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Health Promotion Cycle: Evaluation

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Welcome to the last installment in my introduction to health promotion planning, implementation, and evaluation. And what I’m wanting to do now is just follow through the health promotion cycle. We’ve talked about planning, we’ve talked briefly about implementation, and now I want to talk about how we evaluate the evaluation process. All too often, I get called in by community groups and other groups and other people and asked, “Can you help evaluate our program?”. Except they call me in at the end. If you’re thinking about evaluation, you have to think about it in relation to all parts of the cycle. You think about evaluation at the very beginning. What is your goal?
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What are the objectives you think about it during the implementation? Are we implementing it in the way which we want to? Are we implementing it the way we said we would? Is it being done at the quality and standard we said was important? So you think about evaluation all the way through, not just at the end. The evaluation is not an end point, it is part of the total process. You think about it from the beginning and it’s too late if at the end of the process, you come in and say how to be evaluated. What I’m wanting to do now is just talk about some of the elements that make a good evaluation.
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I mentioned briefly in the PRECEDE/PROCEED model that there were five questions that relate to planning and five to evaluation. These questions are worthwhile thinking about because what they ask you to do is think about what is it you’re going to evaluate and how are you going to evaluate them. Typically, it leads us to a process that talks about evaluating at the beginning, evaluating while we’re doing, and evaluating at the end. And that has some specific terminology attached to it.
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Before you charge down, though, creating a way of evaluating, a questionnaire or whatever else it might be. If we come back to the core elements of health promotion, the issue of equity, the issue of enabling, of empowerment, and of participation, then it’s really worth asking yourself, what are the criteria you could use to judge the value or effectiveness of a program? That’s evaluation.
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That’s the question you might ask if you want to determine: has this program been done? Is it effective?
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But what you should also ask are: what are the criteria that the stakeholders would use to judge the value of effectiveness of the program? And you should not ask that of yourself, but you should actually ask that of the stakeholders. And you don’t ask that at the end, you ask that at the beginning. Because of these two things are different, you have a problem, and that problem needs to be reconciled at the beginning, not at the end. When you’re asking yourself about the effectiveness of it,
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you might have come up with answers like: it’s been delivered on time, it’s been delivered on budget, it’s changed behavior, it’s changed the environment, it’s met its objectives, it’s been accessible, it’s been available, it was culturally appropriate.
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All of those are good criteria to think about for evaluation. But that criteria needs to be checked with the stakeholders. So, consider that because that’s an area that many people doing evaluation fall down on. They forget about the stakeholders. They forget about involving them in the process of evaluation. So, the definition of effectiveness could mean very different things to different people. So make sure you ask your stakeholders and come to some common agreement. Ideally, that agreement should be written, it should be contracted, it’s found in your objectives, it’s written as an objective, a way in which you will determine has the program worked. And it’s absolutely essential that if you write an objective, you have a strategy to evaluate.
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So this is the process: When do we evaluate? How do we evaluate? We evaluate during the planning, the implementation, and at the end of it all.
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At the beginning, our evaluation might be taking the technique of a formative evaluation. We evaluate the process during the intervention itself and we measure both impact before and after and also outcome. I’ll take you through these in a little bit more detail.

In this video, Dr. Bruce will explain evaluation in the health promotion cycle. Evaluation is not an endpoint but a part of the process.

These are the question when you think about evaluation:

  • Has the implementation been carried out as intended?
  • Have the interventions been executed as planned?
  • Have the causes behavioral or environmental risks changed?
  • Has the risk itself changed?
  • Has the problem lessened?

Also, there are criteria when considering evaluation.

  • What criteria could you use to judge the value or effectiveness of the program?
  • What criteria would the stakeholders use to judge the value or effectiveness of the program?

Next, Dr. Bruce presents the strategy to evaluate. The diagram shows the process of when and how we evaluate. We evaluate during the planning, the implementation, and at the end of it all.

diagram

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