| Study |
Overview |
Evaluation |
Performance
Indicators |
Target |
Findings |
Comments |
| Smoking
Cessation |
| Lando 1991 |
General media campaign tied to
a contest to ensure follow-up; Evaluated using telephone surveys to compare those who sent
in interest cards and pledged to stop-smoking versus those who sent in cards but did not
pledge to stop smoking |
Nonrandomized trial with
contemporane-ous controls, also compared outcomes from previous study (historical control) |
Outcomes – comparing
difference in quit rates between pledgers and non-pledgers |
Community- wide intervention,
public awareness activity |
Study contained two
comparisons: (1) historical control and (2) differences between pledgers. The study found
that an extended enrollment period and intensive campaign increased enrollment, and
overall quit rates. Pledgers had higher self-reported abstinence rates. |
No control group of a
community without the intervention, but the historical control is a good indicator of
change; detects differences in those who quit versus those who did not |
| Popham 1993 |
A group of people who quit
smoking were selected from the entire population of those exposed to California’s
anti-tobacco media campaign to measure the exposure of those who quit to the campaign |
Cross-sectional study,
retrospective, no comparison group |
Whether or not respondents saw
the advertisements; Attempt
to determine if process correlates to the specified outcome |
Community, public awareness
activity |
Study sought to evaluate what
influenced people to stop smoking during the campaign and determined that the media
campaign had influenced change |
No comparison group for this
study; other smokers who didn’t quit smoking may have seen the study and not quit |
| Werch 1994 |
Applies Prochaska’s
stages of change model to the formation of a unhealthy behavior to better focus prevention
strategies; Paper is theoretical without an actual intervention |
Methods/theory paper |
N/A |
Community, Public Awareness |
N/A |
Applies health belief, social
learning, and behavioral self-control theories to stages of change and strategies that
could be used in prevention or behavior promotion; May provide a good theoretical
background |
| Prochaska 1983 |
Used a test of 40 questions to
track subjects for 2 years to determine the progression through stages of change related
to quitting smoking |
Methods/theory paper |
N/A |
Community, Public Awareness |
N/A |
No evaluation of specific
intervention but may be correlated to success in stages of change |
| Prochaska 1992 |
Outlines process by which
addictive behaviors are modified and stages of change: precontemplation, contemplation,
preparation, action and maintenance |
Methods/theory paper |
N/A |
Community, public awareness |
N/A |
Stages of change may be a
useful aid to evaluate organ donation strategies; a baseline study could determine how
people cycle through the stages of change leading to consent; then, interventions could be
designed and evaluated based on these stages of change |
| Mammography
and Other Cancer Screening |
| Strickland 1997 |
Compared the impact of three
interventions (physician message, message with class, message, class and reinforcement) on
breast self examination compliance |
Large randomized controlled
trial |
Percentages of women doing
breast self exams at 2 follow-ups over the course of 1 year |
Provider organization
intervention, women general awareness |
The more comprehensive
intervention was more successful in the number of women doing breast self examination |
One of the few examples of a
large RCT done to influence health behavior changes that may serve as a good model for the
organ donation world (particularly because of the provider education/support focus) |
| Champion 1995 |
An evaluation to measure the
effect of an individualized belief and/or information intervention on mammography
compliance |
Randomized controlled trial |
Stages of change and adherence
to mammography screening |
Control group and 3
intervention groups; educational activity |
Women in the belief/
information group were 2x more likely to have been compliant with intervention 1 year
later; women receiving the belief intervention were more likely to move to a higher stage
of change |
A good example of a
randomized, controlled trial used in program evaluation regarding health behavior
education with 4 randomized intervention groups, baseline screening and 2 follow-up
measurements |
| Campbell 1997 |
An office-based computer
system was randomized to provide women who filled out a computer health survey with either
follow-up recommendations or no recommendations. Study sought to determine if these
recommendations made a difference |
Small randomized controlled
trial |
Compared #s who had a PAP
smear in the 6 months following the visit |
Targeted members of community,
public awareness |
Results were inconclusive |
The investigators were unable
to draw conclusions regarding the effectiveness of the computer system due to the modest
proportions of women screened, the small numbers, and the fact that the computer survey
may have created an intervention effect in the control group |
