The program was designed as a pretest and posttest to measure changes in the participant's knowledge, attitudes, and behaviors. The evaluation consisted of a variety of data collection tools to evaluate the effectiveness and the impact of the workshops over time. Participants were asked to complete the paper-and-pencil questionnaires at the beginning of the program and then at the completion of the program, and then at 6 and 12 months. They were invited to return 2 years later and again were evaluated at the beginning and end of the program and at 6 and 12 months after the second workshop. If the participants reported a change in personal behavior related to primary prevention activities and/or documented application of knowledge and conference materials to various cancer care services and professional practice, the workshops were considered a success.
Participant Selection
Materials and resources used to recruit participants remained the same throughout the life of the programs. However, the way in which recruitment was conducted was altered as the global community changed in response to the evolution of technology.
Announcements providing information about the workshops were initially mailed. In the early years of the programs faxing was gradually becoming available but was unreliable in many parts of the world. E-mailing became available sporadically in the early 1990s. Board members of the ISNCC, administrative personnel at WHO, UICC headquarters, International Council of Nurses (ICN), ministries of health, presidents of international nursing associations, deans of nursing schools, selected American nurses with known international contacts, and former program attendees collaborated to identify and recommend potential candidates for participation. Following identification of nurse educators who could be contacted, letters and application forms were distributed to the potential participants. Criteria for participant selection included
* Peer recognition and nomination
* Position of leadership related to influencing curricular change and/or national agenda setting for cancer prevention and control programs
* Ability to communicate in English
* Stated intent to integrate the acquired information into the country's educational programs
* Geographic representation to ensure broad global distribution
* Personal and sponsor commitment to attend both an initial and follow-up program 2 years later
Sample
Figure 3 shows the approximate geographic distribution and Table 4 lists the 140 participants and the WHO regions and countries they represented. Both men and women represented their countries in these programs (Tables 6 and 7). Twelve men and 128 women with diverse educational backgrounds (basic nursing programs, advanced preparation in areas of specialization, and doctoral preparation) attended. A physician from China and 1 from Poland also attended. The variances in program design and educational requirements for nurses throughout the world make it difficult to equate the various levels of preparation. All who attended were selected because of their documented extensive and diverse levels of experience and the recommendations of ministers of health and of academic program directors.
The participants represented clinical and academic teaching as well as administrative roles. They had worked in oncology, community health nursing, primary care, or, in some instances, in outreach areas of their respective countries. Position categories included professors, matrons, directors of hospitals or academic institutions, department chairs, supervisors, deans, coordinators of clinical and academic departments, and instructors. Collectively, they brought significant personal and professional experiences with the multiple diseases and experiences of the cancer world to the program environment.
Methods
The accomplishment of the grant investigators in facilitating the development of an international cancer nursing network is due to the support the grant provided. The selected participants, and the countries they represented, could not have attended without the provision the grant made for transportation, housing, and program materials.
Courses
Initially the program offerings were conducted for 2 days in conjunction with an international conference of either the ISNCC or the UICC. This provided an opportunity for the participants to meet with professionals from other disciplines from their own countries and to be introduced to the greater global healthcare community in a conference setting. In 1998, the program was expanded to 3 days in order to accommodate the additional content related to cancer control activities.
The workshops were designed for 30 people. Each program had 1 returning group of approximately 15 participants and 1 new group of approximately 15 participants. The purpose of a returning group was to reinforce previous learning, present new scientific data, learn advanced concepts, extend the international network, and to encourage commitment. Each returning participant was required to present a verbal and written report of cancer activities initiated in their countries in the 2 years since attending the program.
The education methodology included
* Didactic discussions
* Case studies
* Interactive group process
* Small problem-solving groups
* Classroom and social interaction
* Participant presentations
* Cancer Prevention and Cancer Control workbooks
The Workbooks
Two Cancer Prevention and Cancer Control workbooks were developed by the program faculty to augment classroom materials and to provide information that the participants could select, translate, and present according to their individual needs. The first, 330-page Cancer Prevention workbook was developed and distributed for the first time in 1996. The content was designed to meet the objectives of the first 10 years of the program related to the cancers most prevalent, at that time, in the developing world: breast, cervical, esophageal, gastric, liver, and lung. At the request of the previous participants, information related to nutrition, pain management, palliative care, and psychosocial support was also included (Fig 4).
The second, 243-page Cancer Control workbook was developed and distributed in 2000. The content of the second workbook was designed to meet the objectives of the final 5 years of the grant programs and addressed critical issues in cancer control: cancer-related fatigue, nausea and vomiting, mucositis, unconventional therapies, and identified cultural issues and related support concerns (Fig 5).
