Letteratura scientifica selezionata sul tema "Health surveys Evaluation"

In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

Having spent a considerable amount of time thinking about the uses of large-scale descriptive psychiatric epidemiological needs assessment surveys in our capacity as co-directors of the World Health Organization's World Mental Health Survey Initiative, we agree with many of the conclusions of Henderson and Andrews. Most importantly, we agree: ∘that among the most important benefits of these surveys have been their political value in documenting high prevalence and high disability∘that the time has come to expand the focus to study causes.

Purpose To examine the impact of a pilot VA Whole Health Coaching program, including whether and how the program helps veterans improve their health and quality of life. Intervention Whole Health Coaching is a structured program to support veterans in making healthy behavior changes to promote holistic well-being. Design This mixed-methods quality-improvement evaluation combined surveys (pre- and post-coaching) with follow-up qualitative interviews. Setting The setting was a large VA healthcare system, encompassing a medical center and six community-based clinics in Northern California. Participants 65 veterans completed surveys at both time points; 42 completed qualitative interviews. Method Telephone surveys administered at baseline and 3 months assessed global health (PROMIS-10), perceived stress (PSS-4), and perceived health competency (PHCS-2). Pre- and post-scores were compared using t-tests. A subsample of participants completed a qualitative interview evaluating program experience, goal attainment, and the coaching relationship. Results Surveys showed significant improvements over baseline in mental health (p = 0.006; d = 0.36), stress (p = 0.003; d = –0.38), and perceived health competence (p = 0.01; d = 0.35). Interviewees were highly satisfied with their coaching experience, describing both effective program components and improvement opportunities. Conclusion Whole Health Coaching can help participants make meaningful progress toward health goals, reduce stress, and improve quality of life. The Whole Health model’s emphasis on holistic self-assessment; patient-driven goal-setting; supportive, non-judgmental inquiry; and mindful awareness contributed to program success and enhanced participants’ experience.

Abstract Introduction. Patient satisfaction surveys are still popular tools for obtaining feedback on the quality of health care. Nonetheless, there is a paucity of data to indicate whether health care providers even want patients to assess the quality of care delivered. Neither it is certain whether patients are interested in participating in such surveys. Aim. To present and compare the perspectives of doctors, nurses, and patients on the validity of health care customer satisfaction surveys. Material and methods. A cross-sectional survey design was used. The questionnaires were administered to doctors, nurses and patients in three hospitals of different sizes (small, medium, and large), all in the north-east of Poland. Each sample group was given 200 questionnaires; responses were received from 95 doctors (47.5%), 190 nurses (95%), and 182 patients (91%), and included in the final analyses. Results. Most respondents (doctors - 64.2%; nurses - 61.6%; patients - 87.4%) answered ‘Yes’ to the question ‘Do you think that patients should evaluate the quality of health care?’ Analysis of data allowed to identify the following main reasons why patients should evaluate the quality of health care: 1. to enhance the quality of care; 2. to recognise patients as evaluators; 3. to motivate providers to work more efficiently; and 4. to emphasise the impact of evaluation on a core value, i.e. health. Doctors and nurses outlined reasons why they did not advocate conducting patient satisfaction surveys: satisfaction surveys are redundant; negative evaluations; unwillingness to be evaluated by patients; satisfaction surveys hamper effective work with patients; surveys are not objective; survey results are not communicated to providers. Conclusions. Patient satisfaction surveys are desirable tools for evaluating the quality of health care delivery despite the fact that they frequently raise concerns amongst providers and patients. There is, therefore, a definite need for providers to experience the benefits of measuring patient satisfaction. Another important practical implication is that patients need to be convinced that their opinions do matter and contribute to improving the quality of services.

AbstractEngineering design methods are typically evaluated via case studies, surveys, and experiments. Meanwhile, domains such as the health sciences as well as software engineering have developed further powerful evaluation approaches. The objective of this paper is to show how evaluation approaches from the health sciences and software engineering might further the evaluation of engineering design methods. We survey these approaches and show which approaches could be transferred to the evaluation of engineering design methods.

Although the Drug-Free Schools and Communities Act of 1986 and the 1989 Amendments to the Act require states to evaluate their drug-education programs, no guidelines for conducting these evaluations have been produced, and little has been reported on how the states are conducting such evaluations. In this article, the results of a telephone survey on current state-level efforts to evaluate school programs funded under the Act are reported. Some states report studies of the implementation of the program and some report drug- and alcohol-use surveys. Together, these two types of evaluation efforts form the foundation of an approach for conducting evaluations under the Act. Reasons are presented why experimental and quasi-experimental designs might be inappropriate and impractical for the evaluations, and an evaluation approach linking program implementation findings and drug- and alcohol-use survey results is suggested.

