Chapter 8Community Trials- Determine potential benefit of new policies and programs- Intervention- any program designed to produce a change in the target population- Must determine eligible communities & willingness to participate- Collect basic measures of the problem- Disease rates, knowledge, attitudes, and practices- Communities are randomized and followed over time-Pawtucket Heart Health Programo Focus- help individuals adopt new, healthy behavioro 3 dimensions risk factors- elevated cholesterol, BP, and smoking behavior change- training, social support, maintenance strategy Community activation- through community groups and orgso Results- lower mean cholesterol and BP-AIDS/HIV prevention program in Tanzaniao Target- public schoolso Results- increase in knowledge of AIDS, more positive attitude towards people with AIDS - Advantageso Only way to estimate the impact change in behavior or modifiable exposure on the incidence of diseaseo Better than clinical trials Ability to control entrance into study Delivery of the intervention Monitoring of outcomesEvaluation1. Formative a. Will all plans & procedures work as conceived?b. Begin as soon as the idea for the program is conceived2. Process evaluationa. Is the program serving the target group as planned?b. Begins as soon as program goes into operation3. Impact evaluationa. Has the program produced any changes among the target group?b. Requires collection of baseline information before the program starts.4. Outcome evaluationa. Did the program accomplish its ultimate goal??b. For ongoing programs conduct at specified intervalsc. For one-time program conduct at the end of the programClinical Trial- Planned experiment that assesses the efficacy of a treatment- Outcomes in treated group are compared with outcomes in control group- Phases1. Tests a new vaccine in adult volunteers (less than 100)2. 100-200 subjects from targeted population3. Main test- assess efficacy of vaccine in target population- Greatest control over exposure and observation- groups wont differ significantlyQuasi-Experiment/Community Trial- Ranked lower- Investigator unable to randomly allocate subjects to conditions- Possible contamination across conditions- Difficult to differentiate between effects of intervention and controlIntervention Studies- Controlled clinical trials- focused on individual- Community interventions- focused on community- Multicenter trials- results from several researchers are pooledProphylactic trial- evaluates effectiveness of a substance (vaccine) used to prevent diseaseTherapeutic Trial- study of curative drugs or new surgical procedure to improve Manipulation Randomization Study TypeY Y Experimental Y N Quasi-experimentalN N