| Worden 1994 |
Description of a study design
methodology based on baseline data to assess women’s participation in mammography,
clinical breast examination, and breast self-examination and to measure factors that may
affect their participation. |
Nonrandomized trial with
contemporaneous controls |
Will look at intermediate
objectives, behavioral outcomes, and health benefits |
Women, their physicians, and
the health care system in a single, comprehensive program; public awareness activity and
provider education and support |
The telephone survey did not
receive as good a response as the household surveys |
Sets up a useful framework for
designing an evaluation of a multi-level intervention; uses baseline survey data to
develop program components |
| Rakowski 1992 |
Survey to assess whether or
not stages of change impacted women’s decision about mammography |
Survey, one point in time |
Questions developed to assess
stages of change and at what stage certain behaviors were adopted |
Community, public awareness |
Provided results that could be
used to extend the transtheoretical model of behavior change to mammography screening |
Provides a model for the kind
of baseline study that the organ donation community could use to learn how to measure
stages of change. Then actions could be planned from this study. |
| Rakowski 1997 |
Survey to examine the utility
of the construct of decisional balance for mammography and pap testing |
Survey |
Attitudes regarding testing
and recent testing behavior |
Community, public awareness
activity |
Options about testing may
carry over for several kinds of testing. |
The ability to employ combined
indicators for frequency of testing and test-related opinions is promising for being able
to take a more comprehensive approach to women’s health. |
| Mayer-Oakes 1996 |
Longitudinal study of women
under the care of internists to determine factors that predict mammography use |
Telephone survey |
Sociodemograph-ics, physical
functioning, psychosocial functioning, preventive and self-care behaviors and mammography
use |
N/A – no intervention but
a survey of women in general |
Mammography screening was
significantly higher among women who had recently received a Pap smear, whose annual
household incomes exceeded $30,000 and whose personal health care habits were preventively
oriented. |
A baseline survey from which
interventions could be built and evaluated |
| Savage 1996 |
Survey to assess the Health
Belief Model in relation to a Woman’s decisions to have screening mammographies and
do breast self examinations |
Telephone survey |
Questions developed to assess
correlates of health behaviors including demographics and attitudes |
N/A – no intervention but
a survey of women in general |
Different variables were found
to be predictors of adherence to mammography and breast self exam |
A baseline survey from which
interventions could be built |
| Scammon 1995 |
An evaluation of the role of
free mammograms in motivating first-time screening in a community. |
Series of consecutive cases |
Demographics and attitudes of
factors in decision to get mammogram were measured. |
Women, asymptomatic for breast
cancer, 35 and older; public awareness activity |
The free mammography may have
helped bring women in, but other factors need to be reinforced (i.e., the feeling of doing
something good) to maintain screening patterns. |
No controls, and women who
were willing to return the survey are the results that were included. |
| Physical
Activity Promotion / Obesity Treatment |
| Stone 1996 |
An 8-year multicenter
randomized trial investigating whether behaviorally oriented cardiovascular school and
family-based health program produced positive changes in the health habits that favorably
affect the cardiovascular risk profile of elementary school preadolescents. |
Large randomized controlled
trial (unit of randomization is the school rather than individuals) |
Outcome measures including
changes in serum cholesterol, physical activity, and dietary measures |
Individual students and
family, public awareness activity |
As of publication, data
analysis was in progress. However, due to low prevalence rates of smoking in the 5th
grade, the study did not have sufficient power to detect differences between experimental
and control groups. |
This trial uses schools as the
unit of randomization – similarly the organ donation community could use hospitals or
regional-OPOs as the level of randomization. |
| Marcus 1997 |
A pilot study to test the
feasibility and efficacy of a physician-delivered physical activity counseling
intervention. |
Small randomized controlled
trial |
Physical activity levels |
Provider education to improve
patient results |
Physician-delivered physical
activity interventions may be an effective way to achieve wide-spread improvements in the
physical activity of middle-aged and older adults. |
This small scale study may be
similar to the kinds of hospital-level provider education efforts conducted in the organ
donation community. |
| Cakfas 1997 |
Evaluated whether an
intervention to change physical activity changed such mediators as stages of change,
