Thomas Kliche

Martina Plaumann

Guido Nöcker

Svenja Dubben

Keywords: Disease prevention, health promotion, health education, program, implementation, quality assurance

come

Disease prevention and health promotion programs: benefits, implementation, quality assurance and open

questions-a summary of the evidence

Introduction: Program types and objectives

A common classification defines the main types of disease prevention and health promotion (DPHP) interventions, as incorporated in various quality development approaches, as follows (Töppich and Lehmann 2009): 1. Setting projects: are designed for the health-oriented transformation of entire living environments or settings (e.g., schools, day care centers or communities) following the WHO-based principles of the Ottawa Charter, which emphasize the participation and involvement of target groups and stakeholders, the concept of community empowerment, networking to build alliances for health promotion and education, and the prevention of individual risk factors and risk behaviors by contextual interventions [START_REF] Engelmann | Der Setting-Ansatz in der Gesundheitsförderung. Genealogie, Konzeption[END_REF].

2. Campaigns: involve concerted measures with media support that follow an overall intervention plan, the goal of which is to achieve increased health awareness and behavior changes in major target groups. Subtypes include media campaigns that combine mass media messages (e.g., series of exhibitions, lectures or ads on the reduction of alcohol consumption or smoking in adolescents [START_REF] Bonfadelli | Unterrichtung durch den Bundesrechnungshof. Bemerkungen des Bundesrechnungshofes 2010 zur Haushalts-und Wirtschaftsführung des Bundes (einschließlich der Feststellungen zur Jahresrechnung[END_REF]. Another subtype involves the social development of a broad alliance of health care and political actors for concerted promotion of health awareness on different issues, such as rapid and highquality care for stroke victims through many channels, in many cases, with supportive media campaigns [START_REF] Hannon | Mass Media and Marketing Communication Promoting Primary and Secondary Cancer Prevention[END_REF][START_REF] Rosecrans | Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations[END_REF][START_REF] Scheier | Influence of a Nationwide Social Marketing Campaign on Adolescent Drug Use[END_REF]. (structural, environmental): involve sociopolitical action aimed at changing risk behavior opportunities and decreasing the accessibility and costeffectiveness of risk substances by measures such as raising taxes, banning advertising and/or restricting access to cigarettes or alcohol and installing water coolers in schools.

Contextual interventions

4. Individual measures: short-term health projects which follow specific local approaches (e.g., lectures for school classes or ad hoc training for day care managers).

Programs, i.e., reproducible and standardized behavioral interventions:

A program is an intervention plan template that specifies the approach to a defined goal and describes the model for solution of this task in an intervention manual. A program can also be used as part of a campaign; it often includes recommendations for contextual interventions, such as "reactively" addressing intoxicated adolescents in hospitals and "proactively" developing local drug prevention networks [START_REF] Steiner | Wissenschaftliche Begleitung des Bundesmodellprogramms "HaLT -Hart am LimiT[END_REF].

There is some dispute as to whether multiplier training for non-standardized interventions (e.g., training of specialists for setting projects in communities) should be classified as programs. However, the multipliers' interventions can be seen as a setting project or as individual action, whereas the training itself can be classified as a train-the-trainer behavioral program designed, for example, for promotion of resilience in nurseries [START_REF] Fröhlich-Gildhoff | Prävention und Resilienzförderung in Kindertageseinrichtungen (PRiK). Trainingsmanual für ErzieherInnen[END_REF][START_REF] Guevel | Assessment of a national network: the case of the French teacher training colleges' health education network[END_REF][START_REF] Hahn | Efficacy of training and fidelity of implementation of the Life Skills Training Program[END_REF]. Thus, trainthe-trainer interventions can be evaluated the same as all other programs.

Challenges to the implementation of evidence-based, standardized procedures in health care are not limited to prevention and health promotion, but also affect highly regulated and wellresearched fields of action [START_REF] Driscoll | Evidence-based chronic heart-failure management programmes: reality or myth?[END_REF]. As social technologies, DPHP programs have triggered fundamental and controversial discussions [START_REF] Rosenbrock | Primärprävention -Was ist das und was soll das[END_REF][START_REF] Rosenbrock | Quality of Provider-Participant Relationships and Enhancement of Adolescent Social Skills[END_REF]Wulfhorst and Hurrelmann 2009). The following sections therefore present a problem-oriented summary of the status of research on the usefulness and requirements for programs. This unsystematic review encompasses fundamental research and review articles as well as exemplary studies investigating the methods and effectiveness of programs and listed this in their abstracts, keywords or title. It is not intended as a meta-analysis of efficacy but rather as a structured review of important benefits and requirements regarding the use of programs.

Advantages and benefits of programs

Program-based intervention offers a number of advantages to target groups, professionals and funding agencies (e. g. Hurrelmann et al. 2004;Kalke et al. 2004;[START_REF] Naidoo | Lehrbuch der Gesundheitsförderung. Umfassend und anschaulich mit vielen Beispielen und Projekten aus der Praxis der Gesundheitsförderung. Hrsgg. von der Bundeszentrale für gesundheitliche Aufklärung[END_REF]Wulfhorst and Hurrelmann 2009):

(1) Efficacy: Programs have defined goals, target groups, operating conditions and procedures, making it possible to evaluate their efficacy and effectiveness. A successful intervention is reproducible under similar conditions. Among the large number of moderately effective programs for prevention of drug abuse among children and adolescents [START_REF] Soellner | Prävention von Cannabiskonsum und -missbrauch: Evidenzbasiert oder nur gut gemeint?[END_REF][START_REF] Thomas | Chronic Diseases & Injuries. Chronic Disease Prevention. Injury Prevention Including Substance Abuse Prevention. Family Health. Sexual Health. Infectious Diseases. Sexually Transmitted Diseases (STDs) including HIV/AIDS. Effective Public Health Practice Project (EPHPP), Epidemiology and Evaluation[END_REF]; R. Thomas and Perera 2008), a few had sustainable effects over a 15-year period [START_REF] Skara | A review of 25 long-term adolescent tobacco and other drug abuse prevention program evaluations[END_REF].

