Program Evaluation Webinar Series Part 2:

Program Evaluation Webinar Series Part 2:“Getting Started and

Engaging Your Stakeholders”Presented by: Leslie Fierro and Carlyn Orians

Getting Started and Engaging Your Stakeholders

Leslie A. Fierro, MPHTKCIS Contractor NCEH/[email protected]

Carlyn Orians, MA, Battelle Centers for Public Health Research and [email protected] Presented November 20, 2008

Agenda

Definition of evaluation.

Difference between evaluation & research.

CDC’s Evaluation Framework.

The who, why, when & how of stakeholders.

Tangible examples of engaging stakeholders.

What is the Purpose of Evaluation?

The purpose of evaluation can be:

social betterment

program planning and decision making

empowerment of individuals

Evaluation: Definition 1

Evaluation is the systematic investigation of the merit, worth, or significance of an object.

-- Michael Scriven


Evaluation is the systematic assessment of the operation and/or the outcomes of a program or policy, compared to a set of explicit or implicit standards as a means of contributing to the improvement of the program or policy.

-- Carol Weiss


Evaluation is the systematic collection of information about the activities, characteristics, and outcomes of programs to make judgments about the program, improve program effectiveness, and/or inform decisions about future programming.

-- Michael Patton

The Common Element

Note that all 3 of these statements share a common element. ..

…they all define evaluation as a systematic and formalized endeavor.

Summative Evaluations

Summative evaluations seek to judge a program by asking, “Should this project be…”

cancelled? continued? expanded?

Formative Evaluations

Formative evaluations seek to use the evaluation findings. They ask the question:

“Is the program being conducted as planned?”“Is the program doing well?”

Formative evaluations seek to improve programs or policies.

The CDC Definition

Evaluation is the systematic collection of information about the activities, characteristics and outcomes of the program to make judgments about the program, improve program effectiveness and/or inform decisions about future program development.

Research vs. Evaluation

Specific to Research

Specific toEvaluation

Research and evaluation share methodologies but ask different questions.

Commonalities

The Research Context

Purpose To add to an existing body of theoretical knowledge.

Typical Questions

Does the theory hold in this situation?How can we improve the theory to make

better predictions in every situation?

Research Findings

test and improve theories.develop generalizable theories.theories apply across different

settings, people, and times.

Research is conducted to:

The Evaluation Context

PurposeJudge the merit or worth of a program.

Provide information for decision making.

Typical Questions

Is the program doing what was intended?

What steps might be taken to improve it?

Evaluation Findings

Evaluation results:

are not usually generalizable. focus on a specific situation. evaluation of a single program in a particular context.

Research vs. Evaluation

Evaluation asks: “Is this program working?”

Research asks:“Will this program work across multiple settings?”

The Role of Researchers

Researchers: Play a single role as content experts.


Researchers: Play a single role as content experts.Identify gaps in current knowledge.


Researchers: Play a single role as content experts.Identify gaps in current knowledge.Derive their own questions.


Researchers: Play a single role as content experts.Identify gaps in current knowledge.Derive their own questions.Perform their own research.

The Role of Evaluators

Evaluators:Play multiple roles—facilitator, educator, scientific expert, etc.


Evaluators:Play multiple roles—facilitator, educator, scientific expert, etc.Involve stakeholders.


Evaluators:Play multiple roles—facilitator, educator, scientific expert, etc.Involve stakeholders.Collaborate to identify and prioritize questions.

“Research seeks to prove, evaluation seeks to improve.”

M.Q. Patton

In a Nutshell…

The Findings Must be Useful

To improve a program, the findings must be useful! How?

The stakeholders must be involved. The questions must be relevant to the program.The findings must be credible to key stakeholders.


The Who, When, Why, and How of Stakeholder Involvement

in CDC’s Evaluation Framework

“Who” are the Stakeholders?

Stakeholders are:people and/or organizations that are interested in the program, are interested in the results of the evaluation and/or have a stake in what will be done with the results of the evaluation.

Examples of Stakeholders

Persons involved in program operations• Example: asthma program staff and partners

Persons served or affected by the program• Example: participants in asthma interventions,

asthma patients, families, caregivers, etc.Intended users of evaluation findings• Example: policy makers, managers,

administrators, advocates, funders, and others

Each Program is Different

Develop a list of stakeholders at the start of any evaluation activity.

