Implementation and Evaluation

Students are required to select an article from the list provided on interact, and then to complete a critical review of the article in the context of community heath, health promotion planning, implementation and evaluation. All articles are evaluations of health promotion interventions.
Students will be required to summarize and review the text in detail and provide a critical evaluation of the article.
The summaries should be written in formal English and should contain the following sections;
• Introduction
• Summary
• Critique
• Conclusions
• References

Rationale
This assessment task will assess the following learning outcome/s:
• be able to assess where psychological methods of behaviour change are relevant and be able to apply suitable approach when dealing with an oral health patient
• be able to apply key concepts in indigenous perspectives of health and demonstrated application of these in promoting oral health and improving inequalities in health outcomes
• be able to demonstrate professional behaviour and attitudes at all times in all learning environments
Oral Health Therapists must be able to critically review an article as part of an evaluation of evidenced based research. Students will develop a deeper understanding of;
• be able to assess where psychological methods of behavior change are relevant and be able to apply suitable approach when dealing with an oral health patient
• be able to define key concepts of public oral health policy development and implementation
• be able to describe the significance of evaluating health and how to measure health outcomes, with the ability to re-define the promotion of health

Planning your review Clanchy and Ballard (1991, pp. 91-92) indicate that there are several steps to follow before you start writing your critical review:

Organizing your review:
as is the case with most of the writing you do at university, which is formal writing, a review should have an introduction, body and conclusion. However, if you are given a specific format in the Subject Outline, you should of course follow that.

Introduction (10%)
Identify the article you are reviewing, including the title of the text, the author’s name and their expertise in the field being addressed in the article. Identify the purpose and context in which the article was written. Identify your purpose in writing the review and how your examination of the text will address the topic or problem you wish to resolve. Summarise the main issues raised by the author of the text (Wallace & Wray, 2006, p. 117).

Body (80%)
Analyse the key points made in the text. Evaluate the validity of the evidence used to support each point. Decide whether the conclusions which are reached are convincing when applied in a general sense as well as in the specific situations described in text. This should include both the strengths and weaknesses of the claims made in the article. Clearly distinguish between the views of the author and others (Northey, 2005, pp. 38-39).

Conclusion (10%)
Summaries your evaluation of the text. Make a judgement about the credibility of the overall claims made in the text. Evaluate the usefulness of the text in addressing the issues you wished to resolve in your review (Wallace & Wray, 2006, p. 118).

Structure of a Critical Review
Critical reviews, both short (one page) and long (four pages), usually have a similar structure. Check your assignment instructions for formatting and structural specifications. Headings are usually optional for longer reviews and can be helpful for the reader.
Introduction
The length of an introduction is usually one paragraph for a journal article review and two or three paragraphs for a longer book review. Include a few opening sentences that announce the author(s) and the title, and briefly explain the topic of the text. Present the aim of the text and summarise the main finding or key argument. Conclude the introduction with a brief statement of your evaluation of the text. This can be a positive or negative evaluation or, as is usually the case, a mixed response.
Summary
Present a summary of the key points along with a limited number of examples. You can also briefly explain the author’s purpose/intentions throughout the text and you may briefly describe how the text is organized. The summary should only make up about a third of the critical review.
Critique
The critique should be a balanced discussion and evaluation of the strengths, weakness and notable features of the text. Remember to base your discussion on specific criteria. Good reviews also include other sources to support your evaluation (remember to reference).
You can choose how to sequence your critique. Here are some examples to get you started:
• Most important to least important conclusions you make about the text.
• If your critique is more positive than negative, then present the negative points first and the positive last.
• If your critique is more negative than positive, then present the positive points first and the negative last.
• If there are both strengths and weakness for each criterion you use, you need to decide overall what your judgement is. For example, you may want to comment on a key idea in the text and have both positive and negative comments. You could begin by stating what is good about the idea and then concede and explain how it is limited in some way. While this example shows a mixed evaluation, overall you are probably being more negative than positive.
• In long reviews, you can address each criteria you choose in a paragraph, including both negative and positive points. For very short critical reviews (one page or less) where your comments will be briefer, include a paragraph of positive aspects and another of negative.
• You can also include recommendations for how the text can be improved in terms of ideas, research approach; theories or frameworks used can also be included in the critique section.
Conclusion & References
Conclusion
This is usually a very short paragraph.
• Restate your overall opinion of the text.
• Briefly present recommendations.
• If necessary some further qualification or explanation of your judgement can be included. This can help your critique sound fair and reasonable.
References
If you have used other sources in you review you should also include a list of references at the end of the review.
Summarising and paraphrasing for the critical review
Summarising and paraphrasing are essential skills for academic writing and in particular, the critical review. To summarise means to reduce a text to its main points and its most important ideas. The length of your summary for a critical review should only be about one quarter to one third of the whole critical review.
The best way to summarise is to:
1. Scan the text. Look for information that can be deduced from the introduction, conclusion and the title and headings. What do these tell you about the main points of the article?
2. Locate the topic sentences and highlight the main points as you read.
3. Reread the text and make separate notes of the main points. Examples and evidence do not need to be included at this stage. Usually they are used selectively in your critique.
Paraphrasing means putting it into your own words. Paraphrasing offers an alternative to using direct quotations in your summary (and the critique) and can be an efficient way to integrate your summary notes.

