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Rural Health Information Hub

Evaluation Measures for SDOH Programs

Rural communities addressing social determinants of health (SDOH) are using a range of evaluation measures to track their progress and assess the effects of their programs. Many programs that focus on SDOH seek to achieve long-term outcomes related to complex social factors, including poverty and education. These programs may wait years to see measurable changes in the proportion of program participants who live in poverty or who increase their educational attainment. Therefore, rural programs may also identify short-term and intermediate outcome measures and process measures to assess progress on stated goals. Additional information on identifying strategies and measures for gathering appropriate data and evidence can be found in the Rural Community Health Toolkit.

Evaluation Measure Sources

Rural communities can identify evaluation measures to use in developing an evaluation plan related to SDOH from a range of sources.

Sample Evaluation Measures by Domain

Economic Stability. Rural communities that seek to improve economic stability may be particularly interested in measures related to poverty, financial assets, and unemployment. Examples of measures under this domain could include:

  • Rate of children living in poverty
  • Income inequality
  • Rate of severe housing cost burden
  • Rate of homeownership
  • Rate of children eligible for free or reduced-price lunch
  • Rate of unemployment
  • Rate of job growth

Education. Rural communities focused on education as a means of improving health and well-being may use measures related to educational attainment. Examples of measures under this domain could include:

  • Proportion of eligible children enrolled in early childhood education
  • High school graduation rates
  • Proportion of new high school graduates enrolled in college

Social and Community Context. Rural communities seeking to make changes to the social and community context to address SDOH could be particularly interested in measures of disenfranchisement, civic engagement, incarceration, and violence. Examples of measures under this domain could include:

  • Percent of registered voters who voted in the last election
  • Rate of recidivism
  • Rate of incarceration

Health and Healthcare Access. Rural communities may focus on SDOH as a means of improving health outcomes and increasing access to health and human services. Examples of measures under this domain could include:

  • Percent of patients enrolled in social services for which they are eligible, including Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), or Women, Infants, and Children (WIC).
  • Percent of patients who are uninsured or underinsured
  • Rate of no-shows to healthcare appointments
  • Patient travel miles saved

Neighborhood and Built Environment. Programs focused on making improvements to the physical environment may use measures related to pollution, environmental hazards, and land use, among many others. Examples of measures under this domain could include:

  • Number of drinking water violations
  • Number of reports of housing issues, such as mold or structural violations
  • Rate of children with elevated levels of lead in their blood
  • Number of days with high levels of air pollution particulate matter
  • Number of community members without a mode of transportation to work

Sample Evaluation Measures Across Domains

Rural communities implementing SDOH programs often collect data about program activities that cut across disciplines or apply to multiple topics. For example, some communities may evaluate changes in policies, community participation, or community engagement. Examples of measures that apply to these SDOH could include:

  • Number of stakeholders engaged in SDOH issue
  • Change in public awareness or action related to SDOH
  • Number of policies developed and enacted to address SDOH
  • Number of organizational changes developed and enacted to address SDOH
  • Amount of funding dedicated to SDOH

Resources to Learn More

Exploring Consensus across Sectors for Measuring the Social Determinants of Health
Describes the scope of SDOH measurement across sectors and identifies common SDOH categories captured in measurement tools. Includes a table with links to SDOH measurement tools by sector.
Author(s): Elias, R.R., Jutte, D.P., & Moore, A.
Citation: SSM-Population Health, 7, 100395
Date: 4/2019

Guide to Evaluating Collective Impact – Supplement: Sample Questions, Outcomes, and Indicators
Offers sample measures involved in collective impact projects, including topics related to community capacity and systems change.
Author(s): Preskill, H., Parkhurst, M., & Juster, J.S.
Organization(s): The Collective Impact Forum and FSG
Date: 2014

Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity
Describes recommended practices for measuring SDOH and health inequities.
Author(s): Penman-Aguilar, A., Talih, M., Huang, D., Moonesinghe, R., Bouye, K., & Beckles, G.
Citation: Journal for Public Health Management & Practice, 22(Suppl 1), S33-S42
Date: 2016

Measuring Health Outcomes: Success Measures Evaluation Tools for Community Development and Health
Includes sample evaluation measures and tools to assess the effects of community development projects, including individual health behaviors and community environmental factors.
Organization(s): NeighborWorks America, Robert Wood Johnson Foundation, Kresge Foundation
Author(s): Mulcahy, J.
Date: 2017