Cancer Prevention Workbook: A Course for Nurse Educators
Contributing Authors
Carol Reed Ash, EdD, RN, FAAN, Eminent Scholar, Kirbo Endowed Chair, College of Nursing, University of Florida
Susan L. Beck, PhD, APRN, FAAN, Associate Professor and Associate Dean for Research, College of Nursing, University of Utah
Linda White Hilton, MSN, RN, FAAN, Director, Patient Affairs, MD Anderson Cancer Center, University of Texas
Mary Pickett, PhD, RN, Associate Professor, College of Nursing, Villanova University
Marilyn Frank-Stromborg, EdD, JD, RN, FAAN, Professor, School of Nursing, Northern Illinois University
Carmen Rodriguez, PhD, RN, ARNP, Assistant Professor, College of Nursing, University of Florida
Ruth McCorkle, PhD, RN, FAAN, Florence S. Wald Professor of Nursing, Yale University School of Nursing
Cancer Control Workbook: A Course for Nurse Educators
Contributing Authors
Carol Reed Ash, EdD, RN, FAAN, Eminent Scholar, Kirbo Endowed Chair, College of Nursing, University of Florida
Ruth McCorkle, PhD, RN, FAAN, Florence S. Wald Professor of Nursing, Yale University School of Nursing
Susan L. Beck, PhD, APRN, FAAN, Associate Professor and Associate Dean for Research, College of Nursing, University of Utah
Vernice Ferguson, MA, RN, FAAN, FRCN, Senior Professor Emeritus, University of Pennsylvania
Linda White Hilton, MSN, RN, FAAN, Director, Patient Affairs, MD Anderson Cancer Center, University of Texas
Mary Pickett, PhD, RN, Associate Professor, College of Nursing, Villanova University
Carmen Rodriguez, PhD, RN, ARNP, Assistant Professor, College of Nursing, University of Florida
The workbooks were designed in discrete sections to make selecting relevant material easy. They were intended to provide the participant with flexibility in designing their own programs and in recognition that each educator had specific needs for the information and for developing ways to present that information. The audiovisual section of the workbooks was a replication of the slides the faculty presented during the workshop offerings. For those unable to produce slides it provided additional information and for those able to utilize audiovisual aids it facilitated presentation of the information they required (Fig 6).
Evaluation
Evaluation instruments were modified from those reported for the first 10 years of the program. The instruments were changed to better reflect the commitment of the individual to implement programs on return to their respective countries. The new instruments also assisted each individual in identifying the specific needs of their particular situation and in their respective countries. The instruments included the following.
Demographic Variables
This instrument included the standard background information. A review of the responsibilities of their present position was requested and a description of a significant experience that the individual had with cancer, either with a family member, with a patient, and/or with themselves. Types of cancer they had worked with and with whom were also requested.
A Cancer Attitude Inventory
This was administered once at the beginning of the program.
A Personal Action Plan
This instrument was used to assist the participant in identifying steps to be taken that would help put into practice what had been learned at the workshop. This plan was then used for follow-up evaluation at ongoing intervals. The participants were asked to
1. Indicate the most important thing learned at the workshop.
2. Identify one health-related action that they planned to do in their life based on what they learned at the workshop.
3. List the steps needed to make the action work.
4. Indicate why they felt they could be successful in accomplishing the action.
5. Identify what would make it difficult to accomplish the action.
6. Identify people or resources that could help accomplish the action.
7. Indicate how they would know they succeeded.
A Personal Action Plan "Contract"
This was discussed with the faculty and signed by each participant, indicating that they accepted they would be contacted by the principal investigators. They agreed to report what progress they had made in achieving the health-related action on the basis of what they had learned at the workshop. They agreed to respond to the request for feedback about their progress.
Presentation of Verbal and Written Report
This was to be given at the time of return visit. The criteria for the presentation included
* Both written and verbal report
* Verbal report (5-10 minutes) to be given to workshop group
* Report to be given in the format the participant was comfortable with: slides, transparencies-if they wished, but not required
* Presentation to include
* What programs developed since attending the prior workshop: schools, community, professional?
* What were the rationales for choosing the programs and topics?
* What helped implement the programs?
* What stopped you from implementing the program?
* What happened as a result of the program?
* Report of changes in personal behavior as a result of the cancer prevention information learned at the last workshop attended
A Workshop Evaluation
This requested input related to the accomplishment of program objectives, the effectiveness of each faculty presentation, the program in general: facilities, length, depth of content presented, and a brief description of how they saw themselves using the concepts from the course in their education programs.