Considerations for Evaluating Rural Healthy Aging Programs

Implementers of rural healthy aging programs should carefully consider a range of factors when designing and conducting evaluations. Key considerations for evaluating rural healthy aging programs include:

Measuring what does not happen

Many rural healthy aging programs seek to reduce the risk of adverse events for older adults, such as falls, hospitalizations, and chronic diseases. Measuring the absence of an adverse event — proving that something did not happen — is difficult. Instead, evaluators of rural healthy aging programs can measure the implementation of prevention activities. While it may not be possible to demonstrate that the program directly reduced fall risk among older adults, program evaluators can measure program outcomes such as increases in knowledge, changes in behaviors, and improvements in satisfaction to demonstrate the effectiveness of the program. Positive outcomes in knowledge, behavior, and satisfaction are meaningful indicators of the rural healthy aging program's effectiveness.

Assessing community-level impacts

While rural healthy aging programs are designed to support older adults, they can benefit the entire community when implemented effectively. Assessing impacts not only among older adult participants but considering the changes to systems or wider communities can strengthen and add nuance to evaluation findings. For example, consider whether the program improves access to services, such as transportation for older adults as well as others in the community. Consider whether the program facilitates intergenerational connections and opportunities for younger people to get involved.

Exploring program benefits across age groups

Rural healthy aging programs are typically designed for adults aged 65 and older, however programs may not be centered on the needs and experiences of the oldest age groups, such as those 80 years and older (for example, rising risk of cognitive impairment, decreasing mobility, needs for accessibility accommodations, communication needs). Evaluators should consider collecting the perspectives of program participants from the 80+ years age group to understand the impact of rural healthy aging programs across the lifespan.

Recognizing progress towards outcomes may not be linear

Progress towards desired program outcomes is often nonlinear, particularly when addressing complicated issues such as chronic diseases. For example, program participants may experience periods of improved health followed by setbacks. Some of these challenges may be related to the complexities of aging, individual characteristics (for example, preferences, health or mobility issues), and the unique challenges of receiving services in a rural area. These considerations may inform evaluation measures selected and the timeframe for assessing change. Additionally, qualitative data may provide valuable context for interpreting quantitative data on health-related changes and/or capture outcomes that are not easily quantifiable.

Lack of rural healthy aging evaluation tools and measures

Many existing evaluation tools and measures are not specifically designed for rural healthy aging programs. Input from program participants, program staff, and community partners can help to ensure that the evaluation tools and measures are appropriate for the program and the rural context. Rural healthy aging program implementers must have early and ongoing partner support and collaboration to evaluate rural healthy aging programs.

Older adult participation and attrition

Older adults often experience significant life events that may affect their ability to participate in a rural healthy aging program. These include health-related challenges, such as new diagnoses, physical injuries, or the loss of a loved one. These factors may affect their willingness to or ability to participate in some programs, affecting program attendance. Understanding this context can help evaluators offer appropriate support to participants such as flexible attendance, communication accommodations, and emotional support. Program implementers should plan for older adult program participant attrition or pauses in participation.