2. Why evaluate using a health equity lens
Using a health equity lens when evaluating provides a more comprehensive understanding of the impact being made. Specifically, an evaluation without a health equity lens may reveal overall improvement in health, but overlook that specific health inequities are widening. (Citation: Evaluating, #1)
Reasons to evaluate a program, project, or policy using a health equity lens include the ability to improve existing programs by considering the best interventions for targeted populations based on community context and input. Evaluation using a health equity lens can also improve measurement of the interventions by using measures that fit the intervention and make sense to the community. Using health equity in evaluation encourages stakeholders to be accountable and fulfill their responsibilities of completing certain tasks or activities based on a timeline. It inspires groups to share effective strategies and lessons learned so that other communities with similar populations and problems see positive outcomes and improves the likelihood of funding and sustainability by engaging community input, involvement, and buy-in for the process (Citation: Evaluating, #2)
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1. What is evaluation? Why do we evaluate?
“Without a focus on health equity in evaluation efforts, the effects of an intervention on addressing health disparities and inequities can go unnoticed…health equity-oriented evaluations can be designed to understand what works, for whom, under what conditions, and reveal whether health inequities have decreased, increased or remained the same.”
---CDC, Practitioners Guide for Advancing Health Equity
(Citation: Evaluating, #1)
Evaluation answers questions about program needs, implementation, and outcomes. Ideally it begins with the planning of a program, project, policy, or intervention and continues across the entire intervention to make sure proper implementation. We evaluate so that we can make judgments about a program, project, or policy and to improve the intervention’s effectiveness, and/or to inform programming, project, or policy decisions. (Citation: Evaluating, #3)
3. What types of evaluation exist? What are the sources of data for evaluation?
The four basic types of evaluation (using both quantitative and qualitative data and methods) include:
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Formative evaluation: Conducted before the start of a program, policy, or project begins. The goal is to determine whether materials, messages, or some part of the intervention are feasible, appropriate, and meaningful.
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Process evaluation: Assesses program implementation (e.g. number of attendees at training).
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Impact evaluation: Assesses the extent to which the intervention (program, policy, or project) is meeting its objectives and reflects changes in knowledge, attitude, behavior or other intermediate outcomes.
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Outcome evaluation: Provides long-term feedback on changes in health status, morbidity, or quality-of-life that are linked to the intervention. Also called summative evaluation.
(Citation: Evaluating, #4)
Sources of data for evaluation include quantitative (numbers) and qualitative (words) data and methods. Some of this data you can gather from sources already available (secondary data) or you may need to collect data (primary data). “Triangulation” or the combination of quantitative and qualitative data and methods greatly improves our understanding of impact and outcomes.
Each type of stakeholder involved in the evaluation plan will have a different perspective and bring diverse skills and resource. Involve community members or groups, grant makers and funders, and university-based researchers in evaluation efforts. (Citation: Evaluating, #5)
4. What are the types of stakeholders that should be involved in evaluation efforts using a health equity lens?
5. How to plan for and develop an evaluation plan using a health equity lens?
Keep the following goals in mind while planning or conducting evaluation efforts using a health equity lens:
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Develop a logic model that includes health equity activities and goals;
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Incorporate health equity into evaluation questions and design;
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Identify appropriate variables to track populations experiencing health inequities;
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Use culturally appropriate tools and methodologies;
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Use multiple approaches to understand an intervention’s effect on health inequities;
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Include health equity indicators into performance monitoring systems;
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Use process and outcome evaluations to understand the effect of health inequities; and
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Widely disseminate the results of equity-oriented evaluations
(Citation: Evaluating, #1)
This visual from CDPHE’s Project Planning and Evaluation for A35 grantees may also be a useful way to organize your plan. (Citation: Evaluating, #6)
Please refer to the following resources when making your evaluation plan.
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CDC. Practitioners Guide for Advancing Health Equity (pages 30-33).
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Prevention Research Center in St. Louis. Evidence-Based Public Health: Module 9: Evaluating a Program or Policy.
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Northwest Public Health Training Center. EBPH: Evaluation module.
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Rocky Mountain Public Health Training Center. Evidence-Based Public Health Online Course.
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Community Toolbox. Evaluation.
Resources
Process evaluation provides shorter-term feedback on program implementation, content, methods, participant response, practitioner responses as well as some quick understanding of what is working and what is not working. (Citation: Evaluating, #2)
6. How do you (or can you) develop process evaluation (and measures) using a health equity lens?
7. How do you (or can you) develop impact or outcome evaluation (and measures) using a health equity lens?
Impact evaluation looks at changes in knowledge and attitude. Outcome evaluation involves long-term feedback on health status, morbidity, mortality. It often uses quantitative data to provide results. (Citation: Evaluating, #2)
8. How can we monitor and modify our evaluation plan using a health equity lens?
The evaluation plan is a document that should be updated and reviewed regularly (based on your team or partnership). To make sure that the plan is updated and used, stakeholders need to have buy-in with both with the development of measures as well as collection of data.
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It is a good idea to have a central place where data can be uploaded and shared among agency staff, team members, organizational staff, and partners. Consider training stakeholders in all aspects of evaluation.
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Recognize the importance of gathering qualitative data from stakeholders on the evaluation process (called feedback). Feedback provides important information and lessons learned that will assist with current and future efforts.
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This table from CDPHE’s Project Planning and Evaluation for A35 grantees will help you develop our evaluation plan, including what information to collect and methods to use (Citation: Evaluating, #6).
9. How do you disseminate evaluation findings using a health equity lens?
Providing feedback to stakeholders and community members should occur regularly (and at the end of the evaluation). Findings should be provided during regular meetings of your agency, team, or partnership. Findings should also be provided to funders. Also think about how you will share information with those impacted by the intervention. In addition, consider if you can share findings at city or county meetings, local conferences, or in publications.
Resources
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CDC. Practitioners Guide for Advancing Health Equity (pages 30-33).
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Community Toolbox. Evaluation.
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Health Evidence: Improving Future Decisions: Optimizing the Decision Process from Lessons Learned.
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Prevention Research Center in St. Louis. Evidence-Based Public Health: Module 9: Evaluating a Program or Policy.
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Northwest Public Health Training Center. EBPH: Evaluation module.
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Rocky Mountain Public Health Training Center. Evidence-Based Public Health Online Course.