Which Stakeholders Matter Most?

Review your list of stakeholders and think strategically about these questions:

“Who do we need to…”



“Who do we need to…” enhance credibility?



“Who do we need to…” enhance credibility? implement program changes?



“Who do we need to…” enhance credibility? implement program changes? advocate for changes?



“Who do we need to…” enhance credibility? implement program changes? advocate for changes? fund, authorize, or expand the program?

“Why” Engage Stakeholders?

Engaging stakeholders is an important part of the CDC Evaluation Framework.

Involving stakeholders may be a requirement of your program.


Engaging stakeholders is an important part of the CDC Evaluation Framework

Stakeholders will add credibility.

If you want the results to be acted upon, they must be credible.


Engaging stakeholders is an important part of the CDC Evaluation Framework.Stakeholders will add credibility.

Stakeholders may have resources to help.

Stakeholders may be able to contribute data, skills, analytical skills, etc.


Engaging stakeholders is an important part of the CDC Evaluation Framework.Stakeholders will add credibility. Stakeholders may have resources to help.

Stakeholders may be critical to implementing or advocating for action based on the results.


Engaging stakeholders is an important part of the CDC Evaluation Framework.Stakeholders will add credibility. Stakeholders may have resources to help.Stakeholders may be critical to implementing or advocating for action based on the results.You will build trust and understanding among program constituents. Involving stakeholders helps to reduce fear of the evaluation process.

“Why” Would Stakeholders Want to be Involved?

Get answers to their questions.


Get answers to their questions.Learn about evaluation.


Get answers to their questions.Learn about evaluation.Influence the design and methods.


Get answers to their questions.Learn about evaluation.Influence the design and methods.Protect their constituents.


Get answers to their questions.Learn about evaluation.Influence the design and methods.Protect their constituents.Motivated to help program succeed.

CDC’s Evaluation Framework

Ensure use and share lessons learned

Gather credible evidence

Engage stakeholders

Describe the

program

Focus the evaluation

designJustify

conclusions

STEPS

StandardsUtility

FeasibilityProprietyAccuracy

“When” and “How” Can You Engage Stakeholders?

You can use the CDC Evaluation Framework to engage stakeholders in: identifying and prioritizing evaluation

questions, selecting credible sources, and developing a plan for action based on

evaluation results.

“When” and “How” Can You Engage Stakeholders?

You can engage stakeholders in every step of the evaluation process.

But… you don’t have to engage stakeholders in all these ways in every evaluation.

“How” Depends on…

Evaluator preference.


Evaluator preference.Stakeholder preference.


Evaluator preference.Stakeholder preference.Resources.


Evaluator preference.Stakeholder preference.Resources.Degree of trust or threats to credibility.


Evaluator preference.Stakeholder preference.Resources.Degree of trust or threats to credibility.

If there is a high degree of mistrust, engage stakeholders early in the evaluation process. This helps ensure that the results are viewed as credible and are acted upon.




Engage stakeholders

Describe the

program


designJustify

conclusions

STEPS

StandardsUtility


Who should be involved? Develop list of

potential stakeholders.

Decide which stakeholders are the most important to include.

CDC’s Framework Step 1



Engage stakeholders

Describe the

program


designJustify

conclusions

STEP 1

StandardsUtility


Engage stakeholders

CDC’s Framework Step 2Do stakeholders share a vision of what the program does and its intended outcomes?

Diverse views? Similar views? Engage them early in the

process.



Engage stakeholders

Describe the

program


designJustify

conclusions

STEP 1

StandardsUtility


Describe the

program

CDC’s Framework Step 3What are the most pressing and important evaluation questions for stakeholders?

What questions do they need answered to be able to take action?

What methods are available and preferred?

What will be considered “credible evidence”?



Engage stakeholders

Describe the

program


designJustify

conclusions

STEP 1

StandardsUtility



design

CDC’s Framework Step 4Gather evidence stakeholders will find credible.Ensure use

and share lessons learned


Engage stakeholders

Describe the

program


designJustify

conclusions

STEP 1

StandardsUtility



CDC’s Framework Step 5How do diverse stakeholders interpret the findings?

May engage stakeholders in the analysis.

