Overall Evaluation: Baseline Assessment Guidelines and ...

1 UNDCP/WHO GLOBAL INITIATIVEON PRIMARY PREVENTION OFSUBSTANCE ABUSEO verall evaluation : BaselineAssessment Guidelines andInstruments WHO Department of Mental Health Demand Reduction Section and Substance Dependence Division for Operations and Noncommunicable Diseases Analysis and Mental Health United Nations International World Health Organization Drug Control Programme Geneva ViennaWHO/MSD/ 1 ACKNOWLEDGEMENTSWith financial support from the Norwegian government, The World Health Organization(WHO) and the United Nations International Drug Control Programme (UNDCP) beganimplementing the revised project "The Global Initiative on Primary Prevention of SubstanceAbuse" in July 1999. Without this financial contribution this project would not have beeninitiated. Among the many activities to be undertaken, the task of development of the overallevaluation frame work for the Global Initiative and the respective protocols have beendeveloped by WHO with the technical support of Dr Olav H.

2 Mwansa Nkowane,WHO, GenevaMs Goivanna campelloUNDCP, ViennaDr Shekhar SaxenaWHO, Genvea2 TABLE OF CONTENTSPageACKNOWLEDGEMENTS .. DESIGN .. activities .. interventions .. / STUDY SITES .. OF THE INTERVENTION .. of evaluation .. components .. Summary of Baseline Assessment .. of the components of the Baseline Assessment .. Community profile 1 .. Community profile 2 .. The KAP youth study .. FRAMEWORK .. possible measures of abuse, probablyless accurate and valid .. community mobilisation .. 1: Terms of Reference for the research institution for Baseline Assessment ..10 Annex 2: Community profile 1 ..12 Annex 3: Community profile 2 ..16 Annex 4: Sample size estimation ..27 Annex 5: KAP adult questionnaire ..28 Annex 6: KAP young people questionnaire .. UNDCP/WHO Global Initiative on Primary Prevention of Substance Abuse (GlobalInitiative) is a five-year project , jointly executed by the United Nations International DrugControl Programme (UNDCP) and the World Health Organization (WHO).

3 Itsimplementation started in June 1997. The project was revised in 1998 and implementation ofthe revised project began in July 1999 and is expected to end in the year Global Initiative aims at preventing the use and abuse of all psychoactive substances(licit and illicit substances) by young people. The project will be implemented in 8 prioritycountries in three regions of the world undergoing particularly rapid or dramatic socialchange: Southern Africa, Southeast Asia (part of WPRO as per UNDCP regionalclassification) and Central and Eastern Europe. Prevention activities supported by the projectwill be based on the mobilisation of local communities. The local partners will be involved inmobilising their communities respond to substance use and abuse and in the long runactivities could be evaluated to determine good preparation for the implementation of the project , training materials have been developedand field-tested in regional training of trainers workshop in the three regions.

4 Local partnerswill be supported through training in effective primary prevention approaches, local situationassessment, project design, self-monitoring and evaluation . Following the training they willbe financially supported to implement primary prevention activities in selected activitiesThe design of the intervention will be characterized by five sets of interrelated activities:a) Baseline Assessment , comprised of two parts: community profile 1 andcommunity profile 2, and KAP study among the ) Training of local ) Public health interventions lasting 24 ) Monitoring of ) Post intervention Assessment for impact interventionsThe interventions to be implemented by the local partners could incorporate the followingmain areas:a) Provision of information to increase knowledge and awareness onconsequences of substance ) Improving personal and social skills among the young ) Creation of a safe and supportive environment for prevention of ) Mobilization of communities for action to address problems of substance use intheir focus of the intervention and the approaches will be influenced by the local situationassessments which will be done by the local SITES FOR THE Baseline ASSESSMENTThe Baseline Assessment will be implemented in two selected communities in each prioritycountry.

5 Each community will be defined in such a way that they have formally demarcatedgeographical boundaries ( a cluster of census enumerator districts). The target group forthe intervention will be young people. Important features to consider should relate to; extentof substance use/abuse among young people, location (urban/rural), socio-economic statusand feasibility of implementing primary prevention activities. In this way, it will be possibleto make comparisons across project sites. However, activities will also take place in othersites where local partners will carry out evaluation OF THE INTERVENTIONThe design of the Overall evaluation will be based on a pre- and post- interventioncomparison. The Baseline assessments will serve as the pre-intervention status descriptionagainst which the follow-up assessments will be compared. As the intervention will takeplace over a 24 month period, it is recommended that the follow-up Assessment data arecollected on the basis of a second, independent sample, comparable to that of the pre-intervention survey.

