The World Health Organization Quality of Life (WHOQOL) – BREF. World Health Organization. Geneva, Switzerland. http://apps.who.int/iris/bitstream/10665/77775/1/WHO_MSD_MER_Rev.2012.02_eng.pdf “The following questions ask how you feel about your quality of life, health, or other areas of your life. Please choose the answer that appears most appropriate. If you are unsure about which response to give to a question, the first response you think of is often the best one.
Very poor Poor Neither poor nor good Good Very good
1. How would you rate your quality of life? 1 2 3 4 5
Very dissatisfied Dissatisfied
Neither satisfied nor dissatisfied
Satisfied Very
satisfied
2. How satisfied are you with your health? 1 2 3 4 5 The following questions ask about how much you have experienced certain things in the last four weeks.
Not at all A little A moderate amount Very much
An extreme amount
3. To what extent do you feel that physical pain prevents you from doing what you need to do? 5 4 3 2
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4. How much do you need any medical treatment to function in your daily life? 5 4 3 2
1 5. How much do you enjoy life? 1 2 3 4 5
6. To what extent do you feel your life to be meaningful?
1 2 3 4 5
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Not at all A little A moderate amount Very much Extremely
7. How well are you able to concentrate? 1 2 3 4 5
8. How safe do you feel in your daily life? 1 2 3 4 5
9. How healthy is your physical environment? 1 2 3 4 5
The following questions ask about how completely you experience or were able to do certain things in the last four weeks.
Not at all A little Moderately Mostly Completely
10. Do you have enough energy for everyday life? 1 2 3 4 5
11. Are you able to accept your bodily appearance? 1 2 3 4 5
12. Have you enough money to meet your needs? 1 2 3 4 5
13. How available to you is the information that you need in your day-‐to-‐day life? 1 2 3 4 5
14. To what extent do you have the opportunity for leisure activities? 1 2 3 4 5
15. How well are you able to get around? 1 2 3 4 5
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Very dissatisfied Dissatisfied
Neither satisfied nor dissatisfied
Satisfied Very
Satisfied
16. How satisfied are you with your sleep? 1 2 3 4 5
17. How satisfied are you with your ability to perform your daily living activities? 1 2 3 4 5
18. How satisfied are you with your capacity for work? 1 2 3 4 5
19. How satisfied are you with yourself? 1 2 3 4 5
20. How satisfied are you with your personal relationships? 1 2 3 4 5
21. How satisfied are you with your sex life? 1 2 3 4 5
22. How satisfied are you with the support you get from your friends? 1 2 3 4 5
23. How satisfied are you with the conditions of your living place? 1 2 3 4 5
24. How satisfied are you with your access to health services? 1 2 3 4 5
25. How satisfied are you with your transport? 1 2 3 4 5 The following question refers to how often you have felt or experienced certain things in the last four weeks.
Never Seldom Often Very often Always 26. How often do you have negative feelings such
as blue mood, despair, anxiety, depression?
Do you have any concerns about the questionnaire? _______________________________________________________________________________________________________________
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3. COOP Charts for Primary Care Practice Source: Nelson E., Wasson, J., Kirk, J., Keller, A., Clark, D., Dietrich, A., Stewart, A. & Zubkoff, M. (1987). Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. Journal of Chronic Disease, 40 (suppl 1), 55S–63S. According to the scales’ authors:
“At the heart of the CO-‐OP System are nine scales, each of which is used to measure a different aspect of [a person’s] functional status. Each scale is presented in the form of a chart that is designed to screen functional status in much the same way as Snellen eye Charts are used to screen for vision problems. Four of the CO-‐OP Charts focus on specific dimensions of function (physical endurance, emotional health, role function, and social function), three relate to overall well-‐being (overall health, change in health, level of pain), and two are concerned with quality of life (overall quality of life, and social resources/support). Each Chart consists of a simple title, one question, and five response choices. Each possible response is described in words and presented graphically, as a caricature, along a five-‐point ordinal scale. High-‐numbered responses represent unfavorable levels of functioning on all charts.” (The Dartmouth Primary Care Co-‐operative (“CO-‐OP”) Information Project, nd, Geisel School of Medicine at Dartmouth, http://www.dartmouthcoopproject.org/coopcharts_overview.html)
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4) Warwick -Edinburgh Mental Well-being Scale (WEMWBS) Source: Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J., Secker, J. & Stewart-‐Brown, S. (2007). The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS): Development and UK Validation. Health and Quality of Life, 5, 63-‐76.
Below are some statements about feelings and thoughts. Please tick the box that best describes your experience of each over the last 2 weeks.
