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A framework for evaluating health promotion programs

Article  in  Health promotion journal of Australia: official journal of Australian Association of Health Promotion Professionals · May 2006
DOI: 10.1071/HE06061 · Source: PubMed

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A Framework for Evaluating Health Promotion Programs

This is the author version of paper published as:

O'Connor-Fleming, Mary Louise and Parker, Elizabeth A. and Higgins, Helen C. and Gould,

Trish (2006) A framework for evaluating health promotion programs . Health Promotion

Journal of Australia 17(1):pp. 61-66.

Copyright 2006 Australian Health Promotion Association

A Framework for Evaluating Health Promotion Programs

Authors

Dr. Mary Louise O’Connor-Fleming, Acting Head of School, School of Public

Health, Queensland University of Technology

Dr Elizabeth Parker, Senior Lecturer, School of Public Health, Queensland

University of Technology

Ms Helen Higgins, Senior Research Assistant, School of Public Health,

Queensland University of Technology

Ms Trish Gould, Senior Research Assistant, School of Public Health,

Queensland University of Technology

Contact Details

Dr Mary Louise O’Connor-Fleming

School Of Public Health, Faculty of Health

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A Framework for Evaluating Health Promotion Programs

Queensland University of Technology

Kelvin Grove 4059 Queensland Australia

Ph. 3864 3370 Fax 3864 3369

[email protected]

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A Framework for Evaluating Health Promotion Programs

Abstract

Evaluation of health promotion interventions is essential in order to collect

evidence about the efficacy of a program, identify ways to improve

practice, justify the use of resources, and identify unexpected outcomes.

This paper clarifies the role of evaluation as a crucial component of health

promotion interventions. Moreover, it summarises the key elements of

the most widely used planning/evaluation frameworks necessary for

constructive evaluations of health promotion interventions, and

incorporates them in to a single approach. It provides a methodical

framework for the provision of evaluation guidance to health promotion

practitioners and discusses the importance of including evaluation when

planning any health promotion intervention. The focus of this paper is on

the essential elements of the evaluation of health promotion programs.

Introduction

Evaluation focuses on the systematic collection and assessment of data

that provides useful feedback about the intervention; and according to

Stufflebeam (2001;1), is “about generating information that assists in

making judgements about a program, service, policy or organisation”1.

While Green and Kreuter2 (1999;220) highlight the need to compare the

‘object’ with something else in order to assess it: evaluation is the

“comparison of an object of interest with a standard of acceptability”.

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A Framework for Evaluating Health Promotion Programs

Similarly, the World Health Organization’s (WHO) European Working

Group on Health Promotion Evaluation (1998;3) define evaluation as

the systematic examination and assessment of the features

of an initiative and its effects, in order to produce information

that can be used by those who have an interest in its

improvement or effectiveness.3

This paper seeks to engage health promotion practitioners in a debate

about the importance of program evaluation and the essential elements of

an evaluation. The article’s focus is twofold; a discussion about major

program planning and evaluation models and a synthesis of the evidence

supporting essential elements of program evaluation.

Why Evaluate?

The fundamental goal of evaluation is to provide information to a variety

of audiences, including government bodies, funding bodies, and

professional and client groups; in order to provide accountability, advance

health promotion practice and communicate the knowledge gained.4

Some of the more specific rationales for evaluation include the

determination of the degree of realisation of program objectives; the

estimation of the generalisability of a program; and the fulfilment of grant

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A Framework for Evaluating Health Promotion Programs

or contract requirements.5,6 Which of these various evaluation rationales

ought to take priority depends on the goals and perspectives of the

stakeholder in question.2,5,7,8,9,10,11,12,13 For example, policy makers,

funding bodies and strategic planners need fiscal evaluations, in order to

make decisions about the most efficient use of resources.7,9,14 Program

managers need feedback on whether defined objectives have been

achieved, targeted populations reached and the sustainability of envisaged

changes.7,9

In summary, evaluation can identify ways to improve practice, justify the

use of resources, collect evidence about the efficacy of a program and

identify unexpected outcomes.9,15 Yet, despite the benefits that

evaluation can bring to health promotion programs, in our experience, the

routine inclusion of evaluation in the program planning process remains

problematic. The section that follows explores why this might be the

case.