(2) Efficiency: Programs can be implemented at a favorable cost-benefit ratio for the community as well as for the professionals, funding agencies and target groups for a number of reasons: Development and evaluation can be performed very meticulously, but are onetime costs that benefit all implementation sites later. Programs allow for rapid and targeted responses to health-related needs, and can be carried out by trained personnel. From the first steps on, a well-planned, high-quality and proven effective procedure can be implemented without detours. Programs are optimized for maximal effect, so they can quickly achieve significant effects, which enhances the motivation for participation [START_REF] Ribeiro | School-based physical education programs: evidence-based physical activity interventions for youth in Latin America[END_REF]). Here is one recent example: In a study of nine different programs to promote physical activity in the UK from 2004 to 2006, health improvement was observed in around one-third of all participants [START_REF] Pringle | Cost-effectiveness of interventions to improve moderate physical activity: A study in nine UK sites[END_REF]. The implementation cost per participant ranged from c£55 to c£3,420, and the cost per quality of life year (QALY) gained from intervention types ranged from c£47 to c£509. This is much less than the £20,000 threshold implicit in the British National Institute for Health and Clinical Excellence (NICE) decisions, which is now conventionally used in many countries. Future cost savings per intervention participant were estimated to be c£769 to c£4,891.

(3) Transparency, limits and controllability: Programs give organizations a manageable range of targets with defined costs, approaches, time horizons and benefits and therefore provide a high potential for consensus between stakeholders in DPHP services and organizations. Interventions are possible if consensus on their objectives can be reached. It is not necessary to redesign the entire organization. This minimizes resistance. By virtue of their transparency, programs can be evaluated by cost-benefit analysis and in terms of their contribution to public health goals, making this a fair selection criterion [START_REF] Dushaw | A comparative study of three model comprehensive elementary school health education programs[END_REF][START_REF] Helming | Kurzevaluation von Programmen zu Frühen Hilfen für Eltern und Kinder und sozialen Frühwarnsystemen in den Bundesländern[END_REF]).

(4) Knowledge transfer and professional development: Programs promote the professional development of DPHP staff because the user training programs and program manuals give the implementers an introduction to the state of research and professional practice and provide them potentials for new, evidence-based problem solutions. Programs increase problemsolving skills in DPHP. After widespread implementation, program operating conditions and areas in need of improvement can be identified and continuously added to the manual. Reviews of different programs can be used to comparatively determine the most effective strategies. One review identified the most effective school-based drug prevention programs as those with interactive teaching methods, peer leaders, and a focus on general life skills and the social influence model, particularly by addressing risk behavior and drug abuse in the target groups, which were additionally supported by community interventions designed to reshape contextual conditions of consumption and to emphasize sensitivity to social norms [START_REF] Cuijpers | Effective ingredients of school-based drug prevention programs: A systematic review[END_REF].

Problems in program implementation

On the other hand, research demonstrates the difficulties in exploiting the opportunities afforded by DPHP programs. One review of 30 high-quality studies on school-based drug prevention programs showed that most prevention programs are not effective in broad use [START_REF] Cuijpers | Effective ingredients of school-based drug prevention programs: A systematic review[END_REF]. Many institutions do not adopt entire programs, but only parts or concepts of the programs [START_REF] Barr | Amenability and implementation in secondary school antitobacco programs[END_REF][START_REF] Miller | Innovation in HIV Prevention: Organizational and Intervention Characteristics Affecting Program Adoption[END_REF]. Furthermore, the programs do not remain functional in all institutions, even when considerable funds are invested. One study revealed that, although a state violence prevention agency invested nearly 60 million USD in 170 model prevention programs in over 120 communities, only 45% were operating at the same level or a higher level than the final year of funding, and 33% of the interventions were no longer operating 5 years post-funding [START_REF] Tibbits | Sustaining Evidence-based Interventions Under Real-world Conditions: Results from a Large-scale Diffusion Project[END_REF]. What are the causes of this lack of sustainability? A number of original studies and reviews deal with this subject (e. g., [START_REF] Fröhlich-Gildhoff | Prävention und Resilienzförderung in Kindertageseinrichtungen (PRiK). Trainingsmanual für ErzieherInnen[END_REF]Swerissen and Crisp 2004;[START_REF] Wagner | Health promotion in kindergarten children: an assessment of evaluated projects in Germany[END_REF]):

• Low program fidelity and implementation quality: A number of programs are implemented spottily and with serious deficiencies, e.g., in the area of HIV/AIDS prevention [START_REF] Bertozzi | Making HIV prevention programmes work[END_REF], school-based drug prevention [START_REF] Pentz | Effects of Program Implementation on Adolescent Drug Use Behavior: The Midwestern Prevention Project (MPP)[END_REF][START_REF] Sloboda | Implementation fidelity: the experience of the Adolescent Substance Abuse Prevention Study[END_REF], and obesity prevention in children and adolescents [START_REF] Thomas | Obesity prevention programs for children and youth: why are their results so modest?[END_REF]. Health insurance companies, the main providers of disease prevention programs in Germany, have established quality criteria and evaluation instruments for their health courses but do not use them consistently; therefore, the effectiveness of their courses remains unproven (Bundesrechnungshof 2010). • Exaggerated flexibility subject to political change: The limited applicability of programs encourages their intermittent use, for example, in workplace health promotion [START_REF] Kliche | Die Implementation der BGF in Deutschland -Stand, Hürden und Strategien. Ein Überblick[END_REF]. In cases where the objectives of programs are ambiguous or subject to political instability (e.g., government changes), programs are susceptible to senseless changes by virtue of their flexibility and transparency.

• Inadequately trained and overworked personnel: An overworked staff is a common reason for the lack of program integrity. The lower the work load, the higher the level of education, and the more extensive the introductory training, the higher the willingness of staff to utilize evidence-based interventions [START_REF] Rabin | Individual and setting level predictors of the implementation of a skin cancer prevention program: a multilevel analysis[END_REF]. Inadequately trained staff members are often recruited due to lack of the field experience or time pressure [START_REF] Hasson | Systematic evaluation of implementation fidelity of complex interventions in health and social care[END_REF]. One study found that health education instructors differ in terms of role perception, and that a knowledge transfer-and control-based role perception can weaken health promotion programs [START_REF] Jourdan | Factors influencing the contribution of staff to health education in schools[END_REF]).