Thesis (Ed.D.)--Teachers College, Columbia University.
Typescript; issued also on microfilm. Sponsor: Joan Gussow. Dissertation Committee: Isobel Contento. Includes bibliographical references (leaves 125-131).

The dissertation is a compilation of three essays on Turkey's poverty alleviation programs. The first paper focuses on the welfare impact of the global financial Crisis on Turkish households. The second paper considers the protective impact of the Green Card non-contributory health insurance program in Turkey during the Crisis in 2008-2009. The third paper uses experimental data from the field in eastern Turkey, to look at patterns of agricultural technology diffusion in a rural development program implemented in a post-conflict setting.

This thesis examines the implications of using different correlation input matrices and estimation techniques in confirmatory factor analyses (CFAs) when analyzing ordinal, nonnormal data derived from responses of recently arrived Australian immigrants to the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 is one of the most widely used instruments for determining wellbeing in populations. The response format of the GHQ-12 comprises four ordinal categories and underlying distributions of data obtained invariably do not approximate univariate or multivariate normality. Owing to these data properties, consideration should be given to the application of appropriate statistical approaches for analyzing this type of data sets. This study also investigates the extent to which the GHQ-12 is invariant across gender and cultural groups. A three-dimensional measurement model for the GHQ-12 was initially examined for four groups of Australian immigrants who originated from Hong Kong (n = 201), Mainland China (n =213), former Yugoslavia (n = 259), and the United Kingdom (n = 428). A series of CFAs using either a Pearson�s product-moment or a polychoric correlation input matrix and employing either maximum likelihood (ML), weighted least squares (WLS) or diagonally weighted least squares (DWLS) estimation methods was conducted on the data. A comparison of the parameter estimates and goodness-of-fit statistics obtained for the different analyses provided support for using polychoric correlation input matrices and DWLS estimation in CFAs when analyzing ordinal, nonnormal data with smaller sample sizes. Invariance tests across gender and cultural groups were conducted on a second-order measurement model for the GHQ-12, culminating in significant differences between the two Asian and two European cohorts. The GHQ-12 was invariant for immigrants from Hong Kong and Mainland China, as well as for males and females from the United Kingdom. Partial invariance of the GHQ-12 was found for immigrants from Asia, the United Kingdom, and former Yugoslavia and for Asian males and females. Findings from the present study suggest that estimating models based on nonnormal ordinal responses using polychoric correlations with DWLS is more likely to result in a solution with higher parameter estimates and better indices of fit than other approaches. Further research should be conducted on real and simulated data to investigate the efficacy of WLS and DWLS estimation in CFAs when using polychoric correlations as the input data for varying categorical response formats, with a range of model and sample sizes.

The purpose of this correlational study was to evaluate the validity and reliability of the Healthy Athlete® Health Promotion questionnaire as an instrument to assess the true dietary habits of Delaware County, Indiana, Special Olympics Athletes. A total of 35 Delaware County Special Olympics athletes completed this study. The athletes’ true dietary habits were estimated using a three-day food record and the Caregiver Questionnaire (CQ). Results indicated the Healthy Athletes Software (HAS) nutrition questions lacked statistical strength in both reliability and validity. The test-retest indicated only one-third of the questions were identified as reliable (Kappa ranged from 0.347 to 0.773; r ranged from 0.356 to 0.794). When compared to the standard, only three of the 15 food items on the HAS questionnaire had a significant relationship to the standard (r coefficients ranged from 0.458 to .777). In contrast, 11 of the 15 food items on the CQ were highly correlated with the three-day food record. The results of this study indicate the need for improvement to make to the HAS nutrition questions more reliable and valid in the assessment of Special Olympics athletes’ dietary habits
Department of Family and Consumer Sciences