Challenges in Evaluating Interventions

There are many reasons why evaluation is not always included in program

planning. In our experience, the following factors may contribute to

incomplete or non-existent evaluations:

• lack of expertise;

• limited time and/or resources in the team or with the individual;

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A Framework for Evaluating Health Promotion Programs

• a belief that the program will be successful without any evidence;

• no recognition of the benefits of evaluation;

• fear that a poor evaluation will not support the program’s

continuation;

• the politics of evaluation – for example who wants to know how well

the program has been implemented and their raison d'être;

• no clarity about the purpose of evaluation; and therefore, the type

of program evaluation selected is sometimes inappropriate;

• the costs of external evaluators and the perception that evaluation

is a specialised type of research that can only be undertaken by

experts.

Another reason why people do not evaluate is that they consider the task

too complex and beyond their ability.2,14 South and Tilford found that

barriers to evaluation included controversy about the nature of evidence in

health promotion, the difficulties of proving effectiveness, the need for

wider acceptance of alternative techniques for evaluating evidence, and

the strain of working within a medical model of health.16

Some stakeholders argue for an evidence-based practice or experimental

approach to health promotion interventions. However, not all programs

can, or should be, investigated in this way3,10,12,17,18,19 and economically

these methods can impose an extra burden on interventions.3,17 There is

little consensus regarding what ‘evidence’ is, or if the concept of evidence

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A Framework for Evaluating Health Promotion Programs

is applicable to the evaluation of interventions.18 Consequently, it is

necessary to adopt a more expansive view of evidence that acknowledges

the essential complexity of health promotion;7,12,18,20,21 and embraces

broader indicators of success, for example, equity, community

development, empowerment and social mobilisation.7,12,19,22 Whilst

Randomised Controlled Trials (RCTs) are the gold standard for medical

treatments, their use is limited in social/behavioural interventions to those

that are uncomplicated and explicitly definable.7,8,23 Health promotion

interventions are usually complex and multifaceted,7,13,23 limiting the use

of RCTs for the following reasons: it may not be ethical to withhold the

intervention,1,23 nor to objectify people; achieving random allocation is

problematic; and it is difficult to avoid contamination of a control or

comparison group.23 Health promotion interventions may suffer if

inappropriate methods of assessing evidence are applied, or health status

outcomes and individual behaviour change are given too much weight.17

Awareness of the limitations

Health promotion practitioners need to recognise that there may not be an

ideal evaluation design or definitive measurement to apply to their

program.15 Plans and methodologies may provide a better or worse fit,

for particular settings, behaviours and health conditions.7 The issue for

practitioners then, becomes how to select the most useful evaluation

design for the purposes of the particular program and the stakeholders.

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A Framework for Evaluating Health Promotion Programs

The next section outlines some big picture issues to consider when making

a decision about the nature and extent of the evaluation.

The Politics of Evaluation

A number of political and/or philosophical issues need to be considered

when deciding about the extent of an evaluation. For example, who

supports or opposes the program and/or its evaluation, who determines

the questions to be addressed and the types of evaluations to be

performed; how much organisational commitment is there, especially

financial; is the program/evaluation politically sensitive; and what is the

contemporary health policy for a particular program and/or population?6,24

In addition, it is important to acknowledge that the professed program

intervention goals (such as behavioural or policy changes) may not

correspond with those of the funding body who may have their own

agenda, for example, to demonstrate to the public their concern about a

social/health problem.1,11 These differing goals need to be negotiated with

funding bodies before the program commences in order to establish

realistic expectations.11,13 This may deal with the problem of funding

bodies’ expectations about evaluation results that only deal with the

positive aspects of the evaluation.

Funding the Evaluation

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A Framework for Evaluating Health Promotion Programs

Regardless of whether program staff or an external evaluator will be doing

the evaluation, practitioners should budget for the evaluation at the

program planning stage.25 The minimum amount required for a

constructive evaluation is ten percent of the program costs.3,14,25

Is a small-scale evaluation better than none at all?

Whilst cognisant of White’s argument that an evaluation should not be

attempted in the absence of time, skills or funding,12 it may be useful to

attempt a small-scale process evaluation, or audit, of the participants’

perspectives of the project. This may be preferable to no evaluation at

all, for at the very least, practitioners will want to know if the intervention

had any negative consequences for the participants. If you can only

manage a limited evaluation, then practitioners need to ensure that core

aspects are evaluated, and recognise that the results are unlikely to be

generalisable to other settings. Because most funded health promotion

projects are usually short, process, or impact evaluations are more

realistic for health promotion practitioners, than outcome evaluations.12

An External Evaluator?

