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Evaluation Strategies and Considerations for Community Health Worker Programs

When designing an evaluation, it is important to identify the evaluation purpose, goals, and key questions to be answered. Having clearly defined program goals, objectives, and intended outcomes is important for guiding the evaluation design.

There are many types of evaluation. When evaluating a rural community health worker (CHW) program, process and outcome evaluation questions can be used to assess implementation and measure success of the program.

Process evaluation questions are used to understand how the CHW program was implemented. They can also be used to identify program successes and challenges. Data gathered through process evaluation can be used to help identify areas where a CHW program can be improved to better reach the program's goals.

Examples of process evaluation questions for CHW programs include:

  • What did the CHW program accomplish during the reporting period?
    • How many community members were served?
    • How many sessions were completed? (for example, outreach sessions, home visits, educational workshops)
    • What services did CHWs deliver? (for example, health education, disease management, clinical services, connection to social services)
  • How did community members, participants, and CHWs perceive the program?
    • What were the experiences of those receiving CHW support?
    • How did CHWs feel about their role, training, and resources?
    • What feedback did partners provide?
  • How well did documentation systems capture CHW activities and participant data?
  • What were the barriers and challenges that affected CHW program implementation?
  • Who played a key role in implementing the CHW program?
    • What partners supported program implementation?
  • What program activities were not completed and why?
    • If activities changed, what prompted those changes? (for example, shifts in community needs, priorities, funding, or policy)
  • What are key lessons learned?

Outcome evaluation questions can be used to figure out whether the program successfully accomplished its goals and measure the short- and long-term effects of the program on participants. Program planners who are developing evaluation questions should consider what data are available, what information would be useful to program stakeholders, and how the evaluation findings will be used.

Examples of outcome evaluation questions for CHW programs include:

  • Did the CHW program successfully achieve its intended outcomes?
    • Did the program improve participants' ability to manage their health condition?
    • Did the program increase participants' likelihood to adopt healthier behaviors?
    • Did the program improve participants' adherence to prescribed medications and treatment plans?
    • Did the program successfully connect participants with a primary care provider or medical home?
    • Did participants report improvements in overall quality of life? (for example, increased social support, improved mental health)
  • Did the CHW program result in cost savings to the healthcare system?
    • Did the program reduce unnecessary emergency department visits?
    • What aspects of the program were most cost-effective or least cost-effective?
  • Which program outcomes are most valued by the community?

Evaluation Considerations

Because CHW programs are tailored to the specific needs and priorities of the community it serves, there is no one-size-fits-all evaluation approach. When evaluating a CHW program, it is important to consider:

  • Staffing. CHW programs may hire an external evaluator or assign an internal staff person to lead evaluation efforts. CHWs can be incorporated into the evaluation process in several ways — including supporting data collection — but they may need additional training to perform these tasks.
  • Cost-Effectiveness and Return on Investment. It can be important to measure costs associated with CHW programs. More rigorous program evaluations can help demonstrate the program's return on investment (ROI). Programs can use cost and ROI information to demonstrate the program's effectiveness to community partners, some of whom may be willing to invest resources to support program sustainability. The Kentucky Homeplace program evaluation found cost savings through its CHW program.
  • Existing Gaps in Evidence. The CPSTF identified several evidence gaps — areas where information is lacking — including interventions with a longer follow-up period (greater than 12 months), interventions among varying population subgroups, the impact of large-scale interventions with more than 500 people, and the effectiveness of different service delivery modes (face-to-face, telephone, groups) on CHW program outcomes.

Resources to Learn More

Evaluating a Community Health Worker Program
Document
Provides the basics of evaluation to assist CHW management in the development of an evaluation plan. Discusses the types of evaluation to consider, the selection of information and data collection, and the techniques for reporting and disseminating program performance and decision-making. Designed as part of a larger effort to inform organizations on how to implement best practices for CHW programs.
Organization(s): Center for Community Health Alignment
Date: 2022