There is no one-size-fits-all approach for evaluating rural programs and interventions. Even a well-designed evaluation strategy may encounter challenges. Some of the challenges associated with evaluating rural programs, and their possible solutions, are discussed below:
It may be difficult to determine whether certain outcomes, such as changes in individual behaviors, can be attributed to a particular intervention or program. Some outcomes are much more difficult to measure, such as long-term changes in community norms. Some evaluations of policy, system, and environmental changes focus on tracking intermediate outcomes given time needed to achieve and measure long-term outcomes.
Measuring prevention and showing that a negative outcome that “did not happen”
The ultimate goal of many health programs is prevention. Evaluating programs is challenging because the ultimate outcome is not easily measurable. While it may not be possible to directly evaluate if prevention is happening, communities can measure prevention activities and processes or policies to prevent certain unhealthy behaviors or health outcomes.
The multifactorial nature of health issues
Any given public health issue may have multiple contributing factors: biological/genetic influences, environmental determinants, social and economic drivers (e.g., educational and employment opportunities), the strength of families and social networks, and community safety, among others. Factors contributing to the issue that the program targets in addition to how they relate to each other must be considered in evaluations. The potential influences of these contextual factors are important to consider when developing an evaluation plan.
The diversity of sectors and stakeholders involved in program efforts
Public health programs are developed and implemented by a range of different stakeholders, including policymakers, public health practitioners, clinicians, and community leaders. Each person has a different perspective and may view a public health issue differently. This diversity, coupled with any problems regarding coordination or collaboration, can make program evaluation challenging.
Determining the effectiveness of individual strategies
Many health programs target a combination of policy, system, environmental, and individual changes, which makes it challenging to pinpoint the effectiveness of a single strategy.
Access challenges specific to rural communities
Rural communities face access-related barriers to care that may affect evaluation. Remote geography, long distances to health care providers, and lack of transportation may keep individuals in rural communities from participating in health programs. To reduce attrition, participants may receive payment for travel expenses to participate in program and evaluation activities.
Lack of evaluation measures designed for use in rural settings
Evaluation measures are often not designed for programs in rural settings, which require rural communities to adapt measures to accomplish their evaluation goals.