Orientadores: Karina Gonzales Silvério Ruiz, Cristiane Ribeiro Salmon
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-27T14:21:58Z (GMT). No. of bitstreams: 1 Barbosa_MarcelaDiMoura_M.pdf: 3074144 bytes, checksum: 106aa08cced6cc330bfb74a1eeb1a037 (MD5) Previous issue date: 2015
Resumo: As doenças periodontais são doenças inflamatórias crônicas que afetam os tecidos periodontais de suporte do dente podendo ser destrutivas ou não. A identificação dessas doenças em estudos epidemiológicos é feita com o uso de índices periodontais que visam simplificar a coleta dos dados e possibilitar a identificação da doença em grandes populações. O presente estudo teve como objetivos avaliar as condições de saúde bucal da população do Município de Jundiaí, SP, determinando a prevalência das condições periodontais em indivíduos adultos e idosos comparando o Índice Periodontal Comunitário (CPI) e o Periodontal Screening and Recording (PSR), descrever o perfil demográfico, socioeconômico, o acesso a serviços odontológicos e os hábitos de higiene bucal e verificar a associação entre condições socioeconômicas, demográficas, hábitos de higiene bucal, utilização de serviço odontológico e tabagismo com a doença periodontal. Este estudo transversal foi realizado no Município de Jundiaí, Estado de São Paulo, entre o período de abril a setembro/2014. Foram estudados 372 indivíduos adultos (35 a 44 anos de idade) e 162 idosos (65 a 74 anos de idade) residentes no Município de Jundiaí e visitados em suas residências. Participaram da coleta de dados 5 Cirurgiões-Dentistas que passaram por calibração, apresentando concordância para os índices CPI e PSR de 63 a 91%, com Kappa variando de 0,63 a 0,76. Para as características demográficas e socioeconômicas, hábitos de higiene bucal, informações sobre saúde bucal, utilização de serviço odontológico e condições periodontais, foi realizada a análise descritiva dos dados para a população adulta e idosa, apresentada como valores absolutos (n) e prevalência (%). A diferença entre a média de sextantes afetados com cada condição periodontal para os índices CPI e PSR foi avaliada pelo teste T pareado. Verificou-se que 68% dos adultos e 60,5% dos idosos examinados eram do sexo feminino, 46% e 37% têm renda familiar de 4 salários mínimos ou mais, respectivamente. 57,3% dos adultos e 64,2% dos idosos afirmaram desconhecer o que é a doença periodontal. 58,6% dos adultos com profundidade de bolsa ?4mm afirmaram ter vivido uma infância pobre ou muito pobre e 73,9% afirmaram que a situação econômica atual estava melhor que a da infância. Comparando-se os índices CPI e PSR, houve diferença estatística significativa para o diagnóstico de sextantes saudáveis, presença de bolsa rasa (código 3, bolsa periodontais de 4mm a 5mm) e bolsa profunda (código 4, bolsas com profundidade de sondagem ?6mm), sendo que o índice CPI subestimou a periodontite e superestimou os sextantes saudáveis quando comparado aos resultados de PSR. Escolaridade, situação econômica na infância, frequência de visita ao dentista, uso de fio dental e tabagismo, estiveram associados a maior prevalência de doença periodontal na população adulta. Por outro lado, somente o intervalo de tempo desde a última consulta odontológica e o fato do indivíduo ser ex-fumante estiveram associados a maior prevalência de doença periodontal nos indivíduos idosos
Abstract: Periodontal diseases are chronic inflammatory diseases that affect the periodontal tissues of tooth support and can be destructive or not. The identification of these diseases in epidemiological studies is made with the use of periodontal index to simplify data collection and enable the identification of disease in large populations. This study aimed to evaluate the oral health status of the population of the city of Jundiaí, SP. Determinate the prevalence of periodontal conditions in adults and elderly subjects by comparing the Community Periodontal Index (CPI) and the Periodontal Screening and Recording (PSR). Describe the demographic and socioeconomic profile, access to dental services and oral hygiene habits. Determinate the association between socioeconomic and demographic conditions, oral hygiene, dental service use and smoking habits with periodontal disease. This cross-sectional study was conducted in the city of Jundiaí, São Paulo, between the period April to September / 2014. 372 adults (35-44 years old) were studied and 162 elderly (65-74 years old) residing in the city of Jundiaí and visited in their homes. Participated in data collection 5 dentists who pass through calibration, with agreement for the CPI and PSR rates 63-91%, with kappa ranging from 0.63 to 0.76. For demographic and socioeconomic characteristics, oral hygiene habits, information on oral health, dental service utilization and periodontal conditions, the descriptive analysis of data was performed for adult and elderly population, presented as absolute (n) and prevalence (%). It was found that 68% of adults and 60.5% of elderly participants were female, 46% and 37% have household income of R$3000,00 or more, respectively. 57.3% of adults and 64.2% of the elderly said unaware of what is periodontal disease. 58.6% of adults with pocket probing depth ?4mm said they lived a poor or very poor children and 73.9% said that the current economic situation was better than that of childhood. Comparing the CPI and PSR levels, there was statistically significant difference for the diagnosis of healthy sextants, presence of shallow pocket (code 3, periodontal pocket 4mm to 5mm) and deep pocket (code 4, probing depth ?6mm), where CPI index underestimated periodontitis and overestimated healthy sextants when compared to the PSR results. Education, economic status in childhood, frequency of dental visits, use of dental wire and smoking were associated with a higher prevalence of periodontal disease in the adult population. On the other hand, only the time interval since the last dental visit and the fact that the former smokers were associated with higher prevalence of periodontal disease in the elderly
Mestrado
Periodontia
Mestra em Clínica Odontológica

