A Monitoring and Evaluation Plan for Programs at Urban Health Initiative, Emory University that aids in Reducing Cancer Mortality and Morbidity in People of Atlanta Open Access

Abstract

Background: Cancer is a major public health problem in the United States, as it is the second leading cause of death globally. The prevalence of cancer among low-resourced communities of Atlantan metropolitan regions and Georgia is a growing public health concern. The public and private hospitals provide cancer treatment, however, the cost of treatment and associated disparities, screening awareness, and risk factors associated with cancer, impacts the service utilization, and adds to the burden. Emory Urban Health Initiative (UHI) identified three potential programs to solve this problem through Grady Hospital System and other partner organizations. Currently, three programs under UHI are working intending to improve cancer awareness, improve access to low-cost screening, and ensure timely treatment. These three programs are —Tobacco Use Prevention & Cessation, Cancer Detecting Dogs, and Dental Diversion.

 Methods: The objective of this thesis was to examine program inputs and resources and connect them to activities, outputs, and outcomes. The program indicators identified were specific, measurable, realistic, and commonly utilized in data collection and analysis for cancer screening and prevention programs. This was done to identify areas of research, monitoring, and evaluation for improvement in programs and processes, to demonstrate reach and impact. The existing gaps in the programs were also identified through a comprehensive literature review. 

Results: Three logic models and corresponding monitoring and evaluation frameworks were developed for each program to standardize and improve future monitoring and evaluation efforts. The logic models and frameworks identified indicators crucial for demonstrating program impacts that currently are not being monitored. UHI collects program data and utilizes surveys tools and focus groups for evaluations. However, this M&E framework will provide a foundation to further investigate gaps and revise program needs and goals. 

Conclusions: Program-specific recommendations were made to use the developed monitoring and evaluation framework; indicators were selected based on expected program impacts and formative research conducted by UHI. Prioritization of activities was recommended for engaging volunteers, enhancing partner collaborations, funding, and advertising programs. This thesis serves as a comprehensive resource for UHI as it continues with the programs aiming to reduce cancer mortality and morbidity.

Table of Contents

CHAPTER 1 .......................................................................................................................................................1

INTRODUCTION ......................................................................................................................................................... 1

Problem Statement .............................................................................................................................................. 1

Emory Urban Health Initiative Background ....................................................................................................... 1

Research Question............................................................................................................................................... 2

Significance Statement ........................................................................................................................................ 3

CHAPTER 2 .......................................................................................................................................................4

LITERATURE REVIEW................................................................................................................................................ 4

Background ......................................................................................................................................................... 4

Global burden of cancer...................................................................................................................................... 4

Burden of cancer in United States ....................................................................................................................... 6

Major causes and risk factors of cancer ............................................................................................................. 8

Cancer prevention ............................................................................................................................................... 8

Screening — a preventive tool! ........................................................................................................................... 9

Disparities in screening..................................................................................................................................... 10

Racial disparities in screening .......................................................................................................................... 10

Disparities in rural and urban populations....................................................................................................... 11

Disparities due to socioeconomic status ........................................................................................................... 11

Disparities in awareness ................................................................................................................................... 12

Other preventive methods.................................................................................................................................. 12

Emory Urban Health Initiative.......................................................................................................................... 15

Tobacco Use Prevention & Cessation............................................................................................................... 15

Cancer Detecting Dogs ..................................................................................................................................... 16

Dental Diversion ............................................................................................................................................... 18

CHAPTER 3 .....................................................................................................................................................20

REPORT TO URBAN HEALTH INITIATIVE ................................................................................................................. 20

Executive Summary ........................................................................................................................................... 20

Background and Aims ....................................................................................................................................... 21

Methods ............................................................................................................................................................. 22

Theory of Change .............................................................................................................................................. 23

Connecting Program Inputs and Activities to Outcomes................................................................................... 25

UHI Logic Models and Logical Frameworks .................................................................................................... 26

CHAPTER 4 .....................................................................................................................................................31

DISCUSSION ............................................................................................................................................................ 31 RECOMMENDATIONS............................................................................................................................................... 33

STRENGTHS AND LIMITATIONS ............................................................................................................................... 35

CONCLUSION .......................................................................................................................................................... 36

REFERENCES .................................................................................................................................................37

APPENDICES................................................................................................................................................... 41

APPENDIX 1: TOBACCO USE PREVENTION & CESSATION LOGIC MODEL ................................................................ 41

APPENDIX 2: TOBACCO USE PREVENTION & CESSA TION LOG FRAME .................................................................... 41

APPENDIX 3: CANCER DETECTING DOGS LOGIC MODEL ........................................................................................ 41

APPENDIX 4: CANCER DETECTING DOGS LOG FRAME ............................................................................................ 41

APPENDIX 5: DENTAL DIVERSION LOGIC MODEL ................................................................................................... 41

APPENDIX 6: DENTAL DIVERSION LOG FRAME ....................................................................................................... 41 

LIST OF FIGURES ..........................................................................................................................................41

FIGURE 1: ESTIMATED NUMBER OF INCIDENT CASES AND DEATHS DUE TO CANCER WORLDWIDE, BOTH SEXES, ALL AGES (SOURCE: GLOBOCAN, 2020) ..................................................................................................................... 41

FIGURE 2: NUMBER OF NEW CANCERS IN THE UNITED STATES, 2018 (ALL TYPES OF CANCER, ALL AGES, ALL RACES, AND ETHNICITIES, MALE AND FEMALE), UNITED STATES CANCER STATISTICS ........................................... 41

FIGURE 3: NUMBER OF CANCER DEATHS IN THE UNITED STATES, 2018 (ALL TYPES OF CANCER, ALL AGES, ALL RACES, AND ETHNICITIES, MALE AND FEMALE), UNITED STATES CANCER STATISTICS ........................................... 41

FIGURE 4: STAGES IN TRANSTHEORETICAL MODEL (CDC, 2004)........................................................................... 41 

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Education Health Sciences, Public Health
Keyword	Cancer, Cancer Prevalence, Screening, Disparities in Cancer Screening, Tobacco, Low-cost Screening Methods, Cancer Detecting Dogs, Risk Factors, Vaccine, Low- income Regions, Indicators, Outcome, Impact, Logic Model, Logical Framework, Evaluations, Atlanta, Georgia, and United States
Committee Chair / Thesis Advisor	Girard, Amy, Emory University

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