• Disregard of context: Programs must be appropriate for their specific context [START_REF] August | Can Evidence-Based Prevention Programs be Sustained in Community Practice Settings? The Early Risers' Advanced-Stage Effectiveness Trial[END_REF][START_REF] Kliche | Die Beurteilung der Struktur-, Konzept-und Prozessqualität von Prävention und Gesundheitsförderung: Anforderungen und Lösungen[END_REF]). The indiscriminate transfer of a program from one context to another presumed to be fairly similar can impair program effectiveness. For example, a school-based program can lose effectiveness when transferred from a mandatory to a voluntary after-school setting [START_REF] Gottfredson | An Experimental Evaluation of the All Stars Prevention Curriculum in a Community After School Setting[END_REF]. Due to the large amounts of funds invested in them worldwide, intensive efforts have been made to improve the selection of prevention interventions in HIV/AIDS prevention [START_REF] Bertozzi | Making HIV prevention programmes work[END_REF]. A number of factors contribute to the selection of inappropriate programs, including misleading stereotypes about target groups (e.g., "stoners") held by organization leaders, and the practice of opening of slots to less needy participants simply to fill up classes. A fundamental dilemma also plays a role: Health care innovations are usually implemented at a stage where feasibility studies and intervention development have been completed and the efficacy of the intervention has been proven, but its broad-spectrum effectiveness has not been tested because the intervention has only been broadly introduced once and may have to be modified. If a program is to be implemented in a different context, even if that context is a related subfield such as drug prevention in schools, it should be tested for effectiveness in that specific context prior to implementation (Jerusalem 2003).

• Change of implementation frameworks: Organizational characteristics have a direct impact on program efficacy. Thus, school culture has an effect on drug prevention programs in terms of participation opportunities, ways of dealing with violence, performance norms, common values, etc. [START_REF] Aveyard | The influence of school culture on smoking among pupils[END_REF][START_REF] Fletcher | School effects on young people's drug use: A systematic review of intervention and observational studies[END_REF][START_REF] Reid | School Climate and Adolescent Drug Use: Mediating Effects of Violence Victimization in the Urban High School Context[END_REF].The transfer of a program from one context to another, even if organizationally similar (e.g., from one school to another), should therefore be very carefully considered [START_REF] Kliche | Wie) wirkt gesundheitsfördernde Schule? Effekte des Kooperationsprojekts "gesund leben lernen[END_REF]).

• Lack of supportive contextual interventions: Behavioral interventions often require a high level of motivation on the part of the participants. Combining such measures with simple contextual or organizational interventions (e.g., raising taxes on cigarettes, regulating cigarette vending machines, and making test purchases to check vendor compliance can enhance smoking prevention interventions; changing the structure of work organization to make time for stress management exercises; and providing ergonometric furniture to enhance back exercise classes) makes both approaches significantly more effective [START_REF] Awa | Burnout prevention: A review of intervention programs[END_REF][START_REF] Bonfadelli | Unterrichtung durch den Bundesrechnungshof. Bemerkungen des Bundesrechnungshofes 2010 zur Haushalts-und Wirtschaftsführung des Bundes (einschließlich der Feststellungen zur Jahresrechnung[END_REF]KKH and Walter 2006). However, many programs omit clear instructions for supportive contextual interventions because these may require changes in the entire organization that might exceed the competencies, mandates or objectives of the implementers.

• Plethora of programs: Even professionals find it hard to maintain an overview of the plethora of programs and select the most appropriate programs for a specific case [START_REF] Kliche | Versorgungsstrukturen und Qualitätssicherung für Prävention und Gesundheitsförderung in Deutschland[END_REF]). An (incomplete) search revealed at least 419 primary prevention programs for children in Germany alone [START_REF] Gerlach | Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen: Koordination und Integration -Gesundheitsversorgung in einer Gesellschaft des längeren Lebens[END_REF]Noweski 2009). Confusing concomitant research is forcing the funding agencies to do their own evaluations, which do not necessarily increase clarity. One US public health department alone developed and implemented 34 program evaluation plans and collected data on 52 indicators across 492 measurable objectives in an attempt to identify challenges and recommendations to improve evaluation processes [START_REF] Reedy | Local Public Health Performance Measurement: Implementation Strategies and Lessons Learned From Aligning Program Evaluation Indicators With the 10 Essential Public Health Services[END_REF]. Few public health agencies have the resources needed to create transparency of effects because the effectiveness of the interventions has not been proven.

• Scarce resources and weak organizational support: Readiness of the participating professionals and organizations for change is crucial [START_REF] Wang | Factors that influenced county system leaders to implement an evidence-based program: A baseline survey within a randomized controlled trial[END_REF]). If a new program is introduced as an additional task, they tend to feel used and devalued. Therefore, the support of change is often tied to adequate funding. In addition to staff resources and long-term financial planning, it was found that the support of school principals and colleges is crucial for the stability of violence prevention programs in American schools [START_REF] Tibbits | Sustaining Evidence-based Interventions Under Real-world Conditions: Results from a Large-scale Diffusion Project[END_REF]).

• Resistance to social technologies: Programs imply "teaching-learning". Depending on a person's educational biography, this kind of learning can trigger an attitude of distrust, avoidance, and delegation of responsibility, especially when the target groups feel they are being disciplined or manipulated (Holzkamp 1993). Non-intentional effects may result. Drug prevention in male youth from ethnocultural subgroups, for example, can interact with a risk and macho culture. One study showed that after information about common risk behaviors had shown health-oriented participants that their health behavior was exemplary, their behavior subsequently worsened (MVPP 2008). Likewise, a recent review reported a relative increase in tobacco, alcohol and drug consumption among adolescents in 3 out of 20 studies investigated [START_REF] Petrie | Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: a systematic review[END_REF]).

• Research gaps: Ultimately, the benefits of programs will not become effective unless the facts that are potentially available are actually collected and analyzed. Compared to the clinical sector, prevention research suffers from structural weakness and underfunding in combination with heterogeneous work settings that place high demands on research planning [START_REF] Kliche | Versorgungsstrukturen und Qualitätssicherung für Prävention und Gesundheitsförderung in Deutschland[END_REF]). However, stringent designs are likely to evoke resistance in some fields because practitioners as well as funding agencies feel they are being monitored by robust evaluations that enable comparison. Therefore, despite years of high spending in an area such as HIV/AIDS prevention, and despite favorable results for some approaches such as for life skills training (Yankah and Aggleton 2008), inadequate progress has been made in this field. By 2008, only 21 stronger studies were available, including 17 on biomedical interventions and only a few on behavioral or structural interventions [START_REF] Galarraga | HIV prevention cost-effectiveness: a systematic review[END_REF]). Methodologically inferior evaluations, however, usually underestimate the effects of interventions due to measurement imprecision [START_REF] Thomas | Obesity prevention programs for children and youth: why are their results so modest?[END_REF]. This condition in many subareas is not attributable to a lack of funds alone, but also to unclear program theories that are so immune to empirical findings that they justify further studies that could be career-enhancing and thus attractive to researchers (H. [START_REF] Thomas | Obesity prevention programs for children and youth: why are their results so modest?[END_REF]).