A cross sectional evaluation of an alcohol intervention targeting young university students:

Sharyn Burns1*, Jonine Jancey1, Gemma Crawford1, Jonathan Hallett1, Linda Portsmouth1 and Janelle Longo2

Abstract
Background: Hazardous drinking has been found to be higher among young university students compared to their non-university peers. Although young university students are exposed to new and exciting experiences, including greater availability and emphasis on social functions involving alcohol there are few multi strategy comprehensive interventions aimed at reducing alcohol-related harms.

Methods: Random cross sectional online surveys were administered to 18–24 year old students studying at the main campus of a large metropolitan university in Perth, Western Australia. Prior to the completion of the second survey an alcohol intervention was implemented on campus. Completed surveys were received from 2465 (Baseline; T1) and 2422 (Post Year 1: T2) students. Students who consumed alcohol in the past 12 months were categorised as low risk or hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT). Due to the cross sectional nature of the two samples two-tailed two-proportion z-test and two sample t-tests were employed to determine statistical significance between the two time periods for categorical and continuous variables respectively.

Results: At T1 and T2 89.1 % and 87.2 % of the total sample reported drinking alcohol in the past month respectively. Hazardous levels of alcohol consumption reduced slightly between T1 (39.7 %) and T2 (38 %). In both time periods hazardous drinkers reported significantly higher mean scores for experienced harm, second-hand harm and witnessed harm scores compared to low risk drinkers (p <0.001). Hazardous drinkers were significantly more likely to experience academic problems due to their alcohol consumption and to report more positive alcohol expectations than low risk drinkers at both time periods (p <0.001).

Conclusions: Harms and problems for students who report hazardous drinking are of concern and efforts should be made to ensure integrated and targeted strategies reach higher risk students and focus on specific issues such as driving while intoxicated and alcohol related unplanned sexual activity. However there is also a need for universal strategies targeting all students and low risk drinkers as they too are exposed to alcohol harms within the drinking and social environment. Changing the culture of the university environment is a long term aim and to effect change a sustained combination of organisational actions, partnerships and educational actions is required.

Keywords: Alcohol, University students, AUDIT, Alcohol-related harms, Alcohol-related problems, Alcohol expectancies

