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Evaluating Impact

Given the diversity of community health worker (CHW) programs, there is no one-size-fits-all evaluation approach. Key considerations for evaluating CHW programs are provided below.

Staffing – CHW programs may hire an external evaluator or assign an internal staff member to serve as an evaluator. CHWs may be assigned to collect program evaluation data or administer surveys. This can be a challenge as CHWs may need to participate in additional training to perform these tasks.

Data Collection – CHW program evaluators emphasize the importance of employing simple data collection techniques and using existing data tracking mechanisms, such as:

  • Individual encounter forms
  • Group education session documentation
  • Clinic reports and patient charts
  • Case management reports
  • Surveys

If a CHW program focuses on health services delivery, it may be important for CHWs or other members of the care delivery team to record and track patient information pre- and post-intervention. Evaluations may also solicit feedback from community representatives, program stakeholders, and healthcare providers. These data may assess the effectiveness of CHW outreach or the quality of a health education session. Some programs also ask CHWs for feedback about their job satisfaction and other experiences.

In addition, CHWs may play a key role in community-based participatory research. For example, in one rural program, CHWs helped to enroll community members in a study related to diabetes self-management education.

CHWs can be trained to participate in program data collection and evaluation by entering patient data into electronic health record systems or collecting data from patients, including information on patient-reported changes in health status, knowledge, beliefs, and actions. CHWs may also be trained to conduct focus groups or participate in qualitative research.

Cost-Effectiveness and Return on Investment. It can be important to measure costs associated with CHW programs. The Community Preventive Services Task Force found that CHW interventions for preventing cardiovascular disease are cost-effective. Rigorous program evaluations may enable the program to demonstrate the return on investment (ROI) for utilizing CHWs. Programs could use cost and ROI information to demonstrate program effectiveness to community partners, some of which may be willing to invest resources in program sustainability. To date, few rural CHW programs have focused on the cost-effectiveness of CHW programs or had resources to calculate ROI.

Existing Gaps in Evidence. The Community Preventive Services Task Force identified several evidence gaps—areas where information is lacking, including interventions with a longer follow-up period (greater than 12 months), interventions among diverse 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 outcomes.

Resources to Learn More

Best Practices for Implementing and Evaluating Community Health Worker Programs in Health Care Settings
Document
Guidance for healthcare organizations interested in implementing the CHW model in their system or building upon their current system. These practice guidelines work to address gaps identified in the CHW professional literature and help to assist healthcare professionals and others with designing and implementing evidence-based programs.
Organization(s): Sinai Urban Health Institute
Date: 1/2014

Community Health Worker Evaluation Tool Kit
Document
Guide on program evaluation for CHWs and CHW programs.
Organization(s): University of Arizona Rural Health Office and College of Public Health
Date: 2000

Evaluating Community Health Worker Programs
Presentation Slides
Overview on evaluating community health worker programs that includes evaluation frameworks, example CHW evaluations studies, tools, and resources.
Organization(s): Centers for Disease Control and Prevention
Date: 11/2012

An Innovative Method to Involve Community Health Workers as Partners in Evaluation Research
Document
Discusses the dual role of CHWs as lay health workers and researches. The authors developed a process through which CHWs could actively participate in collection of qualitative evaluation data.
Author(s): Peacock, N., Issel, M., Townsell, S., Chapple-McGruder, T., & Handler, A.
Citation: American Journal of Public Health, 101(12): 2275-2280
Date: 12/2011

Migrant Health Promotion Evaluation Toolkit
Document
Evaluation toolkit for CHW program development. Intended to provide organizations with strategies to design an evaluation of their programs.
Organization(s): Migrant Health Promotion
Date: 2010