MPH 550 Module 8 Evaluating the Initiative Example

Did It Make a Difference? Evaluating a Rural HPV Vaccination Health Education Initiative

Student Name

Master of Public Health Program, Aspen University

MPH 550: Health Behavior and Health Education

Instructor Name

Month Day, Year

Did It Make a Difference? Evaluating a Rural HPV Vaccination Health Education Initiative

A health education initiative is incomplete without a plan to learn whether it worked and how to improve it. This paper completes the proposal for a composite rural county's HPV vaccination initiative by presenting an evaluation plan organized around a public health impact framework, along with the budget and sustainability plan needed to seek funding.

Summary of the Initiative

The initiative aims to raise HPV vaccine initiation among 13-year-olds from 49% to 65% and completion from 34% to 50% over two years, through parent education, clinician presumptive recommendation training, reminder-recall systems, school-located vaccination days and pharmacy access, guided by a parent advisory group.

Evaluation Framework

RE-AIM judges a program on five fronts: the number and kind of people it touches, its effect on outcomes, uptake by settings and staff, how faithfully and at what cost it is delivered, and whether it lasts (Glasgow et al., 1999). It fits community initiatives because success depends on reach and adoption as much as on effect.

Measures

The table lists measures for each dimension.

Outcome Design

The main outcome, vaccination rates, will come from the state immunization registry. Because rates may change for reasons unrelated to the initiative, the evaluation will compare the county with a similar rural county without the initiative, comparing the two counties' trends over the pre-launch and post-launch periods. A difference in trends would suggest an initiative effect.

Beliefs and Intentions

Parent surveys at baseline and after one and two years will measure beliefs linked to vaccine acceptance, such as perceived effectiveness and risk of infection, and whether a clinician recommended the vaccine, which evidence identifies as key predictors (Brewer & Fazekas, 2007). Because intentions often do not translate fully into action (Webb & Sheeran, 2006), the evaluation relies on registry data for behavior rather than self-reported intentions.

Process Evaluation

Process evaluation will track whether components were delivered as planned: the number of clinicians trained, whether presumptive recommendations were used in observed visits, how many reminder messages were sent and how many students were vaccinated at school days. Process data explain why outcomes did or did not change. Short monthly reports from each clinic and school will allow quick fixes if a component falls behind.

Participatory Evaluation

The parent advisory group will help design survey questions, interpret results and decide on changes. Involving community members in evaluation reflects participatory principles of shared decision-making and sharing findings with all partners (Israel et al., 1998), and it increases the chance that results will be trusted and used.

Budget

The two-year budget totals $186,000: $92,000 for a part-time coordinator and data analyst, $28,000 for clinician training and parent ambassador stipends, $24,000 for materials and radio, $18,000 for school vaccination day supplies and staff, $14,000 for surveys and evaluation, and $10,000 for advisory group meetings and child care.

Sustainability

Sustainability depends on embedding changes in routine practice. Standing orders, reminder-recall and presumptive recommendation become clinic habits that cost little after training. School vaccination days can continue through the health department's routine immunization program. The advisory group plans to seek local foundation support for ambassador stipends. The county immunization coordinator's job description will be updated to include maintaining reminder-recall and school vaccination days after the grant.

Reporting and Use

Results will be reported to partners every six months, to the community through school newsletters and local radio and to the state immunization program annually. The evaluation will identify which components to keep, change or drop.

Equity in Evaluation

The evaluation will report vaccination rates by school district, insurance type and, where registry data allow, race and ethnicity. If gains are concentrated among families already more likely to vaccinate, the advisory group will help redesign outreach for families not being reached.

Ethics and Privacy

Registry data will be used in aggregate only, surveys will be anonymous and parents will be told how information is used. The evaluation will be reviewed by the health department's ethics process before data collection begins.

Threats to Validity

Statewide campaigns, changes in school requirements or vaccine supply problems could affect rates in both counties, which the comparison design partly addresses. Shifts in either county that could affect rates, like a new pediatric practice, will be tracked and noted in interpreting results.

Learning Agenda

Beyond whether the initiative worked, the evaluation will ask which components mattered most. Comparing clinics with high and low use of presumptive recommendations, and schools with and without vaccination days, will help identify the most effective elements for other counties.

Communicating Results

Short reports with simple charts will show partners and parents how vaccination rates changed, what parents said and what will change next. Sharing results openly, including disappointments, supports trust and continued participation.

Scaling Up

If the initiative succeeds, the state immunization program could adapt it for other rural counties. The evaluation's documentation of costs, components and lessons will make such adaptation easier.

Timeline for Evaluation

Baseline data collection will occur in the first three months, process data monthly, parent surveys at months 12 and 24, registry analyses every six months and a final report at month 26. A mid-course review at month 12 will allow adjustments.

Capacity for Evaluation

The health department's epidemiologist will lead registry analyses, with support from a state university public health program for survey design and analysis. The advisory group will receive training in interpreting results.

Conclusion

This evaluation plan uses RE-AIM to judge the initiative's reach, effectiveness, adoption, implementation and maintenance, relies on registry data and a comparison county for outcomes, tracks beliefs and delivery, and involves parents in interpreting results. With a modest budget and changes designed to last, the initiative offers the county a realistic path to protecting its adolescents from HPV-related cancers.

References

Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45(2-3), 107-114. https://doi.org/10.1016/j.ypmed.2007.05.013

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/ajph.89.9.1322

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173

Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132(2), 249-268. https://doi.org/10.1037/0033-2909.132.2.249