self-efficacy and social support, and whether changes in the mediators were associated
with behavior change. |
Nonrandom contemporaneous
control |
Mediators (changes in stages
of behavior) and outcomes (actual changes in behavior) |
Providers and patient
education program |
Patients who were counseled
improved significantly more than those in the control group on behavioral and cognitive
processes of change. Two of three mediator variables were associated with changes in
physical activity. |
Serves as a good model for how
the organ donation community might test stages of change model, however measuring
donations as a result of this intervention might be difficult. |
| Fontaine 1997 |
Tested a self-efficacy
questionnaire to assess its predictive validity in treatment outcomes for obesity |
Time-series |
Outcome measures of attendance
and weight loss, intermediate measures of self-efficacy |
Individual patients, awareness |
Self-efficacy judgments (as
measured by the Weight Efficacy Lifestyle Questionnaire) are not predictive of short-term
obesity treatment outcomes |
Another example of a study
used to test the predictive value of measures of propensity to change health behaviors |
| Marcus 1992 |
Survey to assess whether or
not stages of change and self-efficacy impact exercise behavior change |
Survey, one point in time |
Questions developed to assess
stages of change and at what stage certain behaviors were adopted |
Community, public awareness
activity |
Provided results that could be
used to extend the transtheoretical model of behavior change to stages of exercise
behavior change; basic goal is to develop a reliable instrument |
Provides a model for the kind
of baseline study that the organ donation community could use to learn how to measure
stages of change; actions could be planned from this study |
| Potvin 1997 |
Documented the differing
prevalence rates for stages of change for physical activity across rural, suburban and
inner city communities using survey methods and controlling for education, gender and
disease status |
Survey |
Stage-of-change measurements |
Community, public awareness |
The findings suggest that
above and beyond individual difference variables, structural components such as type of
community are related to people’s readiness for physical activity involvement |
There may be community-level
or other types of factors which influence the stage of change someone is in with regard to
organ donation – further studies may be required to determine them |
| Cardinal 1995 |
A stage of exercise scale was
developed to differentiate between subjects classified into each of the transtheoretical
model stages of change and tested in females |
Develops survey instrument for
testing |
Several measures that might
impact stages of change |
Female adults, public
awareness activity |
Results showed that the scale
was able to significantly and meaningfully differentiate between subjects classified by
stage in terms of exercise energy expenditure, physical activity energy expenditure and
other metabolic measures |
The organ donation community
may want to develop and rigorously test a similar type of scale for measuring the stages
of change for organ donation |
| Cardinal 1995 |
The study developed,
evaluated, and compared two sets of written materials which promoted regular physical
activity and fitness-promoting behaviors. |
Review of materials to promote
behavior change |
Measured whether or not the
materials were readable |
Community, public awareness |
No significant differences
were observed between the two information packets; this could have been due to the small
sample size. |
One method for measuring
public reaction to information on organ donation, but instruments would have to be further
tested to see which results in actual behavior change. |
| Marcus 1994 |
Review of studies which
measure stages of change in relation to exercise behavior change |
Review and theory |
N/A |
Community, public awareness
activity |
Applications of the
transtheoretical model of the initiation, adoption, and maintenance of exercise behavior
from clinical community, and public health perspectives are discussed |
The transtheoretical theory of
behavior change may also be applicable to organ donation |
| Occupational
Health |
| Jeffery 1993 |
An evaluation of a program
that used tangible incentives to promote worksite health (specifically obesity and smoking
cessation) |
RCT – Quasi |
Process measures of numbers of
participating employees and one outcome measure of average weight loss |
Community, public awareness
activity |
The power of the study was too
small to determine differences between the incentive and non-incentive groups |
One example of an attempt to
conduct a randomized, controlled study in a naturalistic setting, and suggestions for
improving study power |
| Kurtz 1997 |
An evaluation of peer and
professional trainers in a union-based occupational health and safety training program |
Non-randomized controlled
trial |
Self-efficacy, outcome
efficacy, and behavior |
Community, trainer education
program |
