title: Conceptual evaluation of population health surveillance programs: method and example.
abstract: Veterinary and public health surveillance programs can be evaluated to assess and improve the planning, implementation and effectiveness of these programs. Guidelines, protocols and methods have been developed for such evaluation. In general, they focus on a limited set of attributes (e.g., sensitivity and simplicity), that are assessed quantitatively whenever possible, otherwise qualitatively. Despite efforts at standardization, replication by different evaluators is difficult, making evaluation outcomes open to interpretation. This ultimately limits the usefulness of surveillance evaluations. At the same time, the growing demand to prove freedom from disease or pathogen, and the Sanitary and Phytosanitary Agreement and the International Health Regulations require stronger surveillance programs. We developed a method for evaluating veterinary and public health surveillance programs that is detailed, structured, transparent and based on surveillance concepts that are part of all types of surveillance programs. The proposed conceptual evaluation method comprises four steps: (1) text analysis, (2) extraction of the surveillance conceptual model, (3) comparison of the extracted surveillance conceptual model to a theoretical standard, and (4) validation interview with a surveillance program designer. This conceptual evaluation method was applied in 2005 to C-EnterNet, a new Canadian zoonotic disease surveillance program that encompasses laboratory based surveillance of enteric diseases in humans and active surveillance of the pathogens in food, water, and livestock. The theoretical standard used for evaluating C-EnterNet was a relevant existing structure called the "Population Health Surveillance Theory". Five out of 152 surveillance concepts were absent in the design of C-EnterNet. However, all of the surveillance concept relationships found in C-EnterNet were valid. The proposed method can be used to improve the design and documentation of surveillance programs. It complements existing surveillance evaluation methods. Conceptual evaluation is not a performance-oriented evaluation method and so it is particularly useful for surveillance programs with a valid conceptual framework but limited technical capacity and resources. Such programs would be penalized using existing performance-based evaluation methods. Applying conjointly the conceptual evaluation along with existing performance-oriented evaluation methods will better judge the worth of surveillance programs. We recommend developing a comprehensive surveillance evaluation framework for veterinary and public health surveillance programs that integrates all existing surveillance evaluation tools and provides an appropriate way to evaluate various types of surveillance programs.
authors.affiliation: Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Faculty of Veterinary Medicine, University of Montreal, 3200 Sicotte, Saint-Hyacinthe, Quebec J2S 7C6, Canada. farouk.elallaki@inspection.gc.ca
authors.forename: Farouk
authors.initials: F
authors.lastname: El Allaki
authors.forename: Michel
authors.initials: M
authors.lastname: Bigras-Poulin
authors.forename: André
authors.initials: A
authors.lastname: Ravel
mesh_terms: D000820:Animal Diseases / Q000453:epidemiology* / Q000517:prevention & control; D000818:Animals; D002170:Canada / Q000453:epidemiology; D006801:Humans; D008954:Models, Biological; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health / Q000379:methods / Q000592:standards; D018570:Risk Assessment / Q000379:methods; D014730:Veterinary Medicine / Q000379:methods* / Q000592:standards; D015047:Zoonoses / Q000453:epidemiology*