The principal reason for hiring an external evaluator is the potential to

reduce bias and increase objectivity, since people from within the

organisation are likely to have an understandable partiality for their

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A Framework for Evaluating Health Promotion Programs

program.5,25 Another advantage of employing an outside evaluator is that

it releases implementation staff to continue their health promotion work.

Furthermore, an external evaluator may bring a novel viewpoint to the

project, therefore augmenting the program staffs’ repertoire.25

When considering using an external evaluator, health promotion

practitioners need to weigh up a variety of factors: these include their

background, i.e. an academic may have a different perspective from

someone who comes from another background. In addition, people from

different backgrounds or organizations may have different politics, identify

different problems and solutions, and emphasise different types of

evidence. Regardless of any evaluator’s affiliations; their values,

perspectives and theoretical position will directly influence their

evaluation.14 The previous quality of the evaluator’s work is also relevant,

as is their familiarity with the type of program you are running, and the

specific program. Furthermore, the program’s funding will dictate the

calibre of whom you can employ and for what period. The following

section précis contemporary, essential evaluation models, and outline our

suggested elements for the evaluation process

Contemporary Models

There are some important models of contemporary health promotion

evaluation that should be considered and appropriately applied. Such

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A Framework for Evaluating Health Promotion Programs

models help to focus attention on priorities, and are useful to both

researchers and practitioners when developing, or deciding on, health

interventions.26 Stufflebeam (2001;37) asserts that program evaluation

can begin with “a well-developed and validated theory of how programs of

a certain type within similar settings operate to produce outcomes”.1

Such approaches include the PRECEDE/PROCEED framework of Green and

Kreuter.2 Comparable frameworks can increase a program’s efficacy

because they afford a realistic edifice for evaluation.1 An important aspect

of theory-based evaluations is the determination of the positive or

negative elements of outcomes, and the provision of direction for program

improvement.1 Contemporary models can provide a convincing evaluation

structure for a program’s effectiveness; however, few programs are

founded on well-articulated theories.1,24

Many contemporary models stress that health promotion programs

frequently entail wide-ranging procedures targeting different levels of

activity; for example, education, which influences individuals; community

development, relating to empowerment; and capacity building, concerned

with enhancing the expertise and knowledge of individuals, organizations

and communities. In addition, there is an emphasis on progressing

methodically through the stages of health promotion planning and

evaluation, beginning with the assessment of needs and identification of

the target population and priorities, through to defining outcome

objectives (crucial for evaluation). However, a logical process of planning

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A Framework for Evaluating Health Promotion Programs

and evaluation is not always possible or desirable. Sometimes the process

requires considerable review through formative evaluation.

Is there a checklist of essential elements?

Planning, implementation and evaluation are parts of a repetitive cycle

where evaluation involves revisiting the planning process steps (see

Figure 1). Evaluation should be viewed as a unitary stage in the planning

process and there are elements common to planning models. The

elements of a program include, for example, conducting a needs

assessment, defining the program goals, defining the populations of

interest and defining the outcome objectives.

Evaluation is often interpreted as part of a larger project management

cycle; however, the distinctions between planning, implementation and

evaluation are not always clear. For example, during the planning stage,

which is the first phase of the cycle, the steps may include a needs

assessment, a review of strategic documents and mandates, and

accessing existing data about a particular population. The planning phase

is designed to structure the strategies and to devise the best way for the

implementation to proceed. Depending on the problem being addressed,

a planning process could include the formulation of the problem,

conceptualisation of possible strategies to address the problem and their

implications.

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A Framework for Evaluating Health Promotion Programs

Some of the essential decisions for practitioners, are to determine why,

how and what types of evaluation will be used.6 The evaluators need to

ask whether the evaluation plan: has well-defined program objectives and

measures of impact and outcome; specifies tasks, methods and

procedures; and clarifies the resources to be allocated to realize the core

objectives.6

(Figure 1 about here)

The authors believe there are some fundamental elements in the

evaluation process that must be included in a program evaluation. The

following section identifies these, and they are described in more detail in

Tables 1-3. In addition, we should always remember that evaluation is

not a strictly sequential process; rather, it is more of a cyclical or circular

process where issues are revisited and reconsidered.

