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

• Determine degree to which

sample of PATH leaders adhere

to PATH curriculum

Purpose of PATH Fidelity Assessment

– 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

• How are PATH leaders reflecting on

what occurs in sessions they

conduct? Do they conduct peer or

self evaluations?

Evaluation Question 1

• 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

• What are the PATH

leaders’ perceptions of

the leader training?

Evaluation Question 2

• 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

• Are there ways PATH

leader support could be

enhanced to increase

fidelity?

Evaluation Question 3

• 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

• What are the strengths

and challenges

encountered by PATH

leaders as they conduct

classes?

Evaluation Question 4

• 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

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

Challenges Observed

• Positive thinking activity

• Writing letter to provider

• Buddy call

Evaluation Question 4 Results

• What ways can data

gathered by OSA and

MDCH be used to

monitor PATH fidelity?

Evaluation Question 5

• 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

• 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

• 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