The purpose of this study was to gain information about the community health care needs through a comprehensive assessment. This information will allow providers to identify services and groups of people where the biggest gap exists in receiving needed health care services. This may provide the basis for the design of an advanced practice preventative health intervention for the community.

AbstractIn this chapter, the attention is paid to two fields which are linked with family lifestyle. The first one concerns socioeconomic situations in a family and shows that the economic side of family functioning is actually very essential these days. The importance of family economic situation is affirmed also in the results of our international survey. We asked what was the main family income, experience with unemployment and whether our respondents had possibility to save some money. Furthermore, we were interested in expenditure items and in evaluation of an overall standard of living by respondents. The Germans and then Czechs evaluated it as the best, the worst was found in families in Latvia. The second part monitors life satisfaction as a subjective feeling of well-being and is understood as a part of quality of life. To the question “How do you imagine a satisfied family?”, the most frequent response was—harmonic coexistence without conflicts, well-being, good health of all family members and material security. For the question “What do you lack to your satisfaction?” respondents stated—financial security and lack of free time for the family. However, there were specific differences among individual surveyed countries.

Geographic information systems or geographic information science is a combination of computer-mapping capabilities with additional database management/data analysis tools. GIS is widely used in various sectors such as environmental science, urban planning, agricultural applications etc. Public health is another focus area, where GIS has been used for research and practice areas such as epidemic surveillance and monitoring, among others. The journey of use of GIS in public health spans more than a century and GIS application in public health has evolved from the simple maps to the higher level geostatistical analysis and interactive WebGIS in recent times. GIS is an analytical tool which differs from conventional computer-assisted mapping and any statistical analysis programs in its ability to analyze complex data and visual presentation of spatial data. Specialized GIS techniques such as network analysis, location-allocation models, site selection, transportation models, and geostatistical analysis are well established and used in many developed and developing nations. Unfortunately owing to the high cost of licensed software and specialized skills for advanced data analysis, use of these techniques is limited mainly for the research and by few experts. GIS is proved to be useful for various public health practices and research purposes including epidemiological surveys/investigation, implementation research, program/policy decision making and dissemination of information. The advantage of using GIS is that maps provide an added dimension to data analysis, which helps in visualizing the complex patterns and relationships of public health issues, thus many unanswered questions in public health, can be understood well through use of GIS techniques. Use of GIS in public health is an application area still in its infancy. Wider use of GIS for public health practice such as program planning, implementation and monitoring in addition to building evidence base for the policy making will help reduce inequities in health and provide universal healthcare. Overall, GIS is a helpful and efficient tool especially for public health professionals working in low resource settings. In the future with inclusion of advanced GIS technology like WebGIS can help reach the goal of optimal health care services globally.

Pulmonary rehabilitation [PR] has been successfully carried out via telemedicine however initial patient assessment has been traditionally conducted in PR centers. The first step in PR is assessment of patient’s exercise capacity which allows individualized prescription of safe and effective exercise program. With COVID-19 pandemics assessment of patients in PR centers has been limited resulting in significant reduction of patients undergoing life-saving PR. The goal of this pilot study was to introduce approaches for remote assessment of exercise capacity using videoconferencing platforms and provide initial usability assessment of this approach by conducing cognitive walkthrough testing. We developed a remote assessment system that supports comprehensive physical therapy assessment necessary for prescription of a personalized exercise program tailored to individual fitness level and limitations in gait and balance of the patient under evaluation. Usability was assessed by conducting cognitive walkthrough and system usability surveys. The usability inspection of the remote exercise assessment demonstrated overall high acceptance by all study participants. Our next steps in developing user-centered interface should include usability evaluation in different subgroups of patients with varying socio-economic background, different age groups, computer skills, literacy and numeracy.