• Choices based on marketing criteria instead of effectiveness: Research gaps, complexity and unclear implementation conditions encourage the use of irrelevant selection criteria like the public visibility of decision-makers and their agencies, the image and customer loyalty of health insurance companies, and personality profiling of managers [START_REF] Bertozzi | Making HIV prevention programmes work[END_REF][START_REF] Kliche | Versorgungsstrukturen und Qualitätssicherung für Prävention und Gesundheitsförderung in Deutschland[END_REF]. Competition between funding agencies additionally leads to the unconnected and uncoordinated implementation of programs, resulting in the inclusion of non-target groups, which spoils the effectiveness of the programs. Implementation in less needy target groups results in ceiling effects, whereas implementation in hopeless situations leads to floor effects. For example, it is unlikely that croupiers or betting agency owners who benefit from gambling will intervene when they observe symptoms of pathological gambling, although many current staff training interventions in Germany operate on this assumption.

Methods for the enhancement of quality and effectiveness

Robust intervention plan: The simpler the program structure, the easier and more reliably it can be utilized by professionals and target groups. Programs with a small number of modules and intervention techniques appear to work better, particularly for socially disadvantaged target groups [START_REF] Michie | Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks[END_REF].

Clear and comprehensive manuals:

According to the state of research, program manuals should contain the following elements (Ströbl et al. 2009;[START_REF] Ströbl | The sustainability of health promotion interventions for different levels of social organization[END_REF]): Objectives, target groups, area of use (framework conditions such as field of work and access), inclusion and exclusion criteria, group form and size, modules (individual blocks of action) and their subject areas, number, duration and frequency, instructor qualifications, room size and equipment, media and materials and their applications, preliminary and followup measures, measures for inclusion of the social environment (e.g., family members), and measures for quality assurance and evaluation. The environment should be support the program objectives (e.g., non-smoking hospital for tobacco prevention programs). If necessary, the manual should specify appropriate contextual prevention requirements (e.g., how a non-smoking school should be structured and where to find a roadmap for its introduction). Program experiences should be documented and shared (e.g., regarding proven methods of handling target subgroups). Topics, verifiable learning objectives, time requirements, methods and their sequence, and objectives, teaching principles and materials (worksheets, films, introductory questions, presentation methods, etc.) should be specified for each module (e.g., each session). It is important that implementers are informed on possible margins of discretion to adapt aspects of the program without compromising its effectiveness.

Definition of intervention core and periphery: Differentiation between minimum elements that are necessary for implementation and variable components that may be adapted to local conditions encourages the diffusion of innovations in health care [START_REF] Kliche | Wie bekomme ich neue Ansätze in die Praxis? Erfolgsfaktoren für die Verbreitung, Einführung und Verstetigung von Innovationen[END_REF]. Thus, highquality programs (e.g., for promotion of physical activity in schools) include integral procedural steps that ensure target group-oriented adaptation [START_REF] Ribeiro | School-based physical education programs: evidence-based physical activity interventions for youth in Latin America[END_REF]. Different forms of participation are available which help to integrate practical knowledge in the adaptation of programs (Wright 2010).

Organizational and leadership support:

The management should approve of and appropriately fund and equip DPHP programs. This attitude become clear at an early project stage and can determine the sustainability of program use, e. g. in schools [START_REF] Payne | Do Predictors of the Implementation Quality of School-Based Prevention Programs Differ by Program Type?[END_REF][START_REF] Tibbits | Sustaining Evidence-based Interventions Under Real-world Conditions: Results from a Large-scale Diffusion Project[END_REF]. Agreements or voluntary self-commitments, a continuous flow of information, the appointment of responsible parties or contact persons and their substitutes, and the allocation of working time for the task are central methods to commit the entire organization (GKV-Spitzenverband 2010; Ströbl et al. 2009).

Qualification of users:

Programs increase the professional competence of implementers to conduct effective interventions. The manual and introductory training should emphasize this benefit. Users need appropriate basic qualifications, training and continuing education for the program (GKV-Spitzenverband 2010; Ströbl et al. 2009). Professional competence is also an important factor for self-efficacy and confidence in change (Sale et al. 2008). Introductory coaching or electronic support messages (e.g., for reminders, post-program feedback or invitations for booster sessions) can support professional effectiveness [START_REF] Hahn | Efficacy of training and fidelity of implementation of the Life Skills Training Program[END_REF][START_REF] Ringwalt | Three-year trajectory of teachers' fidelity to a drug prevention curriculum[END_REF]. The time required for training and implementation support can be substantial [START_REF] Hunter | Technical Assistance as a Prevention Capacity-Building Tool: A Demonstration Using the Getting To Outcomes(R) Framework[END_REF]) and should be quantified by the manual. The support of most or all professionals in the field of application is important. In schools, for example, the teachers act as opinion leaders. The entire school staff should be motivated for a program and endorse a health-oriented organizational culture and not limit their professional concept to a technical understanding of teaching isolated facts from different disciplines [START_REF] Jourdan | Factors influencing the contribution of staff to health education in schools[END_REF].

Systematic adaptation to local conditions:

The following steps are useful for the adaptation of programs to new contexts (Card et al. 2011):

1. Selection of a program based on objectives, evidence, suitability, accessibility and attractiveness for the target groups as well as adequate resources available to the implementing organizations.

2. Compilation of all materials.

3. Development of a program theory, i.e., a model of causal relationships between strategies, activities, services, short-and long-term goals, and changes in the target groups.

4. Definition of core elements of the program.

5. Definition of the need for adaptation of goals to target groups (e.g., age, education, culture and language groups), to implementing institutions (e.g., profiles of services provided, qualifications, language skills, target group access), and to intervention settings (e.g., norms and values, management structure, accessibility and local public transport).

6. Adaptation of the program theory, e.g., simplification by concentrating on a target subgroup.

7. Adaptation of the program's core elements to the new setting (language and images, state of development, norms and values, scientific updating, training materials, and evaluation instruments).

