Evaluation Strategies and Considerations for SDOH Programs
Rural social determinants of health (SDOH) programs can be complex, involving multi-sector
partnerships and focusing on policy, systems, or environmental changes that seek to achieve long-term
outcomes (for example, reduced poverty or health inequities). When developing programs to address
SDOH, rural communities should assess and plan for future evaluation needs before the program begins
collecting data. To capture the effects of a project that addresses SDOH, rural communities may need
to consider a range of evaluation strategies. The Rural Community Health Toolkit provides an overview
strategies that can guide rural communities in designing their evaluation plans. This section
provides several evaluation strategies and considerations that may be particularly important for
rural communities addressing SDOH.
Rural communities developing programs to address SDOH may also benefit from evaluation strategies
outlined in the following topic-specific toolkits that focus on issues related to the SDOH:
Demonstrating the Value of SDOH
Evaluation is critical to demonstrating the value of addressing SDOH. In planning an evaluation of a
program that addresses SDOH, rural communities should create a rationale for how program activities,
policy, systems, and environmental changes will ultimately achieve desired outcomes. Rural
communities may develop logic models or theories
of change to identify measurable results for each desired goal. For example, a rural
clinic seeking to implement a transportation program to improve access to healthcare and health
outcomes may choose to track changes in the rate of patient no-shows and emergency department visits.
Demonstrating these improvements can help build a business case for continued investment in upstream
factors that affect health and well-being. Measuring a return on investment (ROI) for addressing
SDOH can help funders and other stakeholders see the financial value of investing in rural SDOH. For
example, rural communities can
calculate how partnerships between community-based organizations, social services, and medical
systems can decrease costly healthcare utilization.
Promoting Community Participation in Evaluation Activities
Rural communities addressing SDOH often emphasize the importance of involving diverse community
perspectives and engaging community members in project planning and implementation. Programs can
involve community members in evaluation activities in order to ground findings in the lived
experience of rural residents.
For example, rural SDOH programs may involve community members in data collection and analysis through a range
participatory research strategies:
involves asking community members to capture and share images about their communities, environments, and
experiences. Photovoice can help amplify the voices of rural residents who are traditionally not included in
research process. For example, the UNC Center for Reduced Cardiovascular Disease Disparities' Heart Healthy Lenoir study is seeking to better understand the SDOH
contribute to disparities in cardiovascular disease in rural Lenoir County, North Carolina. As part of the
study, the project team engaged community members in a Photovoice project to explore ecological
facilitators and barriers to cardiovascular health, such as segregation and poverty.
Most Significant Change (MSC) is a strategy that
solicits stories that demonstrate significant change from community members. Once gathered, a panel of
stakeholders collectively identifies which stories demonstrate the most significant change. This method
investigators be willing to accept unexpected results; part of the value of MSC resides in identifying where
different groups and individuals find meaning. MSC is about the process of change (how change
what change looked like, and on what timeline that change occurred) as much as it is about
collection and reporting of stories.
Storytelling is an effective qualitative method of
collecting and sharing nuanced information with the purpose of effecting change. It can be used to share
stories as well as identify needs in communities. Elected officials and other decision-makers appreciate the
humanity of storytelling that is not evident in statistics and trends. Storytelling may be used on its own
can be used in conjunction with quantitative data methods.
Considerations for Special Populations
Promoting community participation and ownership of data can be particularly important for rural communities
engaging in research with populations who have been historically
harmed by unethical research practices, including tribal communities. Rural communities seeking to
address SDOH among tribal communities can engage in tribally-driven
participatory research to guide issues of ownership and consent, enhance trust, and ensure that
evaluation findings accurately reflect tribal contexts. Rural communities that are addressing issues of racial
and ethnic inequities through their SDOH programs may also benefit from evaluation resources focused on racial
Resources to Learn More
Challenge of Assessing Civic Engagement Efforts: Toward a Useful Framework and Measurement
Describes difficulties in evaluating activities and programs focused on civic engagement. Provides suggestions
for measuring civic engagement.
Organization(s): Organizational Research Services
and Learning for Social Change: Evaluating Community Organizing
Describes considerations for evaluations of community organizing efforts, including key challenges and
suggestions for framing the evaluation.
Author(s): Foster, C.C. & Louie, J.
Organization(s): Center for Evaluation Innovation, Blueprint Research & Design, Inc.
Methods for Evaluating Rural Food Access
Provides high-level overview of evaluation techniques that
could be used to measure different aspects of rural food access programs.
Organization(s): The University of Minnesota Rural Health Research Center, NORC Walsh
Center for Rural Health Analysis, Rural Health Information Hub
Softly and Listen Carefully': Building Research Relationships with Tribal Communities
Describes ethical considerations and historical context for building research partnerships with Native
Organization(s): National Congress of American Indians (NCAI) Policy Research Center,
Montana State University Center for Native Health Partnerships
Leading Community Change: An Evaluation Toolkit
Provides guidelines for youth and adult program staff seeking to evaluate their community projects.
Includes resources to help youth engage in evaluation activities, such as handouts and examples.
Author(s) Flores, K.S.
Organization(s): Rural Youth Development Grant Program of the National Institute of Food and
Agriculture, U. S. Department of Agriculture; Girl Scouts of the United States of America, the
National 4-H Council, the National FFA Organization, and Evaluation Access
Photovoice in your Community
Explains the concept of Photovoice and provides an overview of when and how using Photovoice may benefit a given
Author(s): Rabinowitz, P.
Organization(s): Community Toolbox, University of Kansas Center for Community Health and Development