Perhaps solicit their interpretation before results are finalized.



Engage stakeholders

Describe the

program


designJustify

conclusions

STEP 1

StandardsUtility


Justify conclusions

CDC’s Framework Step 6Which stakeholders can play a role in disseminating results or acting on findings?

This is a critical step for stakeholder involvement.



Engage stakeholders

Describe the

program


designJustify

conclusions

STEP 1

StandardsUtility


Ensure use and

share lessons learned


Tangible Examples ofStakeholder Involvementin the Evaluation Process

Example #1 – Asthma and Home Environment in Low-Income Apts

Intervention to improve indoor environment for children with asthma via following activities:


Intervention to improve indoor environment for children with asthma via following activities:• Provide education and training for apartment

owners, building inspectors, maintenance vendors, and tenants regarding asthma triggers and housing codes.



Provide education and training for apartment owners, building inspectors, maintenance vendors, and tenants regarding asthma triggers and housing codes.

• Work with city officials to enhance existing housing code.



Provide education and training for apartment owners, building inspectors, maintenance vendors, and tenants regarding asthma triggers and housing codes.

Work with city officials to enhance existing housing code.

• Promote smoke-free housing.




Engage stakeholders

Describe the

program


designJustify

conclusions

STEPS

StandardsUtility


Step 1: Engage the Stakeholders

Low-Income Housing Scenario

Who are the stakeholders?




affected families




affected families those who receive training (e.g., owners,

inspectors, maintenance personnel, tenants)





inspectors, maintenance personnel, tenants) trainers





inspectors, maintenance personnel, tenants) trainers city officials responsible for the housing code






smoke-free advocates







Stakeholders may include advocates as well as those resistant to change . It’s important to include a mix of views so you don’t get surprised at the end.

Step 2: Describe the Program


Obtain stakeholders’ views on:




What is the current indoor environment?




What is the current indoor environment? What changes are both desired and seen as

realistic?





realistic? What outcomes do they think are most

important?





realistic? What outcomes do they think are most

important? Which activities contribute to which outcomes?





realistic? Which outcomes do they think are most

important? Which activities contribute to which

outcomes? (You could use a logic model here… Stay tuned for the next Webinar in this series…)

Step 3: Focus the Evaluation DesignLow-Income Housing Scenario

What questions do the stakeholders think are the most important to ask?



Should the evaluation focus on changes to the housing code?




Focus on trigger reduction? Which triggers?




Focus on trigger reduction? Which triggers? What is the best design?



Should the evaluation focus on changes to the housing code? Focus on trigger reduction? Which triggers? What is the best design? Is a pre-post design best?




Focus on trigger reduction? Which triggers? What is the best design? Is a pre-post design best? Should there be a control group?




Focus on trigger reduction? Which triggers? What is the best design? Is a pre-post design best? Should there be a control group? Are observational methods appropriate?

Step 4: Gather Credible Evidence


What role can stakeholders play?



What role can stakeholders play? Are there stakeholders that can facilitate access to

residences and/or translate if necessary?




residences and/or translate if necessary? Can the trainers help collect data before, during, or after

each training? Other opportunities for data collection?





each training? Other opportunities for data collection? What information will the stakeholders need to act? For

example, will policy makers be more influenced by information on environmental conditions, asthma symptoms, or medical care usage?





each training? Other opportunities for data collection? What information will the stakeholders need to act? For

example, will policy makers be more influenced by information on environmental conditions, asthma symptoms, or medical care usage?

Data in what form? Pictures? Stories? Numerical data?

Step 5: Justify Conclusions


How do stakeholders view success? What does “success” look like to them?




Do stakeholders have alternative interpretations of the initial findings?




Do stakeholders have alternative interpretations of the initial findings?

Do they perceive barriers you might have missed?

Step 6: Ensure Use and Share Lessons Learned


Can stakeholders help disseminate evaluation findings?




Is there an owner’s newsletter? A tenant meeting? A neighborhood association?





Is information needed in a different form to prompt action? A report? An executive brief? An oral presentation?





Is information needed in a different form to prompt action? A report? An executive brief? An oral presentation?

Is there interest beyond the community involved in the intervention?

What if you ignored stakeholders?

If you ignore the stakeholders, potential pitfalls include…


Failure to ask important questions.