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Background
The transition period from secondary school to college or university has been identified as a particularly high risk period for a range of health compromising behav- iours, including excessive alcohol consumption [1, 2]. Many young university students drink alcohol at levels that place themselves and others at risk of a range of short and long term harms [3–7]. Hazardous drinking has been found to be higher among young university students in New Zealand compared to their non- university peers [8] with suggestions that the university environment contributes to these differences [8, 9]. Young university students are exposed to new and ex- citing experiences, including greater availability and emphasis on social functions involving alcohol [8]. This is an important developmental period during which many young people explore their identity and form more mature relationships [1]. In addition to these changes some students live away from their family home for the first time [8].
Significant increases in proportions of 12–17 year olds in Australia choosing to abstain from alcohol and fewer young people exceeding adult guidelines for single occa- sion risk between 2010 and 2013 demonstrate encour- aging changes in alcohol consumption for school-aged students. However despite these encouraging findings young people aged 18–24 years were more likely to drink at harmful levels on a single occasion than other adult age groups [10]. These data support the ongoing need to pro- vide positive and effective strategies to reduce levels of al- cohol consumption and associated harm as young people move to tertiary education and the workforce.
Although the university has been identified as an ideal setting for health promotion interventions [2, 11], there is paucity of integrated, comprehensive interven- tions focusing on reducing alcohol-related harms among Australian universities described in the litera- ture. Despite this, there have been interventions focus- ing on a single strategy, usually brief interventions, that have demonstrated some short term changes in alcohol consumption levels [12, 13] and alcohol related prob- lems [12] however no significant differences were re- ported for alcohol-related harms [13].
This paper describes a university based alcohol interven- tion and compares low risk and hazardous drinking preva- lence and experienced, second-hand, witnessed and academic harms for the total sample, and makes compari- sons between low risk and hazardous drinkers at baseline and after the first year of the intervention. The paper will describe the effect of the intervention after year one.
Theoretical basis of the youth alcohol project intervention
The Youth Alcohol Project (YAP) was implemented at a large and culturally diverse university campus in Australia
with the aim of reducing the witnessed and experienced harms associated with alcohol consumption among 18–24 year old students. Social Cognitive Theory (SCT) was used to inform the development of the intervention. The underlying premise of SCT is reciprocal determinism, in particular the relationship between the individual, behav- iours and the environment [14]. Individual traits such as personality, genetic factors and gender have been found to influence alcohol consumption and related behaviours [15–17]. The environment is a significant influence in ini- tiation and drinking behaviours of young people [16, 17]. The university environment which may include events that encourage excessive drinking and new peer networks [8] along with the belief that excessive alcohol use is a ‘rite of passage’ [18] and an integral part of the university ex- perience [19] are important influences. Social and cultural norms which suggest for some young people drinking to get drunk is the main goal of many events and social occasions [20, 21] are often influenced by alcohol ex- pectancies which are formed through social influences including family, peers and culture [22]. SCT recog- nises the power of observational learning such as the actions of peers and significant others [14] which is supported in the alcohol literature, recognising drinking behaviours are strongly influenced by the behaviours of peers, siblings and other family [15]. Norms and expec- tations help reinforce physical aspects of the environ- ment including availability, promotion of alcohol and poorly implemented policy which together encourage excessive alcohol consumption [8, 15].
The intervention
The YAP was implemented using a multi-strategy staged approach. At year one (T1) data analysis some strategies had been only partially implemented. Commitment to a capacity building approach was adopted to embed strat- egies into university structures. Capacity building in- volves processes that build infrastructure, program sustainability and work to skill and empower individuals and groups [23, 24]. The intervention includes a focus on organisational actions, partnerships and education actions. The strategies of the intervention are identified in Fig. 1 with their implementation status highlighted.
To coordinate and provide effective support to strategy implementation [24], partnerships were established with the Guild (student body), student support services, health services, security and housing personnel, campus venues such as taverns, cafes and sports clubs with licences to serve alcohol. These partnerships have worked to ensure more responsible promotion of alcohol on campus. The initiation and maintenance of a Local Drug Action Group (LDAG) (see http://localdrugaction.com.au) provides on going opportunities for community action, advocacy and education. During the first year of the intervention the
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Capacity Building
Organisational and Policy Actions
Embedding strategy implementation within core health promotion unit
University alcohol policy development
Partnerships
Partnerships within university Local Drug Action Group Partnerships with other universities
Educational strategies
Mental Health First Aid Training
Web based THRIVE brief intervention Media and social media messages Responsible Service Training