6 Key groups of variables that will be compared will include (a)community commitment to addressing substance abuse among youth, (b) level of networkssupporting prevention, (c) attitudes, norms and behaviours of adults towards problem ofsubstance abuse, (d) knowledge about substances, (e) availability of substances, (f) prevalenceof use and, (g) attitudes to substance use. At the pre-intervention stage, this information willcontribute to an understanding of the context in which the intervention will take of evaluationThe design of the project evaluation is presented in table below:PriorityCountryComm. Profile 1 Comm. Profile 2 Trainingof localpartnersKAPS urveyProjectInterventionsPost interventionComm. Profile 1 Comm. profile 2 PostinterventionKAP SurveySite 1 XXXXXXXXXSite 2 XXXXXXXXXThe three studies that will comprise the evaluation (Community profile 1 and 2 and the KAPsurveys - Pre and Post intervention -) will be described componentsAssessment of the impact of the intervention will require a comprehensive and multi-levelledapproach, with Assessment of the individual and the Summary of Baseline assessmentThe Baseline Assessment comprises three main components related to the initial situation inthe community:a) Community profile 1, providing information on the organised and the culturalcontext in which the phenomenon exists; relevant community resources on anorganisational level, existing prevention efforts.

7 Communityunderstanding/beliefs, attitudes and customs with regard to substance use,including substance use among young ) Community profile 2, providing information on community and the societywith regard to structures and processes related to substance use among youngpeople, including community resources on an organisational ) KAP youth study, providing information on the phenomenon , related tosubstance use among young people at the community line with the public health perspective adopted the data will not be restricted to informationdirectly related to substance use among young people. The variables and indicators will bedetermined, partly on the basis of the general understanding of substance use, the identifiedneeds and choice of of the components of the Baseline Community profile 1 PurposeTo provide information on community commitment to the issue of substance use and abusewith special emphasis among young people.

8 This information will contribute to anunderstanding of the basis for community mobilisation. VariablesThe relevant variables are local understanding, attitudes, and norms with respect to substanceuse and abuse, community situation Assessment , ongoing intervention projects, programmes,strategies, and networks. JustificationThe form and content of the networks may be taken as an indicator of level of communitymobilisation. Of special importance is the understanding of attitudes towards substance useand abuse among young people in political and welfare organisations and agencies as aresource for or barrier to an envisaged intervention. ImplementationA selected research institution will conduct the surveys Strategya) A sample of 100 adults randomly selected from the target population will beinterviewed (see annex 4)1b) Focus Group discussions with key informants (4)c) Focus Group discussions with young people (2 male, 2 female)d) Interviews with government officials and community leaders 1 Ideally KAP adult should be done before training.

9 However, operationally this is not possible. It will be donewith KAP youth survey. The interpretention of some variables will be affected such as mobilisation would haveoccurred after training of local partners but the effect will be Community Profile 2 PurposeTo provide information on other aspects of the community and the wider societal context thatare relevant to the intervention. These include socioeconomic conditions and structures in thecommunity. VariablesCentral variables are the legal, economic, political, and health, social, and demographic,especially as they relate to substance use and prevention. JustificationThese factors influence the intervention. They include, among other things, locally organisedlife, both as part of civil society and the state, tradition and present situation with regardto mobilisation of (parts of) the community for various collective purposes. Strategya) The information will partly be available in the form of ) New information will be ) Desk reviews should be conducted of available secondary data or databases oncommunity and societal level issues (see Annex 2).

10 ImplementationThe selected research institution will conduct the The KAP youth study PurposeTo provide pre-intervention information on substance use among young people, aged 10 information will serve as a basis for the identification of the need for intervention, and forpost-intervention comparison as part of the outcome evaluation . VariablesThe variables will include: sociodemographic characteristics, understanding of and attitudesto substance use of various kinds, substance-use behaviour. StrategyThe information will be collected from young people (self-report data) on an individual levelin a survey. A questionnaire administered in person to the respondents, with closed-endedanswers, will be used as the data collection instrument (see annex 5). ImplementationA sample of 300 young people be selected in each community. The research institution willconduct the surveys1. Areas/variables to be coveredThe questionnaire consists of 9 parts: 1) background information: sociodemographic andreligious information), 2) availability of substances, 3) use of tobacco, 4) use of alcohol, 5)use of various illegal drugs, 6) use of over-the-counter drugs, 7) abuse related questions(social consequences of substance use), 8) attitudes to substance use, 9) significant others useof substances (parents, closest friend).