REACH: Identifying your Target Population, Recruitment, Outreach in Your EB Project. Philip McCallion, Ph.D.

Transcription

1 REACH: Identifying your Target Population, Recruitment, Outreach in Your EB Project Philip McCallion, Ph.D.

2 REACH Reach The absolute number, proportion, and representativeness of individuals who participate in a given program. Representativeness refers to whether participants have characteristics that reflect the target population's characteristics.

3 Why is Reach Important?

4 Which Program is Better? Program 1 Program2 0 Prog Success -

5 Which Program is Better Reach efficacy Adoption Implement

6 Attending to Reach Potential to change/improve outcomes for a large group of people Possible to serve people who will really benefit from the program Supports gaining funds Supports programs being sustained Helps in the process of figuring out how programs are best delivered to reach the most people likely to benefit Right thing to do?

7 Who usually participates in Studies/Demonstrations More resources More education More likely to self advocate Linked to service network Linked to service agencies or staff charged with recruitment Want help but not overwhelmed Have transportation and informal supports Like the program being offered Have taken part in other programs

8 Who Should Participate? Who needs assistance? Who is best served? Who is most likely to benefit? Who (and how many) does society/your state need to benefit for it to be worthwhile to fund or continue funding a program?

9 Exercise At your tables discuss - three groups you want to reach - why it is important to reach these groups - what have been your successes - challenges and barriers you are experiencing - strategies you are using or considering

10 Ways to improve Reach Use formative evaluation with users and non-users. Seek to discover how users react to the intervention and why non-users opt out. Apply what you learn to increase the rate of participation and to enhance reach. Conduct small-scale experiments. Do test runs to determine what works before conducting a large-scale intervention. Identify and reduce barriers. Find out what causes people to choose not to participate and what makes participants less likely to follow the program. As much as possible, eliminate or diminish the effects of barriers. Use multiple channels. Deliver the program or intervention using several formats and/or venues.

11 Who is the Target Population and where does the number come from? State-specific estimates of dementia or Alzheimer s disease prevalence Estimates derived from other and local datasets

12 Estimated Number of People with Alzheimer s by State, , ,000; 101, ,000; 51, ,000; 50,000 or less 2009 Alzheimer s Disease Facts and Figures

13 Estimated Number of People with Alzheimer s by State, , , ,000; 101, ,000; 51, ,000; 50,000 or less 2009 Alzheimer s Disease Facts and Figures

14 But who are you actually going to serve: Where does that target number come from? Searchable state data available through the Centers for Disease Control and Prevention s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) State s own datasets, e.g., if the state has a dementia registry. National Health Interview Survey (NHIS), National Hospital Discharge Survey (NHDS). What data drives policy making in your State?

15 Potential Target Populations All persons with condition Persons at risk for nursing home placement Persons at risk for Medicaid spenddown High expense consumers Caregivers at risk Underserved Low income Anyone who is interested?

16 Who are you Reaching in your program?

17 Estimated target population [y] 5000 Estimated number exposed to recruitment [a] 2000 Actual number who respond to recruitment [b] 500 Actual number who are eligible [c] 300 Actual number who participate [d] 100 % of target who respond to recruitment 10% % of eligibles who participate 33% % of REACH into target population 2%

18 Calculating and Reporting on Reach Determine a number for all potential participants in the target population (usually defined geographically). List the reasons for and number of exclusions of potential participants. List the number of "lost or indeterminant cases" - e.g., wrong information, not able to be contacted, moved, no answer. List the number of known eligible participants who were offered participation.

19 Divide the number of participants (persons beginning or coming to the first session of a program) by number of known eligible participants who were offered participation to determine Percent Participation. Determine the representativeness of participants by comparing demographic characteristics and other relevant variables between participants and nonparticipants. Report the most common reasons for declining participation.

20 Smoking cessation and a community school Why a principal said no,. Life in that community The resonance of the anti-smoking message Beyond the School s boundaries Who were the partners?