Quality assurance and monitoring of acceptance and effectiveness: Supporting methods for the adequate use of a program include: introductory training and supportive measures for users (coaching/supervision, hotlines, chats, counseling), regular user meetings and conferences offering an exchange of experience, check lists for module implementation, models of good practice, user surveys to improve the modules (e.g., for new target subgroups), sample documents for important steps (e.g., sample letters and brief project profiles for multipliers), the appointment of program champions responsible for monitoring and disseminating information on improvements and new findings regarding the program (e. g., [START_REF] Ringwalt | Three-year trajectory of teachers' fidelity to a drug prevention curriculum[END_REF][START_REF] Rohrbach | The Project Towards No Drug Abuse (TND) dissemination trial: Implementation fidelity and immediate outcomes[END_REF]Ströbl et al. 2009). Participation data provide brief insight into the acceptance, facilitator surveys on problems of use, and basic participant surveys on satisfaction and selected outcome indicators (Ströbl, Friedl-Huber et al. 2007). This requires the selection of valid endpoints to gather data quick and easy, analyze and evaluate in practice [START_REF] Kliche | Gesundheitswirkungen der Prävention: Entwicklung und Erprobung eines Routine-Evaluationssystems für Primärprävention und Gesundheitsförderung der Krankenkassen in Settings, Betrieben und Gesundheitskursen[END_REF][START_REF] Loss | Gemeindenahe Gesundheitsförderung -Herausforderung an die Evaluation[END_REF]. Today, first-rate quality assurance procedures such as QIP, PREFFI and IDM are suitable for testing program integrity, contextual fit and adaptation, and the linkage of behavioral and contextual interventions [START_REF] Kahan | IDM Manual for using the Interactive Domain Model approach to best practices in health promotion[END_REF][START_REF] Molleman | The Multisite Violence Prevention Project: Impact of a Universal School-Based Violence Prevention Program on Social-Cognitive Outcomes[END_REF][START_REF] Töppich | QIP: Qualität in der Prävention. Ein Verfahren zur kontinuierlichen Qualitätsverbesserung in der Gesundheitsförderung und Prävention. Handbuch Gesundheitswissenschaften[END_REF].

Conclusion: Future tasks

Some requirements for program implementation can be derived from this body of evidence. There are requirements related to program development:

1. There should be a clear and comprehensive manual defining

• clear objectives with measureable indicators applicable in practice

• the operating conditions, the necessary resources, and the costs of program launch and implementation • the elements necessary for effectiveness

• the steps for the adaptation of the program or parts of the it to a specific setting (e.g., instructions for combining the program with contextual interventions), if applicable.

2. Quality assurance measures should be available during program launch and implementation.

3. Data on user experiences (e.g., effects) should be aggregated and published.

Some recommendations concern DPHP funding agencies:

4. The selection of programs should follow their suitability for specific target groups and settings. The selection should include a research and discussion stage, if necessary. The above characteristics of effect-oriented, user-friendly program design (cf. section 4) can serve as reference points for selection criteria.

5. There should be evidence of health-related effects. If the evaluation only covers efficacy, then effectiveness must be observed during the implementation, at minimum, using selected indicators for a simple analysis of different subgroups (Donner-Banzhoff 2009). If effectiveness has already been tested, the program should at least achieve small effect sizes and better efficacy than other approaches under real-life conditions in broad target groups.

Finally, tasks for research emerged: managers, teachers, etc.). In addition, users need information on program duration, costs, sources, procurement and implementation times (including informal preparation times), support required by their organizational management, training and qualification requirements, and anticipated effects according to the evidence.

In Germany, these tasks are currently being taken forward by a prevention research funding initiative. The Federal Ministry of Education and Research provided approximately 20 million Euros for around 60 prevention research projects from 2004 to 2012. Over 50 research institutions and more than 200 practice partners are involved. The project leaders develop programs, test their efficacy and effectiveness, expand the methods of quality assurance, and test new approaches to disease prevention and health promotion, especially in vulnerable groups such as children and adolescents, older people, and people in difficult social circumstances. An overview of these activities is provided on the KNP (Cooperation For Sustainable Disease Prevention) homepage: www.knp-forschung.de. KNP provides a network for application-oriented disease prevention research for science and practice as well as for professional associations and decision makers. Additionally, KNP promotes the dissemination of disease prevention research in professions, health care policy, social policy and education policy, and supports collaboration and structure-building in the field. Work groups for practice transfer, policy transfer, health inequality, methods, participatory healthcare research, and prevention and rehabilitation currently exist. Persons or institutions interested in international cooperation are invited to contact the KNP (walter.ulla@mhh.de).

The authors declare that they have no conflict of interest.

This research was funded by the German Federal Ministry of Education and Research (BMBF), in the Cooperation For Sustainable Disease Prevention KNP.

  Instruments for the cheap, rapid and valid analysis of implementation quality should be developed. They provide data that support efficacy and provide certainty about whether a program or its local implementation are to blame for weak effects. If program fidelity data are available, then evaluation methods such as progress assessment, goal-oriented program evaluation and program theory evaluation can be used to analyze the efficacy, even for complex interventions(Regeer et al. 2009;[START_REF] Schochet | An Approach for Addressing the Multiple Testing Problem in Social Policy Impact Evaluations[END_REF][START_REF] Weitzman | Finding the Impact in a Messy Intervention: Using an Integrated Design to Evaluate a Comprehensive Citywide Health Initiative[END_REF][START_REF] Znoj | Methoden der Evaluation[END_REF]. Until now, program integrity has been analyzed in a highly program-specific and cumbersome manner (e. g., Hasson 2010), i.e., with little hope of wide-scale implementation. Even simple short protocols for individual steps and interventions are used reluctantly and incompletely[START_REF] Kliche | Wie) wirkt gesundheitsfördernde Schule? Effekte des Kooperationsprojekts "gesund leben lernen[END_REF]. Therefore, program evaluators have often to rely on retrospective user or expert surveys[START_REF] Curry | A National Evaluation of Community-Based Youth Cessation Programs: Design and Implementation[END_REF]. 9. Systematic program libraries for subfields should be established. Such libraries would allow users to compare programs based on their context, goals and performance criteria (in particular, cost and efficacy), and choose the ones that are suitable for their needs. A program library should contain the following program characteristics: Settings (e. g., daycare center, type of school, enterprise, community, etc.), objectives (weight reduction, promotion of a healthy diet, smoking cessation, alcohol or drug prevention, etc.) and target groups by age, sex and special characteristics (e.g., people with few resources,

	6. Methods for the selection and combination of effect-enhancing contextual interventions in
	synergy with programs should be reviewed and added to the manuals (Lister-Sharp et al.
	1999).

7. Simple quality assurance measures for programs should be provided that are not perceived as de-motivating and controlling.

8.


Christo El Morr

Pierre Maret

Marcia Rioux

Mihaela Dinca-Panaitescu

Julien Subercaze

Virtual Community Life Cycle: a Model to Develop Systems with Fluid Requirements

Keywords: Disability rights, Disability Rights Monitoring, Virtual Communities, Knowledge Networks, Knowledge Management

This paper reports the results of an investigation into the life cycle model needed to develop information systems for group of people with fluid requirements. For this purpose, we developed a modified spiral model and applied to the analysis, design and implementation of a virtual community for a group of researchers and organizations that collaborated in a research project and had changing system requirements? The virtual knowledge community was dedicated to support mobilization and dissemination of evidence-based knowledge produced by the Disability Rights Promotion International Canada (DRPI-Canada) project.

