1. Chapter 17 Evaluation and Evidence-Based Practice
© John Hubley & June Copeman 2013

2. Evaluation
A systematic way of learning from experience and using the lessons learnt to improve current activities and promote better planning by careful selection of alternatives for future action. This involves a critical analysis of different aspects of the development and implementation of a programme and the activities that constitute it, its relevance, its formulation, its efficiency and effectiveness, its costs and its acceptance by all parties involved.
(WHO 1981)

3. Why evaluate?
To learn from experience and to improve methods for future work.
To show that you are doing your job properly.
To justify the money from a funding body.
To convince other people to continue to give their support.
You need to decide at the outset why you are evaluating your programme and who the evaluation is intended for.
Evaluation
We evaluate communication and health education programmes for many reasons. The most important reason is to learn from our experiences and to improve our methods.
But there are other important reasons: you may need to evaluate your programmes to show that you are doing your job properly; you may need to justify the money you have received from a funding body; people around you may not believe that health promotion works and you may need to convince them to give you their support. You will need to decide at the outset why you are evaluating your programme and who the evaluation is intended for. Some important terms used in evaluation are given below:

4. Important terms in evaluation
Effectiveness
Efficiency
Formative evaluation
Summative evaluation
Some important terms used in evaluation are given below:
Effectiveness - whether or not a programme achieves its stated objectives i.e. did it work?
Efficiency - the amount of effort in terms of time, human resources and money required to reach the objectives - was it worth the effort?
Formative evaluation (sometimes called process evaluation) - 'monitoring' progress during the programme involving measurement of intermediate objectives i.e. what have we achieved so far?
Summative evaluation (sometimes called outcome or impact evaluation) - measurement of impact or change at the end of the programme i.e. have we achieved our objectives?

5. Indicators for evaluation
Type of change
Changes in health
Changes in behaviour
Health Empowerment
Knowledge/ awareness/attitudes
Skills
Advocacy
Service Improvement
Example of indicator
Death rates
Lifestyle changes
Heath literacy
Knowledge of symptoms, preventive measures for health conditions.
Ability to perform specific skills
Implementation of policies.
Training of staff.
See box 17.2 indicators for evaluation – strengths and weaknesses
Type of change
Changes in health
Changes in behaviour
Health Empowerment
Knowledge/ awareness /attitudes
Skills
Advocacy
Service Improvement
Example of indicator
Death rates, injury rates
Lifestyle changes - alcohol consumption, increased physical activity
Heath literacy
Knowledge of symptoms, preventive measures for health conditions.
Ability to perform specific skills
Implementation of policies.
Training of staff.

6. Dilemmas in choice of indicator
Knowledge
Easy to measure immediately after a programme but change in knowledge does not imply that there will be changes in behaviour and health so may not be very convincing to policy makers.
Behaviour
Should expect change during the lifetime of a project.
Provides a measure of the programme’s impact.
Value depends on how relevant that behaviour is to the health topic.
Health
Changes in health are useful for convincing policy makers.
Improvements in health take a longer time to achieve. Many things can affect health outcome so it is difficult to link it to specific interventions, e.g. immunization.
Knowledge
Easy to measure immediately after a programme but change in knowledge does not imply that there will be changes in behaviour and health so may not be very convincing to policy makers
Behaviour
Should expect change change during the lifetime of a project
Provides a measure of impact of the programme
Value depends on how relevant that behaviour is to the health topic
Health
Changes in health are useful for convincing policy makers
Improvements in health take a longer time to achieve. Many things can affect health outcome so it is difficult to link it to specific intervention e.g. immunization

7. The Reflective Practitioner
Evaluates the impact of their actions and takes steps to improve their practice.
Applies the concept of evidence-based practice.
Learns from what other practitioners are doing.
Keeps up-to-date with developments in a changing world.
Makes decisions about their own future learning needs.
Plans for their own personal development.
The reflective practitioner
Health Promotion is an ongoing ‘iterative’ process. That means that you need to be a ‘reflective practitioner’ and try out new ideas, evaluate your impact, learn from experience, and try again in an improved form, evaluate, learn from experience etc. In this way you can build up a body of knowledge of what works in your own situation.
Box 17.1 How to be a reflective practitioner
A reflective practitioner is someone who ‘reflects’ on what they do and then tries to improve on it. This involves:
Evaluating the impact of what you do and taking steps to improve your practice.
Applying the concept of evidence-based practice.
Taking note of what other practitioners are doing and learning from them.
Keeping up-to-date with developments in a changing world.
Making decisions about your own future learning needs.
Preparing a plan for your personal development.

8. Managing your personal development in health promotion
Here are some of the questions you will need to consider:
How are my needs likely to change in the future?
What skills will I need in my future work?
Where can I find out more about health promotion practice?
How can I take charge of my own learning?
How can I evaluate my own health promotion?
How can I evaluate other people’s experiences in health promotion?
How can I share my experiences with others?
Managing your personal development
In this book we have provided an introduction to the rich and evolving discipline of health promotion. For some of you this book will only be the start of a process of learning that will continue as your health promotion work develops. In this chapter we suggest ways in which you can take your studies in health promotion further, map out your future learning needs and manage your own personal development in health promotion.
Box 17.4 How to map out my own future development in health promotion.
Here are some of the questions you will need to consider:
How are my needs likely to change in the future?
What skills will I need in my future work?
Where can I find out more about health promotion practice?
How can I take charge of my own learning?
How can I evaluate my own health promotion?
How can I evaluate other people’s experiences in health promotion?
How can I share my experiences with others?