Workers trained in health
safety by their co-workers reported changing behavior more often than those workers
trained by professional trainers |
Intervention may be comparable
to hospital-level interventions and organ donation education programs; this paper provides
one type of evaluation model |
| Zwerling 1997 |
Reviews evaluation strategies
for programs to prevent occupational injury – notes that these kinds of evaluations
could be improved and presents a hierarchy for improvement |
Few RCTs are conducted –
researchers should begin with qualitative studies and follow-up with simple
quasi-experimental designs, then more complicated quasi-experimental designs, and RCTs
when possible |
Outcomes in reduced injury and
intermediate outcomes of measurable events along the causal pathway |
Worker education |
Proposes a number of
strategies to improve these evaluations while recognizing that RCTs may not be feasible
due to difficulties of randomization, study groups contamination, and population turnover |
Provides an overview of
evaluation strategies in another behavioral health intervention field that may inform
efforts to improve evaluations of organ donation activities |
| Other
Conditions |
| Forst 1990 |
A review of AIDS programs
evaluations noting the lack of methodologically rigorous studies and the expense of
longitudinal studies over time. |
Discusses several evaluation
options |
Ouctome measures should
include changes in knowledge, linked to attitude changes, linked to behavior changes
– few studies achieve this |
Community and targeted members |
Some problems with the
evaluations included: sites used only a post-test design to measure competency but no
measure of change; tests were not standardized or compared across sites |
Forst suggests areas for
improvements in AIDS education evaluation studies; these programs face many similar
difficulties as organ donation activity evaluation |
| Nonis 1996 |
A survey was conducted of
college students blood donors versus non-donors to identify attitudes and plan future
studies |
Framework study, No real
intervention to change behaviors |
Attitudes |
College Students |
Develops strategies for blood
collection agencies to market to students |
Blood donation is more closely
related to organ donation than some of the other behavioral change activities—may
provide a useful methodology for understanding organ donation tendencies |
| Evaluation
Methods |
| Terrin 1997 |
Paper evaluates the three
important approaches to evaluating lifestyle and health outcomes: observational studies,
individual subject random assignment trials, and community random assignment trials |
Methods paper for
community-level interventions Observational Studies, individual subject random assignment,
and community random assignment |
Lifestyle and health outcomes |
Community-level interventions |
Community randomized trials
may be the best way to decide such public health policy issues as whether or not to use a
community-wide anti-smoking program |
Community randomization may
also be a good method for evaluating organ donation activities, particularly public
awareness campaigns |
| Stampfer 1997 |
A methods paper discussing how
and why large randomized clinical trials may not be feasible in evaluating the health
effects of behavioral change, but rather how large-scale observational studies might
provide useful information |
Methods paper for evaluating
the health effects of behavioral change; Randomized trials versus large-scale
observational studies |
Health effects |
Community-level interventions |
Due to limitations of using
RCTs to evaluate health behavior change, observational studies continue to provide useful
information |
Evaluations of organ donation
activities face similar constraints as health behavior promotion activities; this paper
describes options for study design that may help to improve the rigor of studies while not
making them infeasible |
| Green 1995 |
Paper outlines an approach for
the design and analysis of RCTs investigating community-based interventions for behavioral
change aimed at health promotion |
Approach to community-matched
trials. 11 matched pairs of communities, randomized at community level, number of
communities determines power |
Outcome of smoking cessation |
Community-level smoking
cessation trial |
Approach outlined helps
improve the rigorousness and robustness of methods for evaluating the effects of community
interventions |
Similar types of community
interventions are employed in the organ donation world; this methodology and the suggested
ways to improve study design could prove useful – particularly with regard to
matching pairs of communities for intervention versus control |
| Guiffrida 1997 |
Reviewed randomized trials
that tested the use of financial incentives to enhance patient compliance |
Review of other RCTs |
Compliance |
Patient-level intervention,
financial incentives |
Financial incentives can
improve patient compliance with medical advice |
As the use of financial
incentives has been suggested as a means of increasing organ donation, this paper provides
references for other financial incentive |