Evaluation Design for Community Health Programs

There are different designs that can be used to evaluate programs. Given that each program is unique, it is important to choose an evaluation that aligns with:

Program goals
Evaluation research questions
Purpose of the evaluation
Available resources

Three types of evaluation design can be used to evaluate the effect that a program has on participants' health outcomes, behaviors, and knowledge:

Experimental designs determine if a program or intervention is more effective than the current process by randomly assigning participants to a treatment or control group. This type of design is often considered the gold standard against which other research designs are judged, as it offers a powerful technique for evaluating cause and effect. Fully experimental designs are unusual in evaluation research for rural community health programs.
Quasi-experimental designs do not have a random assignment component but may involve comparing a treatment group to a similar group not participating in the program. Quasi-experimental methods help estimate the effect of a treatment, policy, or intervention when controlled experiments are not feasible.
Non-experimental designs do not involve control groups. They include pre- and post-intervention studies, case study approaches, and post-intervention-only approaches. The key feature of a non-experimental design is the lack of a control group. While non-experimental evaluation studies are likely to produce actionable findings regarding program outcomes, best practices, and performance improvement, they cannot control for extraneous factors that could influence results, such as community contextual factors or selection bias.

Other frameworks used to evaluate rural initiatives or programs include:

Process Evaluation: Process evaluation is a systematic, focused plan for collecting data to determine whether the program model is implemented as originally intended and, if not, how operations differ from those initially planned. It seeks to answer the question, “What services are actually being delivered and to whom?” This framework also gathers information on stakeholders' perceptions of the program.
Outcome Evaluation: Outcome evaluation examines how well a project achieved the outcomes it set at the beginning. It is generally a summative evaluation of the program, which can be used to recommend future program improvements.
Impact Evaluation: Impact evaluation reviews the effect that a program had on participants and others who are interested in the project. It measures the outcomes and changes that resulted from those outcomes.
Performance Monitoring: Performance monitoring is an ongoing evaluation of the program that compares data at baseline to progress and different milestones in the work plan. Performance monitoring provides continuous, real-time feedback on program progress, informing changes to the program to better align with the program objectives and goals.
Cost-benefit Evaluation: Cost-benefit evaluations study the cost-effectiveness of the program by reviewing the relationship between the project costs and the outcomes (or benefits) from the program. Data collected is used to determine whether the program outcomes were worth the investment in program development and operation.

Resources to Learn More

CDC Program Evaluation Framework, 2024
Document
Offers a framework for developing and conducting evaluations related to health interventions. Identifies standards essential to effective program evaluation and provides a step-by-step guide.
Organization(s): Centers for Disease Control and Prevention
Citation: MMWR Recommendations and Reports, 73(6), 1-37
Date: 9/2024