Problem Analysis & Needs Assessment

(Table 1 about here)

The first stage in the process involves the definition of the crucial health

priorities for a particular population; and the determination of elements to

be targeted. There is no fixed procedure for undertaking a needs

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A Framework for Evaluating Health Promotion Programs

assessment, as the methods will depend on the size of the project and the

community, and the available skills and resources.13

Table 1 provides examples of methodologies used to determine health

priorities and the contributing factors to be targeted. This stage also

includes engagement with stakeholders, in order to ensure credibility and

provide a framework for your evaluation;24 the establishment of objectives

and goals, which is central to the program planning and evaluation

process; and finally, pilot testing, which is required in order to determine

the suitability of the intervention for the targeted community.

Program planning & Implementation

(Table 2 about here)

The second stage involves selecting the strategies; these are well-defined

activities that are implemented in a prescribed manner in order to achieve

the goals and objectives of the program. It is important that a process

evaluation is performed during this stage, rather than undertaken as a

postscript, to ensure that the program is being implemented as

intended.25

Evaluation & Dissemination

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A Framework for Evaluating Health Promotion Programs

(Table 3 about here)

The discussion of evaluation as the last stage of an intervention is

misleading, as evaluation is an integral part of the program that should be

incorporated early on in program planning.5,24 There are three phases of

evaluation: process/formative evaluation (discussed above), impact

evaluation, and outcome evaluation.15

The impact evaluation is the measurement of the immediate effects of the

intervention, and usually relates to the program objective.15 Clearly

defined objective(s) will facilitate this phase of the evaluation.7,24,25 The

outcome evaluation is the assessment of longer-term effects of the

intervention, and typically relates to the program goal.15

There are a number of issues to be considered at the evaluation and

dissemination stage, these include the evaluation management, i.e., how

do you deal with all the players in the evaluation process and their

individual expectations about program outcomes. Moreover, how do you

consider the ‘tyranny of evaluation’, i.e., how do you prioritise the number

and range of evaluation methods in order to ensure the participants do

not bear an excessive burden of the evaluation process.

A program that delivers a benefit for people needs to be communicated so

others may also benefit. Similarly, one that fails to deliver, or has

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A Framework for Evaluating Health Promotion Programs

unintended effects, needs to be communicated to allow for the

reassessment of underpinning theories, program design or

implementation.15,24 Fundamentally, for those involved in the program

delivery, the evaluation is about what was learnt and how that information

can be fruitfully applied in the future.

Conclusions

Research clearly demonstrates that the effectiveness of health promotion

interventions can be substantially improved with the appropriate

application of evaluation techniques. Equally, the field of health

promotion, like any field of professional endeavour, can only move

forward when the outcomes of comprehensive evaluations of what does

and what does not work are made available to practitioners. Despite this

strong need for evaluation, as existing literature and research shows, the

evaluation of health promotion programs is often problematic due to a

variety of personal, situational and institutional factors that can inhibit or

prevent effective evaluations. Furthermore, there is little consensus about

appropriate techniques. These impediments to evaluation can be

overcome with the implementation of specified evaluation guidelines,

methods and practices, and the sharing of evaluation results amongst the

profession.

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A Framework for Evaluating Health Promotion Programs

References

1. Stufflebeam DL. Evaluation Models. New Directions for Evaluation

2001;89:7-98.

2. Green LW, Kreuter MW. Health Promotion Planning: An Educational

and Ecological Approach, 3rd ed. CA: Mayfield Publishing Co.; 1999.

3. World Health Organization. Health Promotion Evaluation:

Recommendations to Policymakers. Report of the WHO European
Working Group on Health Promotion Evaluation. WHO, Copenhagen;
1998.

4. Sparks M. Why Evaluate? Professional Development in Health

Promotion, 2004;4:1. In: Healthlink The Health Promotion Journal of
the ACT Region 2004;Autumn:2.

5. McKenzie JF, Smeltzer JL. Planning, Implementing, and Evaluating

Health Promotion Programs: A Primer, 3rd ed. Boston: Allyn and
Bacon; 2001.

6. Windsor RA. Evaluation of Health Promotion, Health Education and

Disease Prevention Programs, 3rd ed. California: Mayfield Publishing
Co.; 2004.

7. Nutbeam D. Evaluating Health Promotion--Progress, Problems and

Solutions. Health Promotion International 1998;13(1):27-44.

8. Tones K. Evaluating health promotion: a tale of three errors. Patient

Education and Counseling 2000;39:227–236.

9. Wimbush E, Watson J. An Evaluation Framework for Health

Promotion: Theory, Quality and Effectiveness. Evaluation
2000;6(3):301–321.

