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Joan Ilardo, PhD, LMSW
Assistant Professor, Director of Research Training. Core Faculty-Geriatric Education Center of Michigan
Fidelity to the EBDP Programs in
Michigan: Findings of Evaluation
Report
APPENDIX F3
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• Determine degree to which
sample of PATH leaders adhere
to PATH curriculum
Purpose of PATH Fidelity Assessment
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– Completed PATH leader training
– Co-led PATH workshop
– Conducted PATH leader and master trainer
online survey in winter 2010-2011 (118
responses)
– Conducted 6 key informant interviews of PATH
coordinators, master trainers and T-trainers
– Conducted 3 site observations (sessions 2
and 5)
Study Design: Addressed 5 Questions
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• How are PATH leaders reflecting on
what occurs in sessions they
conduct? Do they conduct peer or
self evaluations?
Evaluation Question 1
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• 2/3 of PATH Leaders used recommended self-evaluation form after conducting workshop.
• 86% talk with co-leaders after each session to discuss how it went
• Another 11% have a discussion at end of workshop series
• Only 3% reported they never discussed how things went at PATH sessions.
Evaluation Question Results
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• What are the PATH
leaders’ perceptions of
the leader training?
Evaluation Question 2
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• Felt trainers did well explaining PATH was an evidence-based curriculum based on Stanford Chronic Disease Self-Management Program
• Aware of research showing positive results for participants who apply what they learn.
• 93% reported master trainers did very well emphasizing importance of “sticking to the book”.
• All interviewees were emphatic that curriculum is closely followed.
Evaluation Question 2 Results
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• Are there ways PATH
leader support could be
enhanced to increase
fidelity?
Evaluation Question 3
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• Different versions of the leader manual
• Guided imagery -Session 5, what to do if a participant does not want to do the activity
• Action Planning
– How to do them?
– Writing them down?
• No consensus on leaders doing self-evaluations
Evaluation Question 3 Results
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• What are the strengths
and challenges
encountered by PATH
leaders as they conduct
classes?
Evaluation Question 4
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• Strengths– Understand concept of fidelity and work to impart
that in leader training
– Recruit leaders who are familiar with PATH and see how program can benefit participants
– Very conscious about sticking to book and did excellent job
– Stayed on topic
– Set good boundaries while being approachable
– Strong role models: engaged, positive, respectful, caring
Evaluation Question 4 Results
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Challenges Noted by respondents
• Participants’ literacy levels
• Frail, elderly groups
• Quiet groups
• Chatty groups
• Diverse groups
• Dominating individuals
• Self-interested individuals
Evaluation Question 4 Results
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Challenges Observed
• Positive thinking activity
• Writing letter to provider
• Buddy call
Evaluation Question 4 Results
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• What ways can data
gathered by OSA and
MDCH be used to
monitor PATH fidelity?
Evaluation Question 5
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• All coordinators review information on MI PATH forms before sending them in
• Use data from MDCH for– Reports to agencies
– Recruiting participants
– Presentations to medical groups
– Publicity
– Feedback for PATH leaders
• No system in place to track outcomes but would welcome the information
Evaluation Question 5 Results
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• Guidance from MDCH about resources available at PATH
workshops
• Recruit lay leaders who have chronic conditions since participants
identify with them.
• To increase fidelity, all leaders should role model dealing with difficult
emotions in Session 2.
• Booster sessions should be developed by MDCH and OSA that
reinforce best practices for the action plan and problem-solving
activities.
• Session 5 closing activity is difficult because of the various strategies
offered to participants. Clarification could be provided through the
booster session.
• Session 5 Positive Thinking activity can be confusing. Stanford could
be approached about alternative ways to practice this concept such
as role modeling by co-leaders.
Recommendations
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• Systems for connecting leaders who prefer to work together could
increase leader retention and satisfaction.
• Coordinator should be trained about how to develop/nurture
relationships with primary care oriented-organizations to reinforce the
benefits of PATH for patients with chronic diseases and ways to
encourage patients to attend.
• One way to engage physicians is to offer to conduct behavior change
follow-up surveys for their patients who attend PATH workshops.
Follow-up surveys could be conducted at 6 and 12 months.
• Develop relationships with residency and fellowship to include
evidence-based self-management programs as part of their
community resources segment of fellowship training.
• Consider using a Facebook page as an additional way to promote MI
PATH. The official MI PATH website link could be part of the page.
Recommendations