Introduction

Virtual communities (VCs) have drawn attention of researchers since the inception of the web. Health Virtual Communities (Health VCs) started to take shape in the mid of 1990's. Nevertheless, even though Health VCs share advantages and challenges with other types of VCs some of the advantages they present and the challenges they face are health care specific. Therefore, there is a need to conduct a Health VCs assessment. People form virtual communities in order to achieve a certain aim, e.g. playing, chatting, discussing, researching, collaborating, etc. Chat rooms, bulletin boards, and email groups can be considered as virtual communities that allow people to gather and bond. VCs received a visible level of attention from the research community in many disciplines: Computer Science, Sociology, Psychology, and other disciplines. Preece [START_REF] Preece | Online Communities: Designing Usability supporting Sociability[END_REF] suggests that a virtual community is shaped of: (a) socially interacting people, performing special roles or satisfying their needs, (b) a purpose, which is the reason behind the community, (c) policies to govern people interaction, and (d) a Computer Systems that support social interaction.

The problem

While Virtual Communities are well defined and virtual communities modeling has been giving fair attention it is by definition assumed that the purpose, aims and objectives of a community members are well defined in advance; it follows that the inherent assumption -from an information systems perspective -is that existing development life cycles can be followed when developing any virtual community. Though, in a fluid environment, such as a situations where participants can change their role/situation/position in their participation, in multidisciplinary research and collaborative teams, or when the environment is evolving with the time (some external parameters are changing), little -if any -concrete systems objectives, other than the general 'purpose' of collaboration, are defined in advance. Indeed, the concrete requirement needs are revealed as the project progresses or even during the community's life. To the best of our knowledge, there has not been an attempt to explore the system development life cycle model needed in projects where requirements are not only not well defined but also fluid and changing in nature. This paper is an attempt to draw the first sketches of such model in the context of a multidisciplinary collaborative virtual knowledge community. Our approach is general and is based on our experience in virtual communities for Human rights monitoring and for health prevention. Most of our examples will be taken from this first domain of application; however some requirements cited will illustrate our second domain of application which contains some additional characteristics (for instance information gathering based on sensed data).

Virtual Communities for Human Rights Monitoring

Framework of Disability

Disability activists and scholars refer to disability rights as "…the equal effective enjoyment of all human rights by people with disabilities" (Disability Rights Promotion International (DRPI), 2003). The majority consensus is that "disability" is a consequence of negative social conditions rather than an individual's specific medical impairment [START_REF] Barnes | Exploring Disability: A Sociological Introduction[END_REF][START_REF] Fougeyrollas | The Quebec Classification : Disability Creation Process[END_REF][START_REF] Rioux | Disability: The Place of Judgment in a World of fact[END_REF][START_REF] Rioux | Bending towards justice[END_REF][START_REF] Shakespeare | What is a Disabled Person?[END_REF][START_REF] Thomas | Disability Theory: Key Ideas, Issues and Thinkers[END_REF].

A review of international human rights literature shows that, unlike areas such as women's rights (Callamard, 1999a[START_REF] Callamard | A methodology for Gender-Sensitive Research[END_REF], disability rights monitoring is relatively underdeveloped (International Disability Rights Monitor, 2004). Mobilization and dissemination of evidencebased knowledge produced through monitoring processes represent the keystone of a holistic approach to monitoring; though integrating different facets of monitoring requires collaboration among a broad range of individuals (including people with disabilities) and organizations. This paper proposes an operational tool that enables dynamic collaboration among project's participants and knowledge creation and sharing.

Systemic human rights violations against people with disabilities are usually interpreted as issues of service provision rather than being recognized as fundamental rights in order to achieve a society in which people with disabilities are free to fully and equally participate. This requires a conceptualization of disability within a human rights framework that looks at how society marginalizes people, and what strategies are needed to address existing inequalities. It involves moving away from viewing people with disabilities as anomalies towards viewing them as rights holders and equal citizens (Quinn & Degener, 2002).

Rights monitoring is the first step in making this shift possible. While there are a number of international and Canadian human rights commitments and rights monitoring initiatives in the international arena(Disability Rights Promotion International (DRPI), 2003; International Disability Rights Monitor (IDRM), 2004), Canada lacks comprehensive and multi-level analysis of disability rights violations. DRPI-Canada project takes a significant step forward in developing a system to monitor the human rights situation of people with disabilities.

Mobilization and Dissemination of Evidence-Based Knowledge

Holistic disability rights monitoring is grounded in on-going communication and sharing of resources, training and methodological approaches among four themes (Policy and Law Monitoring, Individual Experiences Monitoring, Media Monitoring, Statistics Monitoring). Furthermore, it is essential to build capacity, leadership and knowledge development within the disability community in order to promote greater awareness of disability discrimination and to enable people with disabilities themselves to take ownership of disability rights monitoring. In this context, a complex system is required to facilitate the collaboration of a full range of project participants -researchers, representatives of disability community, policy makers, and general public -and support capacity building within disability community through access to online tools and training resources.

The Virtual Knowledge Community

This section describes the design and development process of a Virtual Knowledge Community (VKC) to support, in this case, the holistic disability rights monitoring.

Virtual Communities

VCs received a visible level of attention from the research community in Computer Science, Sociology, Psychology and other disciplines [START_REF] Preece | Online Communities: Designing Usability supporting Sociability[END_REF]. A virtual community is a form of social system; it inherits some of the social system's characteristics [START_REF] Weissman | A social ontology[END_REF] such as causal reciprocity, purpose, design, roles, circumstances, officers, passion, needs, loyalty, and access. There are different perspectives and different classifications of VCs [START_REF] El Morr | Encyclopedia in Mobile Computing & Commerce[END_REF][START_REF] El Morr | Mobile Virtual Communities Research: A Synthesis of Current Trends and a Look at Future Perspectives[END_REF][START_REF] Stein | A Classification of U-Commerce Location Based Tourism Applications[END_REF]; though, VCs can be constructed to form a knowledge network. Virtual knowledge Communities are communities where participants capture, access, use, create, and define knowledge [START_REF] Merali | Knowledge capture and utilization in virtual communities[END_REF], and/or where information is automatically captured to be accessed and shared in-between participants. Our purpose is to design and implement a VC for Knowledge Mobilization, i.e. for knowledge generation, dissemination and use, in the contexts of DRPI and health prevention.

