Evaluating Health Programmes

By Geoff MiddletonLecturer: Health Promotion & ExerciseFaculty of Health Life and Social Sciences

Why Evaluate?

• To describe and/or assess what was intended? (goals/aims/objectives/KPIs?)

• May be to describe what was unintended?• What was actually implemented?• What outcomes/results where achieved?• What are the implications of the findings?

(actions/recommendations?)

• To answer three basic questions:

WHAT? SO WHAT? NOW WHAT?

Adopted from: Patton (2008)

Interaction of health promotion programme outcomes

Adopted from: Nutbeam & Bauman (2006)

Health status & disease changes

Social & behavioural outcomes

Short-term programme impact

Raised awareness and participation

Health promotion evaluation stages

FINAL OUTCOME EVALUATIONHas there been changes in health or

perceived health?Has there been long-term changes in

behaviour/attitude?

INTERMEDIATE OUTCOME EVALUATIONWhat proportion of the target group have heard of the health promotion activities?

Has there been a change in behaviour, for example more people exercising?

PROCESS EVALUATIONIs the programme reaching the target

group?Are the participants satisfied with the

programme?

Adopted from: Davies & Macdowall (2006)

Health promotion actions

EDUCATIONExamples include patient

education, school education and broadcast media communication.

SOCIAL MOBILISATIONExamples include

community development, group facilitation and

technical advice.

ADVOCACYExamples include lobbying, political

organisation and activism and overcoming

bureaucratic inertia.

Health promotion outcomes

(outcomes of the process of intervention)

HEALTH LITERACYMeasures include health-

knowledge, attitude, motivation, behavioural

intentions, personal skills and self efficacy.

SOCIAL ACTION & INFLUENCE

Measures include community participation,

community empowerment, social

norms and public opinion.

HEALTHY PUBLIC POLICY & ORGANISATIONAL

PRACTICEMeasures include policy statements, legislation,

regulation and resource allocation and

organisational practices.

Intermediate health outcomes (programme impact or short-term outcomes)

HEALTHY LIFESTYLESMeasures include tobacco use, physical activity, food choices, alcohol and illicit

drug use.

EFFECTIVE PREVENTATIVE HEALTH SERVICE

Measures include access to and provision of

relevant and preventative services.

HEALTHY ENVIRONMENTS

Measures include safe physical environment,

supportive economic and social conditions, suitable

food supply and restricted access to

alcohol/tobacco.

Social health outcomes

(long-term outcomes)

SOCIAL OUTCOMES

Measures include quality of life,

functional independence, social capacity and equity.

HEALTH OUTCOMES

Measures include increased morbidity,

reduced disability and avoidable mortality.

Adopted from: Nutbeam & Bauman (2006)

Review

• Evaluation has simple principles: “What”, “So What” and “Now What”.

• Health programmes should be evaluated across the spectrum of it’s activities

• This will require different time-points of inquiry and different types of evaluative procedures (process, intermediate and final outcomes).

• Concentrating just of the final outcomes will mean a narrow focus, and will most likely divulge programme ‘failure’.

• Concentrating on evaluation at the start and throughout can inform progress, change and evolve the programme creating final outcomes of value.

References

• Nutbeam, D., Bauman, A. (2006) Evaluation in a Nutshell: A practical guide to the evaluation of health promotion programmes. McGraw Hill: New York, USA.

• Davies, M., Macdowall, W. (2006) Health Promotion Theory: Understanding Public Health. Open University Press: Maidenhead, UK.

• Patton, M. (2008) Utilisation-focused Evaluation. SAGE: London, UK.

Geoff Middleton, MSc, RNutSchool of Sport, Coaching and Exercise ScienceUniversity of LincolnSports Centre: 1st Floor officesBrayford CampusLincolnLincolnshireLN6 7TSTel: 01522 837308Email: gmiddleton@lincoln.ac.uk

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