CHAPTER 26 Public Health Practice in Communities 329 effective? Are there effective interventions suited for that community support and perceived as culturally congruent community? What might effective interventions cost? What are more effective. Lastly, any intervention needs to be tai is the likely return on investment? lored to individual patients'needs for maximum engage Recommendations address a wide variety of topics, such ment, especially for hard-to-reach populations. the following a Worksite health promotion (e.g, tobacco policy, physical E. Implement Innovations inactivity, health risk appraisa Supporting local community health (e.g, community Implementation of interventions poses its own challenges, ater fluoridation, school vaccination program, school ainly managing people's reaction to change(see Chapter based physical ed 28). The role of the environment and community capacity Addressing social determinants of he should not be underestimated. The Guide to Community Preventive Services evaluates the effectiveness of types of ommendations, the guide provides the following ratings: tematic reviews of all available research in collaboration with recommended, recommended against, and insufficient vention progran IP), a searchable database of cancer control interventions with detailed program materials. RtIP RECOMMENDATIONS is designed to provide program planners and public health practitioners with easy and immediate access to research- Changing Risk Behaviors Commensurate with policy suc tested materials cesses, data is abundant to rate tobacco interventions Box 26-1), but much less for other less-funded topics, such high-calorie foods and firearms. There are also sometimes F. Evaluate heterogeneous results for identical interventions on various Evaluation should be built into the entire process of any diseases, such as patient reminders for breast cancer screen- project. The evaluation must be planned at the start of the ngs versus other cancers. Examples for community inter- planning process. If left until the end of the project, impor ventions aimed at changing risk behaviors include tant opportunities to understand what did and did not work community-wide campaigns to promote the intake of folic may be lost. The overall structure of an evaluation program acid among women of childbearing age and restricted hours was outlined by the CDC in 1999 with 30 standards for effec for teenage drivers(see Chapter 24) tive program evaluation guided by the following overarching Addressing the Environment Commensurate with the influ ence of environment on behavior, many community guide Utility. Evaluations should serve the practical information commendations address the importance of the environ needs of a given audience. Questions for this domain ment. Examples include laws mandating seat belt use, include: Is the purpose of your evaluation clear? who community-level urban redesign to make neighborhoods needs the information, and what information do they more walkable and bakeable, and community water florida- need? will the evaluation provide relevant, useful infor tion to decrease caries. Other agencies have also published mation in a timely manner? numerous strategies to improve diet and exercise (e. g Feasibility Evaluations take place in the field and should be improving school food policies to make healthy choices realistic, prudent, diplomatic, and frugal. Questions for ailable for lunches and snacks), adopting worksite wellness this domain include: How practical is your evaluation policies that promote healthy lifestyle choices for staff and How much money, time, and effort can you invest? Is the the community, establishing smoke-free environments in planned evaluation realistic, given the time, resources, parks, and establishing farmers' markets and community ind expertise available? Propriety. The rights of individuals affected by evaluations should be protected. Questions for this area include Reducing Disease, Injury, and Impairment Community guide What steps need to be taken for your evaluation to be recommendations addressing the reduction of disease ethical and legal? Does it protect the rights and welfare of injury, and impairment include early-childhood home visi the individuals involved? Does it engage those affected by tation programs for violence and in revention influ the program and the evaluation? enza vaccination programs for health care workers, and Accuracy. Evaluations should produce and convey accurate partner notification for HIV-positive individuals information about a program's merit and value. Q tions for this area include: Have you documented your program clearly and accurately? What design will provide 2. Cultural Congruence of Interventions ccurate, valid, and reliable information? Have you dem- It is important to balance evidence-based interventions with onstrated that your measures are valid and reliable? Have those that are culturally congruent with the community ou used appropriate analyses, and are your conclusions Health program evaluators have long known that a particu justified? Is your report impartial? ir program may be an outstanding success in one commu Other examples of domains to think through in evalua ity, place, and time, yet fail miserably in another community tion include the RE-AIM model: reach, efficacy, adoption, or even in the same community at another time. Even strong implementation, maintenance. evidence is not a substitute for common sense and sensitivity For evaluating, it can sometimes be helpful to structure to local culture. Evidence supports that interventions with evaluation of a project in the logic model. The basic logic