While several virtual communities platform exist, none are general enouth to be adapted to our research team objectives in terms of creating dynamic relations among team members, enabling particularly each member (and not only administrators) to create folders and upload/download documents, to co-edit documents and to share files across communities in different levels of granularity: share with one person, one group of people and a whole community. Besides, none of these sites is fully accessible to people with visual disabilities or with limited abilities in the use of computers systems, while accessibility is an essential objective that we strive for in our projects. The VKC is described in detail in the next sections of the paper.

Platform Design and Implementation

Community Design

In the field of disability, tools and training resources for evidence-based data collection are scarce as are tools and methods for multiple levels of analysis (i.e. individual, systemic. Development and dissemination of these tools incorporating an e-learning component to a virtual knowledge community in order to support continuous training to develop monitoring skills (online manuals, course guides, books, tools…). Internally, the VKC finally consists of data/document base with links and interactions in-between participants. It should enable participants such as researchers (who are supposed to access and work on this great amount of data) and practitioners (who are supposed to assist concerned people), to communicate and cross-check their findings, and to collaborate around subjects of interest during the research activities. Therefore, members will need a component allowing collaboration to facilitate knowledge creation. Finally, the VKC needs to facilitate the search for information for communities' members. Consequently the VKC was designed into four components allowing (1) knowledge creation, (2) knowledge discovery, (3) knowledge dissemination and (4) VKC management. The VKC platform was designed to comprise functionalities that support all four components.

Community Platform Implementation

This section presents the implementation choices we have made for the implementation of communities. Open source material has been used throughout the development of the model. The VC platform allows two major roles to be played: Administrator and Member; the members can play three possible roles: consumer, producer and consumer/producer of information. In the domain of human rights monitoring, information stored and exchanged materializes into documents (in different formats). In the domain of health prevention, information may also consist of raw data captured on or around the patient, or on aggregated data combining several data sources.

The administrator is concerned with the maintenance of the VKC (community and member management), such as creating a new community (figure 2). Several communities can created, and members can belong to more than one community. Access to a community can be public or controlled. The application portal allows a person to connect and to create his/her own profile. In order to simplify information dissemination, we decided that a public community allows people to join without administrator approval since it is designed to disseminate knowledge (research findings, articles, reports, etc.) to the public in the society at large. Members of the public community can play the role of information consumers. Members of communities, other than the public, are both information producer (e.g. upload documents) and information consumers of information exchanged inside their community (e.g. download documents, consult data). Administrators and members of the themes communities can upload and assign each file or each data a "visibility" right (figure 3); that is a member can decide if his/her file is visible by a whole community or a specific person in that community, or any combination of these two possibilities.

Figure 3. A member assigning "visibility" right (i.e. access rights) to other specific members and/or while communities.

Usability and accessibility

To ensure the usability of the portal, we took into account relevant guidelines (U.S. Department of Health and Human Services, 2008) and decided to use a light XHTML W3C compliant template for the layout, with few pictures, to reduce users waiting time and enhance accessibility. The layout is light and easy to scan by the users, a menu on the left gives access to all the features of the portal in one click. The navigation was designed to minimize users' interaction to access information. Fonts and colors have been chosen for their clarity for people who are not visually impaired. To avoid accessibility issues, we use a layout with few pictures. Thus, most of the content being readable text, accessibility features were implemented easily. We followed the Web Content Accessibility Guidelines (World Wide Web Consortium, 2008) from the W3C; thus, for example, we made menu items accessible using keyboard shortcuts.

Knowledge Management

Knowledge Management on the Platform

Nowadays, there are 2 main KM trends: People centered, and Information Management/Information Technology Centered KM. Using previous experiences [START_REF] Davenport | Successful Knowledge Management Projects[END_REF], we used several relevant guidelines to develop our approach in our healthcare related platforms. As our initiative focuses more on the technical purpose than on a human approach, guidelines regarding technical support were taken in account. Flexible knowledge structure and good usability are important for the success of the initiative. During the development of our platform, those basic guidelines were taken in account, from early specification to late implementation.

Within the platform, numerous users, i.e. producers, will share large amount of documents within and between the communities for consumers. We identified two major issues and defined features to address them. First, searching through a large number of documents; therefore, finding relevant documents in the platform regarding to the users interest is identified as of utmost importance. Second, as the information producers are mainly researchers, this platform offers a great opportunity to create cross-theme synergies, open new collaborations or enforce the existing ones. Besides, the platform is designed for the public, and other researchers and organizations at a later stage. The large number of potential contributors will make the discovery of potential common interests between members difficult. Consequently, it is important to facilitate this discovery process.

To address these two issues, we designed a matching feature that enables the system to describe users and documents using metadata in order to (1) notify the user when relevant information has been added to the platform and (2) match users having a "similar" profile. We identified four sequential steps in the process: Information gathering, information extraction, matching, and push mechanism.

During information gathering we gather all the information concerning each member. While during information extraction, keywords are extracted from documents using a text-mining library: RapidMiner (rapid-i.com, 2008). These keywords will complete the documents metadata. These extraction will take place for both documents uploaded by users and the publications they entered to complete their profile. Navigation will also be mined to extract relevant topic of interest [START_REF] Widyantoro | Learning user interest dynamics with a three-descriptor representation[END_REF][START_REF] Xiaobin | Mining navigation history for recommendation[END_REF]. We trained the RapidMiner model with more than 50 documents related to healthcare. Using this healthcare dedicated text-mining model gives impressive results for keyword extraction. Once the keywords automatically extracted, the owner of the file can decide to manually edit, add or remove keywords from this list (figure 4). Afterword, matching algorithms allowed us to provide a user to document and user to user matching. Both matching algorithms follow the same principle of computing a distance between the gathered metadata. Yu et al. [START_REF] Yu | Matching User's Semantics with Data Semantics in Location-Based Services[END_REF] presented an algorithm for matching demands and supplies of profiles using a description logic based approach, a similar approach can be used for the user/documents matching.

Multiplying channels of exchanges enhance the global performance of knowledge dissemination; therefore, we've build a forum and a mail system for users. Those communication channels are complementary. Users interaction is thus enhanced, discussion on a paper uploaded in the repository can start and lead to a better understanding or constructive critics.