21 How do you Reach people: Recruitment Where do people listen? - faith communities, pharmacies, beauty salons, doctors offices, hospitals, help-lines, local newspapers, local TV & radio, health fairs, community carnivals, local diners What do they listen to? -Messages that are meaningful to their lives What should they walk away with? - A name, a number, a web address - Basic information - Agreement about follow-up - A date and time to start if they are ready - A chance to think about it

22 Inclusion/Exclusion Criteria Explicit: targeting those who are known to benefit from the program and those who you now wish to serve Implicit: the extent to which the content or the manner of delivery encourages or discourages participation

23 When the program is not enough Support groups and education when we need care management and benefits counseling Some things are meaningful and others are not part of our lives: What are core elements? I do not see myself in your group participants, your literature and in your leaders I don t like sitting in a group Recruiting men: What can we learn from each other?

24 What comes first? Enough deliveries of the intervention in enough places with sufficient diversity that it seems credible that this is a mechanism to Reach the target population? Demonstration first in smaller efforts that the intervention will address the needs of the target population and its quality can be sustained?

25 Barriers to Participation Location and timing - Why does the meeting have to be evening/day/weekend/morning/afternoon - Why weekly/biweekly - Why the same day and time for every session - How do people with no transportation get there AND get home afterwards? - What about respite? - Do all the sessions have to be delivered in person

26 Listening to non-participants - What part of the message didn t I hear? - What aspects of the program didn t appeal to me? - What components of the program made me uncomfortable? - What was it about the messenger that turned me off? - What was I looking for that the program isn t providing? - Can people with few respite supports really attend?

27 Listening to drop-outs - What aspects of the program didn t appeal to me? - What components of the program made me uncomfortable? - What was it about the leader or the other participants that turned me off? - What was I looking for that the program isn t providing? - What was it about location, timing, respite supports and transportation that made it difficult for me to continue? To what extent are these issues relevant for other people we are trying to Reach

28 Listening to completers Same questions as for drop-outs What aspects of the program and its delivery encouraged me to come back? Why would I recommend this program to someone else? How can we involve you in delivery, recruitment or other support of this program?

29 What else should we look at? Reach and Cost of Delivery - staffed models are more expensive to deliver than volunteer-led and may be difficult to sustain, particularly in rural and inner city communities, is there sufficient Reach to justify the cost? - Reach itself is a cost center Understanding the Competition - is this program providing something different from available non-evidence based programs or other evidence based programs? - are barriers to participation greater here than for available nonevidence based programs or other evidence based programs? Engagement of partners coalition building - do you believe that the program speaks for itself and other organizations should either help or get out of the way or are you working effectively with those organizations?

30 Who are you? Elite Organizations: Serving the community but not always located there; professionally staffed, who funders turn to but community is one of many priorities Intermediary or mid-tier: Community based, founded to respond to unmet needs or lack of culturally relevant services, rarely well resourced Grassroots: Assumes a provider role often serving the most isolated and disconnected with few resources of their own

31 Engaging New Partners Becoming competitive for awards Recognizing that existing approaches are not effective Partnering Technical assistance Purposeful cultivation Not accepting that it cannot be done

32 The Healthy Hearts on the Hill Coalition

33 Needs Assessment and Evaluation Technical Assistance An Advocate Information Clearinghouse A Community Member Grant- Writing Center for Excellence in Aging Services Project Management Co-Designer Co- Facilitator Program Fidelity Evidence-based Program Expertise A Genuine Partner

34 Faith Communities Center for Excellence in Aging Services Volunteers Koinonia Health Center Neighborhood Association Health Advocates

35 Faith Communities Center for Excellence in Aging Services Volunteers Koinonia Health Center Neighborhood Association Health Advocates

36 Faith Communities Center for Excellence in Aging Services Volunteers Koinonia Health Center Neighborhood Association Health Advocates

37 Evidence based health promotion programs Caregiver support Neighborhood health advocates Weekly health screening programs Walking clubs and safe places to exercise The Biggest Winner Contest

38 Is Reach the Most Important Concern? An intervention with high Reach, but little or no Efficacy will have limited impact. If an intervention has high Reach and impressive Efficacy, but no organizations will Adopt the intervention, or only a handful of experts can successfully Implement the program, it will have limited real world impact.

39 Questions?