In the field of public health, we promote evidence-based practice, which involves drawing on the best available research about what works to promote health. Sometimes, however, the best available research doesn’t tell us how to promote health in our community, for our population, with our resources. This is particularly true for rural or heavily minority communities like southwest Georgia. There is a growing call for more practice-based evidence to strengthen and support evidence-based practice. We have much to learn from evaluating community-based programs, which—at least in their local context—are doable, accepted by community members, and potentially more sustainable than programs fully developed and funded from outside the community. High quality evaluations of these programs can strengthen the individual programs evaluated and provide valuable evidence for others working in similar areas; however, many community organizations lack the expertise or resources to evaluate their programs.
With input from our Community Advisory Board, the Emory Cancer Prevention and Control Research Network developed a four step process to identify and evaluate promising cancer prevention programs. We used this process to identify and evaluate two programs developed and conducted in southwest Georgia: the Cancer Coalition of South Georgia’s Community Cancer Screening Program™ (CCSP) and The Langdale Company’s Employee Benefits Program.
Four-step process to identify and evaluate promising cancer prevention programs:
In 2011-2012 the EPRC conducted an outcome evaluation of the colorectal cancer (CRC) component of the Cancer Coalition’s Community Cancer Screening Program™ (CCSP). The CCSP uses professional health navigators to improve access to colonoscopy screening services for low-income, uninsured and underinsured community health center patients. Patient navigators address both system and individual patient barriers to screening. This evaluation addresses a critical gap in the cancer control research literature: The Community Guide currently has no recommended strategies for colonoscopy promotion. The evaluation used a quasi-experimental design to determine: (1) whether rates of colonoscopy screening among uninsured/underinsured patients age 50-64 at four intervention clinics were significantly higher than at nine comparison clinics, and (2) the degree of program effectiveness towards improving colonoscopy screening behavior. Trained abstractors reviewed over 900 medical charts from 13 clinical sites (4 intervention and 9 comparison) to abstract data on patient demographics, CRC history and risk, and CRC referral and screening exams. Patients who received navigation services through CCSP were significantly more likely than those who did not to receive a colonoscopy referral, have a colonoscopy exam, and be current on any type of recommended CRC screening (colonoscopy, sigmoidoscopy, or blood stool test) at the end of study. Data collection occurred from August, 2011 – March, 2012, and we completed our analyses in June, 2012.
As a result of this evaluation, the Cancer Coalition's navigation program has received recognition from several national organizations. The Cancer Coalition was an Honorable Mention Recipient of the 2013 Community Partnership Award from Mutual of America Foundation. Upon learning of the Mutual of America award announcement, the Agency for Healthcare Research and Quality included a profile of the of the CCSP on its Innovations Exchange website, an online compendium of innovations and tools to improve quality and reduce disparities. Finally, the CDC recently expressed interest in featuring the CCSP as a Community Guide success story.
Click here for a related publication. http://www.ncbi.nlm.nih.gov/pubmed/23719894
In 2011-2012 the EPRC conducted a descriptive case study of The Langdale Company’s (Langdale) Employee Benefits Program. Langdale started in 1894 as a family-owned livestock and turpentine timber company, and today is a diversified enterprise with subsidiary companies across rural southwest Georgia. Based in Valdosta, Georgia, Langdale employs a mostly blue-collar workforce of about 1,100 employees. Langdale’s self-insured, self-administered employee benefits program necessitates a preventive approach to health care. Plan participants who are identified as having or being at risk of a chronic disease receive health coaching and intervention, including individual education, counseling, and assistance navigating the health system. Langdale’s benefits program incorporates several elements of the Chronic Care Model (CCM), a framework which employs a patient-centered system focused on prevention and chronic care. The long-term goal of Langdale’s benefits program is to reduce health care costs and to improve employee health. Our qualitative inquiry assessed the applicability of the CCM in an employee benefits context.
Click here for a related publication http://www.ncbi.nlm.nih.gov/pubmed/24976627