Appendix F
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Appendix F

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Background

Table of Contents • Introduction • What Do I Need to Get Started? •  Falls Free® Logic Model  • Standard Set of Survey Questions • Next Steps • Appendix 

In 2008 NCOA, the UNC Institute on Aging and the initial 10 state coalitions collaborated in the development of an online coalition building tool (www.coalitions.fallsfree.org) in which the greatest challenge identified by states was the lack of evaluation capacity to measure the impact of coalition activities. Recommendations that emerged from a subsequent CDC/ National Center for Injury Prevention (NCIPC) and Safe States Alliance meeting emphasized the need to measure a variety of outcomes that can demonstrate progress toward a change in the rate of falls or fall-related injuries. In 2009 with the support of the Archstone Foundation, NCOA convened the States Coalitions’ on Fall Prevention “Evaluation Committee” that included research advisors from CDC and academic institutions. To better inform the work of the Committee and in recognition of the rapid growth of State Coalitions on Fall Prevention to over 40 states today, the Committee first surveyed states on their current evaluation activities and capacity. With those findings in mind, the Committee explored a variety of potential evaluation activities resulting in the recommendations put forth in this document.  

Who is making the recommendations?: The Evaluation Committee is made up of 15 members whose participation was invited by NCOA. The list of Evaluation Committee members is included as Appendix H. Members have diverse and complementary professional backgrounds in research, public health, and/or gerontology. Each member is actively involved in his or her state coalition.

Assumptions: The Evaluation Committee’s collective and deliberate discussions have resulted in strong evaluation recommendations. The evaluation committee worked under several assumptions:

  • State Coalitions have a vested interest in enhancing their evaluation capacity.
    • State Coalitions share a long term goal of reducing the rate of falls and falls-related injuries and deaths; measuring the coalitions’ impact on falls and fall injury rates will necessitate a long-term strategy.
    • By demonstrating the impact of their work, state fall prevention coalitions will be in a better position to leverage funding, influence policy and build partnerships within the coalitions and across the state.  
  • Evaluation activities are needed to measure the impact of state fall prevention coalition activities on modifiable outcomes.
  • The strongest fall prevention evidence available pertains to older adults living in the community; therefore community-based older adults and their supports should be targeted through coalition-based evaluation efforts.
  • The process of developing and implementing community interventions and facilitating the movement of stakeholders can be portrayed in a logic model. 
  • Measuring stakeholders’ beliefs, attitudes and behaviors is consistent with health behavior theories and results in measurable short term and longer-term outcomes.
    • Documenting short-term outcomes can keep coalition members and stakeholders engaged, support recruitment of new members, keep state and local governments interested in the topic of falls, and obtain funding sources. 

It is important to note that the above assumptions are consistent with findings from the 2009 State Evaluation Survey. Those findings highlight that state coalitions and their partnering agencies 1) have limited budgets; 2) have varying levels of evaluation expertise and resources; and 3) have varying evaluation needs and capacity.

The premise of the national Falls Free® Initiative is that everyone in the community has a contribution to make, within his/her own sphere of influence, to reduce falls among the elderly. The principle comes from the evidence-based, consensus recommendations found within the National Action Plan.  

The Evaluation Committee embraced the CDC’s (MMWR 1999) recommendations that emphasized the importance of balancing of the following standards to ensure evaluation effectiveness.

 CDC (1999) MMWR: Framework for Program Evaluation in Public Health

    • Utility: The evaluation should be meaningful and useful.
    • Feasibility: The evaluation should provide a practical analysis and should also be cost effective.
    • Propriety: The evaluation should consider confidentiality of participants, in addition to the legal and ethical implications for those affected by the results.
    • Accuracy: The evaluation should provide a truthful representation and should communicate technically accurate information.

 

Falls Matrix

A Concept for Evaulating State Falls Coalitions

Jonathan Howland, PhD, MPH,
Elizabeth Peterson, PhD, OTR/L, FAOTA,
Tamara Vehige Calise, DrPH, MEd

The aim of this matrix is to array the stakeholder/awareness cells which contain specific measures and data collection methodologies. Each cell, for example, might have two or three measures and for each measure one or more data collection methodologies (e.g., survey, key informant interview, focus group, analysis of archival data). Detailed operationalization of measures and methods would comprise a manual which coalitions could use to guide their evaluation activities.

To support state coalitions in their evaluation efforts, NCOA could support development of a manual or detailed matrix that details how to operationalize recommended measures (e.g. fall prevalence among older adults) and data collection methods across the public health framework. The aim of the manual would not be to limit what and how coalitions evaluate.  Instead, the aim would be to ensure that if coalitions wanted to assess items within a specific stakeholder-awareness cell, they have the ability to use a uniform measure and data collection methodology. This would allow for longitudinal tracking of trends and cross- state comparisons.

It is acknowledged that many coalitions have limited resources to devote to evaluation. It is assumed, therefore, that coalitions will pick and choose stakeholder-awareness cells to focus on, either at a given time or over time. Nonetheless, coalitions can pursue funding for evaluation and using measures and methods that are uniform and the product of cross-coalition consensus should enhance the likelihood of external funding and the value of evaluation results.

 
EVALUATION MATRIX

Overview

Older AdultsAdult Children of Older Adults Primary Care Providers

State Legislators

 SALIENCE
(e.g., How important is fall prevention? 

 X

 X

 X

 X

 BELIEFS
(e.g., are falls preventable?)

 X

 X

 X

 X

 BEHAVIORS
(e.g., what do we do to prevent falls?) 

 X

 X

 X

 X

 FALLS INCIDENCE 

 X

 NA

 NA

 NA

 

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