<em>Abstract.—</em>Fishing license sales are stagnant in Minnesota and declining in many states. It is important to understand what motivates and constrains people’s fishing participation. In 2005, we mailed surveys to 900 male and 900 female residents of the Minneapolis–St. Paul, Minnesota (USA) metropolitan area to determine attitudes and beliefs about outdoor recreation and fishing. Based on survey responses from 39.3% of the sample, we examined factors that motivate and constrain fishing among urban and suburban residents. Five factors motivated outdoor recreation: (a) achievement, (b) appreciation, (c) personal development, (d) affiliation, and (e) health. Appreciation and health were the most important motivators for outdoor recreation. Fishing was seen as a way to satisfy appreciation and affiliation motivations, and less likely to satisfy other motivations. Seven factors constrained outdoor recreation: (a) costs/regulations/crowding, (b) discomfort/dislike, (c) concerns about safety or discrimination, (d) planning required, (e) physical ability, (f) access, and (g) family/work commitments. Family/work commitments and cost most limited outdoor recreation. Constraints related to family/work commitments, cost, and lack of interest most limited fishing participation. We examined how perceived benefits and constraints predicted intention to fish. About 55% of respondents indicated that they would likely fish in the future, and about 50% of respondents said that they would likely fish in Minnesota in the next year. Appreciation, affiliation, and health motivations and constraints related to discomfort, discrimination/safety, and physical ability predicted future fishing. About 27% of respondents indicated that fishing was a “favorite” activity. Appreciation, comfort, and reduced access to angling opportunities predicted whether fishing was a favorite activity. We suggest that managers emphasize the multiple benefits of fishing including nature appreciation, social connection, and stress reduction, and develop programs and facilities to address discomfort and discrimination associated with fishing.

Surveys collect descriptive data about the behaviors or opinions of a population. The power of surveys comes from applying the same questions and the same response choices to a large number of people. In the health humanities, surveys have most often been used for course or program evaluations, to learn about patient experiences, and to collect data on opinions. A good survey has a defined research question and respondent population, and it asks carefully crafted questions including yes/no, multiple choice, ratings, rankings, sliders, pull-downs, and text entry. Surveys require Institutional Review Board review and a knowledge of basic statistics. While a good survey can provide generalizable perspectives, one of their main limitations is that they do not explain why people answer as they do.

This study aims to report and evaluate teaching based on Project-Based Learning towards an undergraduate subject of Applied Health Informatics. As an evaluation method, the development of mobile health applications was proposed. The research was conducted in a class with 21 students, who were evaluated qualitatively by two surveys. The students reported a positive impact of the discipline on their training and improvement in computational thinking abilities. Overall, the students created six m-health applications, and they achieved a new technology perception. Moreover, 15 students (71.4%) said to be more motivated to learn new technologies and 16 (76.2%) reported to be able to develop new applications.

Aim/Purpose: This research paper reports on the evaluation of a mental health self-management program provided to immigrant nurses working at various rural South Australian aged care services. Background: The residential aged care staffing crisis is severe in rural areas. To improve immigrant nurses’ employment experiences, a mental health self-management program was developed and conducted in rural and regional health care services in South Australia. Methodology: A mixed approach of pre- and post-surveys and post workshop focus groups was utilized with the objectives of exploring the experiences of 25 immigrant nurses and the impact of the mental health program. Feminist standpoint theory was used to interpret the qualitative data. Contribution: A new learning environment was created for immigrant nurses to learn about the theory and practice of maintaining and promoting mental health. Findings: Statistical tests showed a marked difference in responses before and after the intervention, especially regarding knowledge of mental health. The results of this study indicated that a change in thinking was triggered, followed by a change in behaviour enabling participants to undertake self-management strategies. Recommendations for Practitioners: Include expanding the workshops to cover more health care practitioners. Recommendations for Researchers: Feminist researchers must actively listen and examine their own beliefs and those of others to create knowledge. Extending the program to metropolitan areas and examining differences in data. E technology such as zoom, skype or virtual classrooms could be used. Impact on Society: The new awareness and knowledge would be beneficial in the family and community because issues at work can impact on the ability to care for the family, and there are often problems around family separation. Future Research: Extending the research to include men and staff of metropolitan aged care facilities.

