NUR 4420 Module 6 Community Project Evaluation Example

What Twelve Weeks Produced: An RE-AIM Evaluation of a Student-Supported Asthma Home-Visit Partnership in Trenton

Student Name

Accelerated B.S.N. Program, Thomas Edison State University

NUR-4420: Nursing Care in the Community

Mentor Name

Month Day, Year

What Twelve Weeks Produced: An RE-AIM Evaluation of a Student-Supported Asthma Home-Visit Partnership in Trenton

In the previous module I proposed Breathe Easy at Home, a partnership between a food pantry nurse, two community health workers and the school nurses serving Trenton's East Ward, to reduce asthma triggers in the homes of children with asthma. The partners began the work during the final twelve weeks of my clinical placement. This paper gives an honest account of what those twelve weeks produced, evaluates the project with the RE-AIM framework against the objectives set in the plan, and recommends what the partners should change before the next six months. The families are not identified, and the figures are the project's own tracking data, rounded and reported with the partners' permission.

The Evaluation Approach

Two frameworks guided the evaluation. The federal framework for program evaluation in public health lays out a six-step cycle that opens by drawing in the people with a stake and setting down what the program is, then moves through collecting evidence people will trust and drawing defensible conclusions, and ends with making sure someone acts on the results (Centers for Disease Control and Prevention, 1999). I used those steps to plan who would see the results and how they would be used. To organize the results themselves, I used RE-AIM, which Glasgow et al. (1999) argued that a program's public health value depends on five things at once: how many of the intended people it touches, whether it works, whether organizations take it up, whether it is delivered as designed, and whether it lasts. RE-AIM suits a small community project because the questions that matter most early on are whether the intended families are reached and whether the work is delivered as planned.

Reach

The six-month enrollment target was thirty families with an asthmatic child of school age or younger. In the first twelve weeks, the monthly pantry asthma table and church announcements identified twenty-six families, of whom seventeen enrolled. Fourteen enrolled families spoke Spanish at home and three spoke a Mayan language; two of the latter needed an interpreter who could be scheduled only on Saturdays. The nine families who did not enroll gave reasons that matched the vulnerable population analysis: four were worried about having anyone in their home, three were moving, and two could not find a time. Reach was therefore on track in number, at seventeen of a six-month target of thirty, but the refusals confirmed that fear of home visits is a real limit.

Reach also has a quality dimension. The families enrolled were the ones the plan was designed for: all lived in rental housing, most had a child with at least one emergency visit in the past year, and nearly all relied on the pantry for food. The project did not drift toward easier-to-reach families, which is a common risk when enrollment targets press.

Effectiveness

Because the project has run only twelve weeks, effectiveness can be judged only on short-term outcomes. Of the eleven families who completed all three visits, ten reported reducing two or more of the triggers identified at the first visit, most often by using bedding covers, replacing scented products and reducing cockroach exposure with bait. Caregivers reported a median of three symptom days in the previous two weeks at the third visit, compared with six at enrollment. These are self-reported, uncontrolled before-and-after figures from a small group and cannot show that the project caused the change; the change of season and the simple effect of receiving attention could account for some of it. The direction is consistent with earlier trials, such as the Seattle home visit study by Krieger et al. (2005), in which more intensive community health worker visits produced greater improvement in caregiver quality of life and less urgent care use, but the project's own evidence is not yet strong.

Adoption, Implementation and Maintenance

Adoption concerns whether the organizations involved take the program on. The pantry has added the asthma table to its monthly calendar, and two of the three school nurses serving the enrolled children used the home summaries to update action plans; the third school did not respond, a gap to address. Implementation concerns fidelity and cost. Community health workers completed visits as designed in most cases, but the second visit was often delayed by rescheduling, stretching the planned three months to four. Supplies cost an average of ninety-two dollars per family, close to the planned one hundred.

Maintenance is the weakest dimension. The small grant covers community health worker time through the end of the year, and no long-term funding has been secured. The pantry nurse plans to present the twelve-week results to the local hospital's community benefit committee, using the tracking data and the published evidence together. Without that, the project will end when the grant does, regardless of its results.

Implementation data also revealed a training need. In two early visits, a community health worker recommended a bleach solution for mold, which can itself irritate the airways of a child with asthma. The pantry nurse and I revised the visit guide to recommend detergent and water for small areas and to refer larger mold problems to the landlord and housing inspection, and the second round of visits followed the revised guide.

Recommendations and Reflection

Four changes follow from the evaluation. Offer Saturday and evening visits routinely, since time and interpreter availability limited enrollment. Allow families to begin with a visit at the pantry rather than at home, to lower the fear barrier, and move to home visits once trust is established. Contact the unresponsive school through the district nursing supervisor. And add emergency visit tracking from the hospital, with consent, to replace self-report for the long-term outcome.

For me, the most important lesson was the difference between planning and evaluation. The plan assumed families would welcome home visits; the evaluation showed that a third of interested families did not, for reasons the community assessment had predicted. Community nursing is measured not by whether a plan was carried out but by whether the people it was meant for were reached, and RE-AIM made that visible.

References

Centers for Disease Control and Prevention. (1999). Framework for program evaluation in public health. MMWR Recommendations and Reports, 48(RR-11), 1-40.

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Krieger, J. W., Takaro, T. K., Song, L., & Weaver, M. (2005). The Seattle-King County Healthy Homes Project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4), 652-659. https://doi.org/10.2105/AJPH.2004.042994