10. Oakley A. Evaluating health promotion: methodological diversity. In:

Oliver S, Peersman G, editors. Using research for effective health
promotion. Buckingham; Open University Press, 2001.

11. Tones K, Tilford S. Health Promotion: effectiveness, efficiency, and

equity, 3rd ed. Cheltenham, UK: Nelson Thornes; 2001.

12. White I. What should you evaluate? Professional Development in

Health Promotion, 2004;4:3. In: Healthlink The Health Promotion
Journal of the ACT Region 2004;Autumn:2.

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A Framework for Evaluating Health Promotion Programs

13. Baum F. The new public health, 2nd ed. Vic.: Oxford University
Press; 2002.

14. Goodstadt M, Hyndman B, McQueen DV, Potvin L, Rootman I,

Springett, J. Evaluation in health promotion: Synthesis and
recommendations. In Rootman I, Goodstadt M, Hyndman B,
McQueen D, Potvin L, Springett J, Ziglio E (Eds.), Evaluation in
health promotion: Principles and perspectives. Copenhagen: World
Health Organization; 2001.
http://www.who.dk/document/e73455I.pdf

15. Hawe P, Degeling D, Hall J. Evaluating Health Promotion: A Health

Workers Guide. Sydney: MacLennan and Petty; 2003.

16. South J, Tilford S. Perceptions of research and evaluation in health

promotion practice and influences on activity. Health Education
Research 2000;15(6):729-741.

17. Judd J, Frankish CJ, Moulton G. Setting standards in the evaluation

of community-based health promotion programmes—a unifying
approach Health Promotion International 2001;16(4):367-380.

18. McQueen D. Strengthening the Evidence Base for Health Promotion.

Health Promotion International 2001;16(3):261-268.

19. Aro AA, Van den Broucke S, Räty S. Toward European consensus
tools for reviewing the evidence and enhancing the quality of health
promotion practice. Promotion & Education 2005; special issue, The
challenge of getting evidence into practice: current debates and
future strategies, 10-14.

20. Jones C, Scriven A. Where are we headed? The next frontier for the
evidence of effectiveness in the European Region. Promotion &
Education 2005; special issue, The challenge of getting evidence
into practice: current debates and future strategies, 39-40.

21. Jones C, McQueen DV. The European Region's contribution to the

Global Programme on Health Promotion Effectiveness (GPHPE)
Promotion & Education 2005; special issue, The challenge of getting
evidence into practice: current debates and future strategies, 9-10.

22. Saan H. The road to evidence: the European path. Promotion &
Education 2005; special issue, The challenge of getting evidence
into practice: current debates and future strategies, 6-7.

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A Framework for Evaluating Health Promotion Programs

23. Tones K. Evaluating Health Promotion: Beyond the RCT. In Best

Practices Quality and effectiveness of Health Promotion, 4th
European IUHPE conference, Helsinki; May 16-19, 1999.

24 O’Connor-Fleming ML, Parker E. Health Promotion: Principle and

Practice in the Australian Context, 2nd Ed. Crows Nest: Allen and
Unwin; 2001.

25. Issel L. Health Program Planning and Evaluation: A Practical,

Systematic Approach for Community Health. London: Jones and
Bartlett Publishers; 2004.

26. Glasgow RE. Evaluation of theory-Based interventions. In: Glanz K,

Lewis ML, Rimer BK, editors. Health Behavior and Health Education:
Theory, Research and Practice, 3rd ed. San Francisco: Jossey-Bass;
2002. p. 530-544.

27. Nutbeam D, Harris E. Theory in a Nutshell: A Practical Guide to

Health Promotion Theories, 2nd ed. NSW: McGraw-Hill Australia Pty;
2004.

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A Framework for Evaluating Health Promotion Programs

Table 1. Planning and Evaluation Checklist: Problem Analysis & Needs

Assessment

Getting started
Deciding what issues need to be considered in the planning and evaluation
cycle
• Define the health priorities for a particular population;
• Decide the environmental or behavioural factors to be targeted, for
example, individual beliefs or organisational practices27
• Identify the stakeholders and their concerns, values, expectations and
agenda24
Methods:
• Focus groups
• Questionnaires
• Surveys
• Analysis of epidemiological and/or demographic data.24,13

Determine Program Objectives/Goals/Mission

Outline a hierarchy of outcomes to guide action, and to link strategies and
evaluation
• Objectives need to specify the target population, the projected health
benefit, the size of the benefit to be achieved, and when the benefits will
be achieved6
• Goals provide the framework for program planning and, as such, provide
a set of clear end-points around which many strategies can be organised.
As the health promotion situation changes, the strategies may change
but goals are rarely affected.