The aim of this study is to identify distribution of occupational diseases and related health complaints among health workers and also to detect employee apprehensions about availability of occupational health and safety issues in the workplace. The application area of this study is a private hospital subservient in Istanbul and accredited by JCI. Within the framework of this study, a survey which contains 8 queries about demographic and personal features, 12 queries about occupational diseases and related complaints and 24 queries about occupational health and safety issues is applied to health staff employed in variable departments and positions in this hospital. The reliability coefficient of this survey is found .816 (Cronbach’s Alpha). In the conclusion of this study; it is detected that the employee’s perception about the occupational health and safety issues in the workplace has a positive aspect. Moreover, arm and leg pains (%65.6), over-fatigue (%64.1), insomnia (%59.7) and presence of venous varicosises (%54.2) were the most determined diseases and complaints, which are considered as work-originated among healthcare workers. In accordance with findings, the privileged improvements about the problems in occupational health and safety issues in this hospital have been presented.

Effects of excessive information level difference between providers and receivers of health care services on patients will be presented with this work. Fundamental concepts like health care service, information asymmetry and it’s effects will be explained. Information levels of attempts and treatments that were put in practice to the patients, surgical operations and billing will be studied and the outputs of the information level difference between the provider and the receiver will be determined. In this research, it will be revealed if the practical applications and the concepts in the literature overlap each other and developing a new method towards evaluating the information level difference will be attempted. Patients who received a certain number of treatments will be targeted. Survey questions that will be asked to the patients will try to reveal the amount of information on the procedure they have undertaken and the between this level of information and the their satisfaction. SPSS software is used for the analysis of the data. Resolving of the relation between patient satisfaction themeasured percentage of level of information about the procedure the subject have undertaken will be attempted during the evaluation of the survey results. The effects of gender, age and education on level of information-customer satisfaction will also be investigated while determining the patients level of information with this survey.

This report details both the process undertaken to develop an evaluation instrument that can collect feedback from children in the Love of Learning program and feedback the children have provided. A total of 178 children who are beneficiaries of the program completed the survey, and 91% confirmed the program was positively supporting them. They provided their feedback using a 20-question survey which measured four protective factors that previous research suggests supports children to engage with and enjoy learning, helping them to thrive in school and life. The protective factors are known to foster social, emotional, and academic development and success. There is a strong positive association between these factors, and the results of the survey suggest the Love of Learning program is influencing children's attitude towards learning and school. This report highlights some of the design challenges and complexities when engaging children in participatory evaluation. Importantly, to ensure children are given an opportunity to provide feedback, they must be supported by their foster carer who need to also feel informed and confident to be part of the evaluation process and empower children to speak up. Further research will now be conducted to implement the evaluation process more widely and ascertain if the protective factors improve a child’s health, educational engagement, and performance.

Childhood asthma is a significant public health problem in the United States. Barriers to effective asthma management in children include the need for caregivers to identify and manage diverse environmental triggers and promote appropriate use of preventive asthma medications. Although health care providers may introduce asthma treatments and care plans, many providers lack the time and capacity to educate caregivers about asthma in an ongoing, sustained manner. To help address these complexities of asthma care, many providers and caregivers rely on patient navigators (defined as persons who provide patients with a particular set of services and who address barriers to care) (Dohan & Schrag, 2005). Despite growing interest in their value for chronic disease management, researchers and providers know little about how or what benefits patient navigators can provide to caregivers in managing asthma in children. To explore this issue, we conducted a mixed-method evaluation involving focus groups and a survey with caregivers of children with moderate-to-severe asthma who were enrolled in the Merck Childhood Asthma Network Initiative (MCAN). Findings suggest that patient navigators may support children’s asthma management by providing individualized treatment plans and hands-on practice, improving caregivers’ understanding of environmental triggers and their mitigation, and giving clear, accessible instructions for proper medication management. Study results may help to clarify and further develop the role of patient navigators for the effective management of asthma in children.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

From 2000 to 2003, FRONTIERS collaborated with the Senegalese nongovernmental organization Tostan to evaluate the effects of a community-based education program on awareness, attitudes, and behavior regarding reproductive health and female genital cutting. The Tostan program provides modules in local languages on hygiene, problem solving, women’s health, and human rights. It was designed to improve women’s health and promote social change by enabling participants, mainly women, to analyze and find solutions to community problems. As stated in this brief, Tostan implemented the education program as part of a scale-up effort in 90 communities in the Kolda district of southern Senegal. The FRONTIERS evaluation took place as part of the project and compared changes in knowledge, attitudes, and behavior of men and women in 20 villages in the intervention area with those living in 20 nonintervention villages. Changes were measured using pre- and post-intervention surveys of women and men in the intervention and control areas and qualitative interviews with key community members. They also assessed pre- and post-intervention changes in the number of girls under 10 who had been cut.