Strategies implemented prior to T2 data collection (red) Strategies not yet implemented (purple)
Fig. 1 Intervention Strategies
LGAG produced an educational wallet card with first aid strategies for helping intoxicated friends and supported the Mental Health First Aid (MHFA) strategy.
Specific training, such as Responsible Service of Alco- hol (RSA) training and MHFA were implemented to enhance the skills of the student community [25]. Provision of face-to-face Responsible Service of Alcohol training courses enhances skills and employability of students. These courses provide an additional oppor- tunity for advocacy for responsible service, especially among clubs and groups. The adoption of responsible service practices was found to reduce levels of high risk drinking at community sporting clubs [26]. During the first year of the intervention two face-to-face RSA trainings were conducted with university sports club committee members (n = 30). Young university students have been found to experience higher levels of mental health problems than their peers [27] and high comor- bidity with mental health problems and harmful alcohol consumption [28] reinforcing the importance of inte- grated strategies. MHFA aims to improve mental health literacy and to develop skills and confidence to provide help and referral in a mental health crisis or for ongoing
mental health problems, including those related to al- cohol and other drug use. The program has previously demonstrated effectiveness in the community [29], among university students [30] and workplaces [31]. During the first year of the intervention 295 students received MHFA training.
The web-based THRIVE (Tertiary Health Research Intervention Via Email) alcohol brief intervention, devel- oped through this university and evaluated through a randomised controlled trial [13, 32], was updated and in- tegrated into the university website to provide an easily accessible and anonymous intervention for students. The program is a brief motivational health intervention consisting of an online alcohol assessment that delivers immediate and personalised feedback to participants on drinking behaviour, risks of harm, strategies for redu- cing consumption, and available support services for those drinking at harmful levels [13]. THRIVE is em- bedded in the student web portal and is voluntarily accessed. The program’s referral system supports stu- dent transition to other existing interventions and alco- hol and other drug counselling services provided through campus health services. Promotional strategies
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including the development of a bookmark distributed at campus events and web-based promotion were im- plemented to enhance the awareness of THRIVE.
To improve skills and empower young people the development of intervention strategies have been em- bedded into a core health promotion unit for under- graduate students. Students worked in small groups to develop, implement and evaluate a number of organisa- tional actions, partnerships and educational actions. Embedding strategies within a unit supports sustain- ability and a committed group of project officers which stretches limited health promotion dollars further [33]. In the first year students worked on a range of projects linked to the ongoing strategies of the YAP.
The YAP is currently planning educational strategies with a focus on media and social media. Six focus groups were conducted with key stakeholders from the Tavern (n = 5), Security (n = 6) and students (four groups; n = 35 students) to inform the development of educational strategies. Educational actions can be ef- fective in improving knowledge, attitudes, skills and behaviours [23]. Based on the findings of the focus groups the intervention will utilise social media to fa- cilitate positive change during the second year of the intervention Policy interventions are often integral to positive changes in health behaviour [34, 35]. The de- velopment and implementation of an alcohol policy is a current focus of the intervention.
Methods
Random cross sectional online surveys were conducted during July-August 2013 (baseline: T1) and 2014 (year 1: T2) in one university. The YAP commenced implemen- tation after T1 data collection. For both time periods 6000 students aged 18–24 years were emailed via their student email address by the University Surveys Office to invite them to participate in the study. Inclusion cri- teria required that the respondents’ be studying at the main campus of the university and enrolled internally. In addition, random intercept surveys, administered by trained research assistants and completed online via i-pad, were conducted on campus market day (food and market stalls and activities) during the data collection period. Due to costs associated with data collection both surveys were cross sectional and a specific cohort was not followed. This study was approved by the Curtin University Human Ethics Committee (Approval no. HR 54/2013).
Instrumentation
Students were asked if they had drunk alcohol during the last 12 months [36]. Students who responded ‘no’ to this question did not complete the 10 item Alcohol Use Disorders Identification Test (AUDIT) [37] and the Alcohol Problems Scale [38] questions.
Consistent with other Australian studies the AUDIT scores were computed to binary variables low risk (non-hazardous; < 8) and hazardous (risky; ≥ 8) drinking [5, 6, 13] to measure level of alcohol-related harm and consumption.
Harms experienced in the past 12 months were mea- sured by the Alcohol Problems Scale, a 17 item scale of harms as a result of personal alcohol consumption) [4, 38]. Students responded yes, no or prefer not to an- swer [score range 0–17] (See Table 4 for specific items). Second-hand harm, harms as a result of other students drinking during the past 4 weeks were measured using an 11 item scale [38, 39]. Witnessed harms, harms witnessed as a result of other students drinking during the past 4 weeks included a scale comprised of six harms [40]. For second-hand and witnessed harms students were pro- vided with