Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement

The Relationship Between Self-Efficacy and Interpersonal and Neighborhood Social Factors On Physical Activity In Low-Income, African American Adults

Objectives. Understanding individual and social determinants of physical activity (PA) in low-income, minority adults may guide strategies for reducing obesity-related health disparities. The present study examined the direct and interactive relationships between self-efficacy and interpersonal and neighborhood social factors (social support from peers, social norms for PA, neighborhood social interactions) in predicting moderate-to-vigorous PA (MVPA) in African American adults. Methods. Baseline data from the Positive Action for Today\u27s Health (PATH) trial were used (n = 434, men = 166, women = 268; 100% African American). Self-efficacy for PA, social support from peers, social norms and neighbor social interactions were assessed via self-report. Objective assessments of MVPA were obtained using accelerometers. Results. Regression analyses were used to examine the interactions between self-efficacy and peer social support, social norms, and neighborhood social interactions in predicting MVPA. Results revealed significant main effects for self-efficacy (B=3.45, p\u3c.05), social norms for PA (B=3.66, p\u3c.05) and neighborhood social interactions (B=6.28, p\u3c.05) suggesting that participants who reported higher self-efficacy, higher perceptions of social norms for PA and had more positive ratings of neighborhood social interactions engaged in more MVPA. No other main effects or interaction terms were significant. Conclusions. Enhancing one\u27s self-efficacy for PA, improving individual\u27s perceptions of the acceptability of walking in the neighborhood and providing opportunities for increase social connectedness may positively influence MVPA among underserved populations