• For example, it may be important to know if tenants have access to quit-smoking services.



Difficulty gaining access to or trust of program constituents.

• For example, will you gain access to data or be received into residents’ homes?



Failure to uncover unanticipated consequences.

• For example, if improvements are made, will rents increase?



Failure to communicate results in ways that are understood and/or accessible.

• For example, are there literacy or language issues? Cultural preferences?



If you fail to involve the stakeholders…

…your evaluation may not lead to action!

105

Example #2 – Care Coordination Across Health Systems

Intervention to provide and integrate care coordination and case management for high-risk children with asthma.

106



Involves standardizing protocols across care systems, including:

Medicaid HMOsHome nursing agenciesHealth departments

107



Involves standardizing protocols across care systems, including:

Medicaid HMOsHome nursing agenciesHealth departments

The goal: to prove success and thus convince insurers to continue reimbursing case management services.

Engage the Stakeholders

Housing Scenario Healthcare Scenario

affected families

those who receive training

trainers

city officials


Who are the stakeholders in this scenario?



affected families


trainers

city officials


insurers



affected families


trainers

city officials


insurers case managers



affected families


trainers

city officials


insurers case managers families



affected families


trainers

city officials


insurers case managers families health system

administrators

Focus the Evaluation Design


What changes are both desired and seen as realistic?

What outcomes do they think are most important?

Which activities contribute to which outcomes?

What outcome questions?






Is this intervention sustainable?






Is this intervention sustainable?

What is the cost of doing this kind of case management?

Gather Credible Evidence



Stakeholders that can facilitate access ?

Trainers help collect data ?

What type of data do they need to make a decision?






Is quantitative data more highly valued than qualitative data?






Is quantitative data more highly valued than qualitative data?

Do the data need to show cost savings?






Be sensitive to the stakeholders’ interests and time constraints.






Be sensitive to the stakeholders’ interests and time constraints.

Be aware of and consider the political environment.

Example #3 – Daycare EducationIntervention to train childcare providers to identify triggers and to manage children with asthma.


Intervention reaches out to:Large daycare centersLicensed home daycare programsParticipation is encouraged through continuing education credits


Intervention reaches out to:Large daycare centersLicensed home daycare programsParticipation is encouraged through continuing education credits

Long-term goal: to expand beyond pilot providers to larger community.


Housing Scenario Daycare Scenario

affected families


trainers

city officials


Who would be the stakeholders in this scenario?



affected families


trainers

city officials


trainers daycare providers licensing boards families






What outcome questions?






behavior change environmental

outcomes evidence to support

decision to expand beyond pilot



Focus on changes to the housing code?

Trigger reduction? Should there be a

control group? Observational

methods?

What design mix?



Focus on changes to the housing code?

Trigger reduction? Should there be a

control group? Observational

methods?

Consider pre-post design.

Consider control group design.






What data collection methods?






Success stories may be important .


Tangible Examples ofStakeholder Involvement in

Applying the Evaluation Standards

Evaluation Standards Apply to Every Step



Engage stakeholders

Describe the

program


designJustify

conclusions

STEPS

StandardsUtility


The Evaluation Standards

Standards

• Utility• Feasibility• Propriety• Accuracy

The Evaluation Standards

There are actually 30 evaluation standards grouped into four categories.

A complete list of the standards is published in CDC’s Framework for Program Evaluation in Public Health. (See link under “Learning Aids”.)

Why Use Standards?Standards provide a way to:

Make difficult decisions when designing and implementing an evaluation.Judge the quality of an evaluation.Determine where an evaluation can be better balanced.

The “Utility” StandardWho needs the evaluation information and

what information do they need?

Identify affected stakeholders. Collect data that addresses important

questions. Ensure the data is responsive to the needs of

the stakeholders.

The “Feasibility” StandardHow much money, time, and effort can we put into this?

Keep the burden of data collection as low as possible.

Consider the political interests of the stakeholders.

Ensure that the evaluation is cost effective.

The “Propriety” StandardWhat steps need to be taken for

the evaluation to be ethical?

Ensure the ethical treatment of evaluation participants.

Ensure the ethical treatment of those who commissioned the evaluation.

Ensure the ethical treatment of those affected by the findings of the evaluation.