Pilot testing
This stage serves to provide feedback about the quality and suitability of the
program for the target community; in addition, it engages the community thus
ensuring their commitment to the project24
• Decide how many participants
• Undertake formative evaluation through the development and testing of
materials and methods

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A Framework for Evaluating Health Promotion Programs

Table 2. Planning and Evaluation Checklist: Program planning &

Implementation

Select and describe strategies and methods

A strategic plan of action should anticipate the barriers and resources required
to achieve a specified objective2
• Selection is linked to objectives
• A sound understanding of theories of behaviour change is crucial so that
health promoters can more accurately inform their strategy selection in
those programs with a behaviour change focus24
• Determine costs - decide what resources (human, financial, time) are
available to meet the planned actions
• Data Collection – decide what, when, and how to measure (pre-
intervention testing - otherwise there is no basis for doing a reasonable
evaluation, and post testing)
• Data Analysis – decide how much and what should be analysed
• Using external evaluators: consideration needs to be given as to whether
you/your team have the expertise, resources and time to develop the
necessary skills and competence, to perform the evaluation. If not, you
may need to employ an external evaluator to do it.

Implementation process
An implementation plan needs to be developed and the process managed in
detail.

Process evaluation
The primary purpose of process evaluation is to provide information about
program improvements; by establishing whether the implementation is
proceeding as planned, i.e.,
• is the program is reaching all parts of the target group,
• are all the materials and components of the program of good quality,
• are all the planned activities of the program being implemented,
• are all the participants satisfied with the program7,15,25
Methods:
• Questionnaires for participants and health promotion practitioners
• Focus groups involving participants and practitioners
• Checklists
• Observation.
If the intervention is not yielding the expected results, then it is useful to
revisit the implementation process to establish the extent to which
improvements can be effected, then re-implement and reassess.15

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Evaluating Health Promotion Programs

Table 3. Planning and Evaluation Checklist: Evaluation & Dissemination

Evaluation procedures
Before undertaking the next two evaluation stages, it is useful to conduct an
evaluability assessment15, i.e., determining whether the program is functioning
well and likely to be having an effect.
Impact evaluation
This measures the immediate effect of the program, ie whether it meets
its objectives;15 by assessing what changes, if any, have occurred in the
predisposing, reinforcing and enabling factors, targeted behaviours and
the environment2,6
Methods:
• Pre/post test questionnaires administered to the participants.
• A self-reported, post-evaluation questionnaire for participants
could be utilised if no pre-evaluation test has been undertaken.
• Focus groups to expand on information gathered from participants
as a means of identifying themes for question development.
• For practitioners, a checklist could be completed15,24
Outcome evaluation
This measures the long-term effects of the program, i.e., whether it
meets its goals; 15 by determining what changes, if any, have occurred in
health status and quality of life.2,6
Methods:
• Intermediate outcomes could be assessed by three and six month
post-intervention questionnaire for participants.
• Health-promotion staff who delivered the intervention could be
followed up with a questionnaire.

Dissemination of the results

To whom, and for what purpose, are we disseminating the results?
• For an evaluation to influence decision-making, it is important to
consider how best to reach the decision-makers so their specific
interests can be targeted.
• The style and emphasis of an evaluation report will depend on the
intended audience and the elements that are important to
them.6,25
• Regardless of who the readers are, they will all need to know the
intended goals of the project, why those goals were important,6
and to what extent they were achieved.
• A formal report delineating the program’s processes and outcomes
may provide guidance to others in future decision-making about
health promotion programs, it may be used to determine if, and
how, to modify the existing program, and whether it could be
fruitfully applied to other settings.6,7
Methods:
The dissemination could take a variety of forms, for example:
• press release
• seminar presentation
• newspaper article
• published report
• journal article.4,5

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 Evaluating Health Promotion Programs

Figure 1: Planning, Implementation and Evaluation Model

Problem & Program

Needs Planning
Assessment Develop goals,
objectives &
Situational strategies
Analysis
External
factors, eg
Politics Program
implementation

Internal
Outcome factors, eg
evaluation Resources

Process/Formative
evaluation
Impact
evaluation

Evaluability Program
assessment redesign and re-
implementation

23

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