Development of a planning and evaluation methodology for assessing the contribution of theory to a diabetes prevention lifestyle intervention.

The benefits of utilizing and measuring application of theory for behavior change programs are numerous, including the emergence of new theories and theoretically bound strategies. Despite recent attempts to make theory use more salient, there remains a dearth of practical frameworks for the development and evaluation of theory-based programs. Without literature documenting how theories have been specifically applied to interventions and their evaluation, health educators may not be well prepared to utilize theory for the design, implementation, or as a focus of the evaluation. Using a case study example of a diabetes prevention program, this article describes how theory was used for the program design and the evaluation and provides a framework for using theory in other programs. Issues discussed include: the challenges in successfully utilizing theory for intervention development and the processes of developing theoretically based instruments.

Relationship of stages of change to attendance in a diabetes prevention program.

PURPOSE: To determine whether preintervention stage-of-change measures are indicative of subsequent attendance at diabetes prevention intervention sessions. DESIGN: Cross-sectional. SETTING: Local community. SUBJECTS: Seventy-five adult American Indian women participated. MEASURES: Attendance, stage-of-change questions for seven diabetes prevention behaviors, and mean stage-of-change score to reflect the combined stages of change for all behaviors. ANALYSIS: Univariate analyses for stage-of-change distribution and Fisher's exact test and prevalence ratios for the association between attendance and stage of change. RESULTS: Participants' readiness for change at baseline was distributed across all stages of change. The most common stage was preparation. There was a significant relationship between the mean stage-of-change scores and attendance. Participants with lower mean stage-of-change scores (mean +/- SE, 3.03 +/- 0.13) were less likely to attend all 5 sessions than those with higher mean stage-of-change scores (mean +/- SE, 3.38 +/- 0.10) (p = .04). Participants in the action category (preparation, action, and maintenance stages) before the intervention were 6.7 (95% confidence interval, 1.0-44.1; p < .01) times more likely to be high attenders than those in the preaction category (precontemplation and contemplation stages) before the intervention. CONCLUSIONS: Findings from this study suggest that stage of change may be a good predictor of attendance at diabetes prevention intervention sessions and have implications for intervention design and assessment. The mean stage-of-change score may be a more stable estimate of stage of change.

The North Carolina Youth Empowerment Study (NCYES): a participatory research study examining the impact of youth empowerment for tobacco use prevention.

This article describes the North Carolina Youth Empowerment Study (NC YES), a 3-year participatory evaluation of youth programs addressing tobacco use prevention. The study goals of NC YES were to (1) convene an advisory board comprised of lay youths and adults in a participatory research process, (2) document the characteristics of youth programs for tobacco use prevention and control in North Carolina, and (3) track the role of youth involvement in initiating and implementing 100% tobacco-free policies in local school districts. The NC YES Statewide Advisory Board helped guide the evaluation process, reviewed study protocols and data collection instruments, and helped interpret preliminary findings. Both quantitative and qualitative methods(e.g., telephone interviews and written questionnaires) were used to gather data from youth and adult leaders to achieve these aims. Lessons learned about the process of conducting participatory evaluation approaches and summary findings about the role of youths in policy advocacy efforts are presented.

Passage of 100% tobacco-free school policies in 14 North Carolina school districts.

Though comprehensive tobacco-free school policies constitute an important component of state tobacco control efforts, little research exists about their adoption process. In the past two years, efforts occurred in North Carolina to increase the number of school districts adopting 100% tobacco-free school policies. As part of the North Carolina Youth Empowerment Study (NC-YES), researchers developed a school tobacco policy interview guide to conduct interviews with 40 key people (e.g., school board member, principal, etc.) in each of 14 school districts that adopted a 100% tobacco-free school policy by the end of 2001. Results showed seven districts adopted their school policy in the past two years. Seven themes emerged: 1) Catalysts: Local adult and youth "champions" facilitated policy change; 2) Process of Adoption: Most school policies were adopted with an administrator or other adult initiating the change, but youth involvement increased in recent years; 3) Methods of Adoption: Advocates personalized health concerns by focusing on children and role modeling by adults; 4) Political Leadership: Governors of North Carolina, through letters to school districts and a policy summit, played an important role in stimulating policy change; 5) Barriers to Adoption: Concerns expressed before policy adoption, about teacher attrition or inability to enforce the policy, did not occur as feared; 6) Enforcement Issues: A key to policy enforcement involved being consistent, supportive, and firm; and 7) Economics of Tobacco Farming/Manufacturing: Though a local tobacco economy did little to influence policy adoption, districts that adopted policies were not located in counties with heavy tobacco production. Public health advocates may use this information to encourage school districts to adopt 100% tobacco-free school policies.