The “Accuracy” StandardWhat design will lead to

accurate information?

Clearly and accurately document the program. Gather data in a way that produces reliable

information. Analyze and report the data in a systematic and

unbiased way. Assure that the source of the information is

defensible.

CDC’s Asthma Control Program

CDC’s Asthma Control Program funds 35 states and territories to implement statewide asthma control programs using a public health perspective.

Their approach involves:Engaging, enhancing, and maintaining relationships with partners.Developing, improving, and conducting asthma surveillance activities.Designing and implementing interventions with partners.

Example #4 - Asthma Program Monitoring System

This example involves collecting information for the purpose of evaluation across multiple sites.

Example #4 - Asthma Program Monitoring System

Purpose:

Develop a strategic, systematic approach to collecting information about our program activities, progress, and accomplishments across all funded states.

Employing the Framework ModelStep 1: Involve the stakeholders CDC Air Pollution and Respiratory

Health Branch. Representatives of funded State

Asthma Programs.Step 2: Describe the Program Develop logic models.

Step 3: Focus the evaluation design Identify and prioritize evaluation

questions.Step 4: Gather credible evidence Create data collection instrument.

Developing the Data Collection Instrument

In this example, developing the data collection instrument was a highly collaborative endeavor aided by the program evaluation standards.

The Iterative Process• CDC internal workgroup identifies core information needs and drafts survey

instrument.

• State workgroup members review instrument, pilot test, provide pilot data and comments.

• Create mock report to illustrate type of information obtained from instrument.

• CDC internal workgroup discusses comments and mock report.

• Modify instrument as necessary.

Applying the StandardsHow were the evaluation standards employed in this example?

How was “engaging the stakeholders” important in applying each of the standards?

The “Utility” StandardWho are the intended users of the information?

Why do they need the information?

CDC Air Pollution and Respiratory Health Branch

State partners

Examine progress. Identify promising

patterns. Share successful practices Identify areas for

improvement. Compare and contrast

program designs and performance.

The Utility Standard in Action• Determined what information the CDC needed to do their job and how they will use the

information.

• Engaged states in discussions about how to make the information useful for them.

• Developed mock reports to facilitate conversations with stakeholders about how the data could be used.

The “Feasibility” StandardHow much money, time, and effort can we put into this?

Remained conscious of how much time this data collection will require of the states.

Identified areas where processes could be streamlined.

Recognized that there will be less time for other programmatic activities.

The Feasibility Standard in Action• Carefully selected “need-to-know” questions.• Asked states:

• What information do you already have?• How feasible is it for you to obtain?• How long does it take to locate information?• How long does it take to fill out the data collection instrument?

• Always kept the burden of data collection as low as possible.

The Feasibility Standard in ActionThe content of the data collection instrument was a careful balance between feasibility and utility.

High priority data requiring higher burden was balanced by eliminating lower priority questions.

The “Propriety” StandardWhat steps need to be taken for

the evaluation to be ethical?

Program monitoring systems can be used to generate performance measures.

The data collected could have significant implications.

Understand that the information collected can affect the stakeholders’ programs.

The Propriety Standard in Action

• Used a highly collaborative process.

• Fostered open, honest dialogue about expectations and concerns.

• Remained highly responsive to stakeholder concerns.

• Modified instrument to address stakeholder concerns.

The “Accuracy” StandardWhat design will lead to

accurate information?

Be certain that the information collected is valid and reliable.

If the information is inconsistent or irrelevant to the concept, reconsider whether to collect it.

Balancing the Standards

When balancing feasibility vs. accuracyconsider the effect on propriety.

The Accuracy Standard in Action

Involved states in:

• Pilot tests and reviews.

• Discussions about “guessing”.

• Analyzing the quality of the information provided.

• Revising questions or collecting information that would help to improve accuracy.

• Decisions to discard some questions.

What We Have Reviewed Today• The goal of evaluation and role of stakeholders.

• Who to engage as stakeholders.

• Why it is important to engage stakeholders.

• When and how to engage stakeholders.

• Stakeholder involvement across all steps of CDC framework.

• Stakeholder involvement in fulfilling the evaluation standards.

• Examples: Single and multiple sites

Thank You for Joining Us!

Leslie Fierro: [email protected] Orians: [email protected]

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