Step 9: Evaluate Progress
Evaluation should be planned throughout the community health assessment (CHA) process to assess the impact of your strategies and progress toward your goals. This step suggests a modified version of CDC’s evaluation guidelines, and may be used as a starting point to tailor an evaluation for a particular community health improvement effort, at a particular point in time.
Find your baseline
Determine your baseline to understand the impact of your strategies. This can include measuring a number of things such as knowledge and attitudes; community norms; biometric measures such as BMI or HbA1c levels; health behaviors like tobacco use, physical activity and eating healthy foods; or health-promoting policy and system changes. The evaluation should focus on the CHA priority areas being addressed and their associated goals, objectives and strategies. Refer to your driver diagram (see below) to review how you are addressing the primary and secondary drivers that can positively impact the health priority being addressed.
Include stakeholders from your hospital and community, including those involved in program operations, those involved in previous CHA steps, those served or affected by the program and primary users of the evaluation. View the Community Engagement section to see different ways that stakeholders can be involved in the process.
Focus the evaluation design
The evaluation should be designed to assess the issues identified as priorities in your CHA. If you developed Population Health Driver Diagrams for the priorities identified in your CHA, once interventions associated with secondary drivers have been selected for action, your implementation team(s) can establish metrics (i.e., measures and targets) for each of the interventions. These metrics can be used for determining progress and evaluating the impact of your strategies. Consider the purpose, users, uses, questions and methods. Key questions include:
- What will be evaluated?
- What framework will be used?
- What criteria/metrics will be used? How will you ensure that those are the metrics that matter?
- What metrics will indicate success?
- What process metrics or indicators will suggest progress toward the goal?
- What conclusions will you be able to make based on the criteria/metrics being measured?
Gather credible evidence
Accurate, high-quality data are required to strengthen your evaluation’s credibility and any recommendations that follow. These aspects of evidence gathering typically affect perceptions of credibility: indicators, sources, quality, quantity and logistics. Evidence should be gathered to support:
- Process indicators: Metrics to provide evidence that the action steps are being implemented according to plan.
- Short-term impacts: Intermediate outcomes of the action plan indicating progress toward the ultimate outcome objectives.
- Outcomes: Long-term goals such as change in health status that you are hoping to achieve from your strategies.
Data sources for evaluation may include:
- Epidemiological community health status data
- EHR data
- Community surveys
- Program attendance
- Policies enacted
- Partnership quality assessments
Measure progress on each priority early and often
Measuring the extent to which metrics were achieved and progress toward goals was made should be done regularly. A practical, ongoing evaluation process will allow you to correct your course if the implementation is not eliciting the intended outcomes. Embedding a Plan-Do-Study-Act approach will allow your team to regularly check how the intervention is going and how it could be modified to be more effective.
Link your conclusions to the evidence gathered and judge them against agreed-upon values or standards set when you planned your implementation strategies. How do your results fit with the metrics established to accompany your Population Health Driver Diagram? Justify conclusions using standards analysis/synthesis, interpretation, judgment and recommendations.
Use the results to improve or modify programs
The evaluation should point to what elements of your program are working and what could be altered. Use this feedback to expand or change the program arc at any point; you do not have to wait until the next CHA cycle to make improvements on the implementation strategies.
Share the results and lessons learned with stakeholders in the hospital and community. Prepare it in a format that stakeholders and community members will be able to easily access and understand. You may also use the evaluation of your strategy to contribute to the evidence base related to the impact of interventions to address a community health issue. Be prepared to state the impact of your implementation strategies as part of your next CHA.