Statements
None of the time
Rarely Some of the time
Often All the time
I’ve been feeling optimistic about the future. 1 2 3 4 5 I’ve been feeling useful. 1 2 3 4 5 I’ve been feeling relaxed. 1 2 3 4 5 I’ve been feeling interested in other people. 1 2 3 4 5 I’ve had energy to spare. 1 2 3 4 5 I’ve been dealing with problems well. 1 2 3 4 5 I’ve been thinking clearly. 1 2 3 4 5 I’ve been feeling good about myself. 1 2 3 4 5 I’ve been feeling close to other people. 1 2 3 4 5 I’ve been feeling confident. 1 2 3 4 5 I’ve been able to make up my own mind about things. 1 2 3 4 5 I’ve been feeling loved. 1 2 3 4 5 I’ve been interested in new things. 1 2 3 4 5 I’ve been feeling cheerful. 1 2 3 4 5
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5) General Self-Efficacy Scale Source: Schwarzer, R. & Jerusalem, M. (1995). Generalized Self-‐Efficacy Scale. In J. Weinman, S Wright, & M Johnston, (Eds), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-‐37) Retrieved June 12, 1012 via http://userpage.fu-‐berlin.de/health/engscal.htm Questionnaire item
Not at all true
Hardly true
Moderately true
Exactly true
I can always manage to solve difficult problems if I try hard enough 1 2 3 4 If someone opposes me, I can find the means and ways to get what I want 1 2 3 4 It is easy for me to stick to my aims and accomplish my goals 1 2 3 4 I am confident that I could deal efficiently with unexpected events 1 2 3 4 Thanks to my resourcefulness, I know how to deal with unforeseen situations 1 2 3 4 I can solve most problems if I invest the necessary effort 1 2 3 4 I can remain calm when facing difficulties because I can rely on my coping abilities
1 2 3 4
When I am confronted with a problem, I can generally find several solutions 1 2 3 4 If I am in trouble, I can usually think of a solution 1 2 3 4 I can usually handle whatever comes my way 1 2 3 4
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6) Healing Lodge Assessment Wheel – “Where I am today?” Source: Awo Taan Healing Lodge. (2007). Aboriginal Framework for Healing & Wellness Manual. Alberta: Awo Taan Healing Lodge Society.
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References Awo Taan Healing Lodge. (2007). Aboriginal Framework for Healing & Wellness Manual. Alberta: Awo Taan Healing Lodge Society. Bent, K. (2004). Anishinaabe Ik-‐We Mino-‐Aie-‐Win. Aboriginal Women’s Health Issues: A Holistic Perspective on Wellness. University of Athabasca. http://www.pwhce.ca/pdf/abWoHealthBentFull.pdf The Dartmouth Primary Care Co-‐operative (“CO-‐OP”) Information Project, nd, Geisel School of Medicine at Dartmouth, http://www.dartmouthcoopproject.org/coopcharts_overview.html Hume. S., Rutman, D., Hubberstey, C., Lentz, T., & Van Bibber, M. (2009) Final Summative Evaluation Report: Key Worker and Parent Support Program. British Columbia: Ministry of Children and Family Development. Retrieved from http://www.mcf.gov.bc.ca/fasd/kw_evaluation.htm. Nelson E., Wasson, J., Kirk, J., Keller, A., Clark, D., Dietrich, A., Stewart, A. & Zubkoff, M. (1987). Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. Journal of Chronic Disease, 40 (suppl 1), 55S–63S. Schwarzer, R. & Jerusalem, M. (1995). Generalized Self-‐Efficacy Scale. In J. Weinman, S Wright, & M Johnston, (Eds), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-‐37) Retrieved June 12, 1012 via http://userpage.fu-‐berlin.de/health/engscal.htm Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J., Secker, J. & Stewart-‐Brown, S. (2007). The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS): Development and UK Validation. Health and Quality of Life, 5, 63-‐76.
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World Health Organization, (2004). The World Health Organization Quality of Life (WHOQOL) – BREF. World Health Organization. Geneva, Switzerland. http://apps.who.int/iris/bitstream/10665/77775/1/WHO_MSD_MER_Rev.2012.02_eng.pdf
Funding for this project has been received from the Public Health Agency of Canada, Fetal Alcohol Spectrum Disorder (FASD) National Strategic Project Fund. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. Suggested Citation: Nota Bene Consulting Group and BCCEWH. (2013). Participant Outcomes: Health and Well Being of Women. In Evaluation of FASD Prevention and FASD Support Programs. Vancouver, BC: British Columbia Centre of Excellence for Women's Health. For more tools and resources related to evaluating community-‐based FASD prevention programs for women including pregnant women and recent mothers, supportive intervention programs for adults and older youth with FASD, and FASD programs in Aboriginal communities, please visit: www.fasd-evaluation.ca