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Volume 15, 2000 - Fall

Monitoring Health Technology Assessment Agencies

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Pages :
1-33

The increased use of "regulatory science" in decision and policy making is an important component in the governance of modern states. However, contrary to what one would be tempted to assume, the use of knowledge from advisory bodies is not straightforward. Health Technology Assessment (HTA) agencies are currently preoccupied with their impact on the health care system and the examination of more active dissemination strategies. This article suggests that their influence depends on how HTA users and other actors react to an assessment, agree with or contest its content, and negotiate solutions. A continuous monitoring system is presented that could be implemented by such agencies for documenting actors' views and actions. This framework combines attributes both of self-assessment approaches and of impact assessment models.

Caught In The Web: Piloting A Methodology To Assess Community Capacity In A Rural Heart Health Project

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Pages :
35-55

As health promotion practitioners, we have been encouraged to implement strategies that embrace a community-building approach for strengthening community health. In this article, we present our experience in piloting a methodology to assess the extent to which community capacity was built in a rural heart health project. We defined community capacity as the degree to which a community (and its agency partners) can develop, implement, and sustain actions for strengthening community health. An assessment protocol that included a series of guiding questions and a ranking procedure to assess seven domains of community capacity was designed for focus group application. Following from this, community capacity webs, which visually depict the extent of capacity built through the heart project, were produced for each community. The methodology requires further refinement; however, through this process we were able to further our understanding of the effectiveness of this project in building community capacity.

Evaluating Policy Outcomes: Federal Ecc Development Programs In Atlantic Canada

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Pages :
57-68

The Atlantic Canada Opportunities Agency (ACOA) was established in 1987 as the federal government agent for ecc development in Atlantic Canada. This article describes the Agency's "corporate" approach to provide credible, quantitative estimates of the long-term policy outcomes of total Agency activity. The focus of evaluation activity has been to determine the contribution of ACOA as a whole to its legislated mandate to enhance the growth of earned incomes and employment opportunities in Atlantic Canada. To provide reliable impact estimates for senior management, ministers, parliamentarians, stakeholders and taxpayers, the Agency has used multiple lines of evidence, both qualitative (client-user surveys and independent verifications) and quantitative, such as ecc statistics from multiple sources, ectric modelling, and time-trend analysis versus a comparison group (ACOA clients versus all Atlantic small- and medium-sized enterprises), to measure policy outcomes. This methodological approach is detailed and the findings with respect to broad macro-ecc indicators such as employment creation, earned income, tax revenues, and the unemployment rate are presented.

Is The Bottom Line "Impact" Or Profits? A Rejoinder

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Pages :
69-73

Support To Business In Underdeveloped Regions Makes Ecc Sense: A Reply

Logic Models In Primary Care Reform: Navigating The Evaluation

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Pages :
81-92

Primary care is under the microscope in Canada and worldwide. Governments are spending millions of dollars on reform initiatives to see whether innovative approaches will make any difference to the quality and cost of delivering primary care. The question of where to start in planning the evaluation of a reform is a common concern. This article considers the strengths and weaknesses of logic models in helping to evaluate reforms and highlights the model for the Nova Scotia Primary Care Demonstration Project evaluation. Lessons learned from the development of a logic model for this project are also discussed.

The Effectiveness Of A School-Based Hiv Education Program: A Longitudinal Comparative Evaluation

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Pages :
93-116

A school-based HIV/AIDS/STD education program was carried out and evaluated in four provinces. The Skills for Health Relationships program was developed from a conceptual model and included knowledge, attitudes, skills, and motivational supports. Teachers were trained in delivering the program and were given instruction on how to recruit and train student peer group leaders and how to encourage parental involvement. The evaluation used a quasi-experimental comparison group design with a student pre-test and three post-tests over a two-year period. The comparison group received their schools' usual sex education curriculum. The intervention group gained significantly in knowledge about STDs, in attitudes towards people living with AIDS, in intentions to communicate assertively in sexual situations, and in condom use skills. There were no significant differences in the proportions of students being sexually active or in actual use of condoms. The effect of a peer strategy was minimal in changing group norms.

Proposition d'un modèle d'évaluation de la mise en oeuvre et des effets de la planification des programmes régionaux d'organisation des services de santé mentale au Québec

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Pages :
117-147

To effect changes in the health care system, the Quebec government advocates an integrated program management approach within each region. In particular, regional service organization plans (PROS) are a strategy for developing this approach. PROS are complex and dynamic tools for planning services that aim to meet the diverse needs of regional populations and to coordinate delivery of services. To assess the potential of this intervention, this article presents an evaluation model adapted to the context of reform in the mental health sector. The evaluation model is based on exhaustive research on the implementation and impact of PROS and their contribution to implementation of the Mental Health Policy. This article provides guidelines for interpretation, the analytical framework, and relevant variables for evaluation. It also promotes a participative, emerging, and preventive approach to evaluation of integrated regional programs for mental health services.