Content management: a Human Rights Monitoring tool

The last aspect of the platform is the management of the content, i.e. human rights monitoring as such. Researchers and NGO (Non-Governmental Organizations) needed a way to collate data from different geographically dispersed sources and then to use it anywhere. Also they were in favor of creating a public community for the dissemination of knowledge to the people. Administrators decided then to create five communities: a public one and four dealing with the four substantive themes of research identified as such for the monitoring of disabilities:

1-Policy and Law Monitoring: involves the collection of legislation, policy and program data specific to disability rights in. A template is designed to gather data addressing all categories of rights (civil, cultural, economic, political and social). The template serves as an assessment tool, allowing the identification of gaps in legislation and policy and includes cross-references to the relevant provisions of key international human rights treaties. The community members of this theme investigate the policies and laws that are related to disability, on the provincial and federal levels. Researchers in this community are interested in looking into analyzing to which extent the Canadian laws and policies follow the International conventions related to disabilities. This is done through a survey that is designed to look into each article in an international convention that is related to disability and to see if there are policies and laws and case laws in the provinces and the federation that accommodate that article or that on the contrary hinder its application or simply do not acknowledge it.

2-Individual Experiences Monitoring: Monitoring of disability rights obligations should include a way to assess the actual situation of people with disabilities in a given country or area. Individual experiences monitoring involves the collection of data through surveys and collect the individual experiences of people with disabilities.

3-Media Monitoring:

The media plays an important role in reflecting and influencing public opinion. Given the role that public opinion and attitudes play in facilitating or hampering the enjoyment of human rights by people with disabilities, a holistic approach to disability rights monitoring also examines the nature and extent of media coverage on disability issues. The media monitoring team monitors the depiction and coverage of disability in the media. The analysis of media stories will take place on two levels -one quantitative (analyzing media coverage) and one qualitative (analyzing the context of media reporting).

4-Statistics Monitoring: that analyzed governmental statistical data to unveil the kind of data that can be used to draw a picture about the life of people with disabilities.

We've built a tool that organizes the different kinds of data and connects them together. The tool is built around a database designed to gather information from the different communities and to enable searching for data collected from the different communities. At this moment the tool has been used since several months to enter data. Researchers are currently formulating the criteria to be used to search for information; once these criteria are set search capacity will be added online to allow for researchers and later NGOs to use it to produce report about the state of disability rights in Canada. Researchers and disability institutions from around the globe have showed interest in using this tool (we expect it will be used in USA, Sweden, Portugal, Kenya, Cameroon, India, Croatia, and Australia).

Requirements elicitation during the project

The Virtual Knowledge Community that we've presented before replies to a tangible need, i.e. to monitor the application of human rights treaties and international conventions in the Canadian context. This approach is based on a versatile model extensible to other situations.

After each requirement elicitation phase the development team went into analysis, design and prototyping of the virtual knowledge community based on those elicited requirements. In a later stage, community members assessed the prototype together with the changing environment and injected the team with changed or new requirements that were deemed essential in the next step of their collaborative work.

At the end of the development we've noticed that the requirements that were thought to be the most important at the beginning of the project (i.e. file sharing and searching capability) were given less priority and important in a later stage. Community members found that the e-library and the especially the content management tools (the human rights monitoring tools) are the most useful and the most potent to have a tangible impact on their collaborative work. Indeed, users used occasionally the VKC to store files and share them, and disregarded almost completely the email and forum facilities (at least at this stage), they expressed their preference not to have too many login passwords and too many email systems to use at the same time. On the other hand, the e-library and the monitoring tool were enthusiastically welcomed by the researchers and organization partners. Data entry has already started and search criteria are under development.

Model development

Models for system development life cycle already exist. The traditional 'waterfall' model requires all requirements to be gathered and clarified in order for the design to start, and the implementation to take place (after the design). This model obviously does not fit projects with fluid requirements.

The spiral model (Boehmm, 1986) is a more subtle model that relies on iterative prototyping in order to develop a system. This model gives more flexibility in terms of development and input/output tuning, though it needs that the requirements/objectives be defined in advance (at least in terms of processes); indeed, "each cycle of the spiral begins with the identification of the objectives of the portion of the product being elaborated (performance, functionality, ability to accommodate change, etc.)" (Boehmm, 1986). In a fluid environment, where the needs are changing during the progress of work, functionalities are defined and re-defined, and some may be relegated altogether at the end. The spiral model doesn't seem to explicitly accommodate this situation since the requirements are defined clearly at the beginning of the life cycle. We suggest a modified version of the Spiral Model that takes into consideration the requirements elicitation in a fluid environment. Our model involves a prototyping approach like the spiral model with one difference: at every cycle the requirement may change based on environmental changes (e.g. changes in the community members need) and therefore the Verification and Validation after each phase should involve not only the prototype but also the requirements, which permits to detect arising new needs, or fading former needs (once believed to be important) (Figure 8). Once requirements are detected they are communicated to the development team that goes into analysis and design and prototyping, while the requirements may evolve in parallel due to environmental changes. Once a prototype is ready an assessment meeting gathers the development team with the community members in order to:

1-Assess the prototype (interface, functionality, etc.)

2-Elicit new requirements and tune former requirements

Then the process starts all over. Since iterations end with "verification and validation", we suggest that the requirements elicitation process, shown in figure 8, be part of the Verification and Validation phase.

We believe that this updated Spiral Model is flexible enough to allow development in a fluid environment where requirements change during the System Development Life Cycle (SDLC).

Conclusion

We have proposed in this paper the description of a life-cycle of community based applications. Our methodology has been mainly illustrated by the example of a system implementing Virtual Knowledge Communities for the monitoring of human rights. Communities are the right tool to support the creation of information and the exchange of information in-between participants such as researchers and partners, and to mobilize community members, academics, students, as well as the media and policy makers around disability rights. We've observed during the project development that some of the formerly believed important requirements were relegated while other requirements appeared to be more important at a later stage in the project and were included in a subsequent Verification and Validation phase. We have then suggested a modified Spiral Model for information system development in a fluid environment to take into consideration changes in requirements during SDLC. More work should be done to observe if this modified spiral model can be applied in similar contexts.

Figure 1 .

 1 Figure 1. A high level view of the components of the collaborative platform

Figure 2 .

 2 Figure 2. Creating a new community

Figure 4 :

 4 Figure 4: Keyword editing after extraction

Figure 5 .

 5 Figure 5. A partial View of the database

Figure 6 .

 6 Figure 6. Part of a form to enter Law and Policy Monitoring data

Figure 7 :

 7 Figure 7: A partial view of the Spiral Model that shows how requirements are to be elicited at the beginning of the life cycle

Figure 8 :

 8 Figure 8: Requirements Elicitation in a Fluid Environment

Acknowledgements

We would like to acknowledge the SSHRC (CURA, Social Sciences and Humanities Research Council of Canada) for funding this research project as part of a larger initiative on Disability Rights Monitoring.