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Evaluating the Results of
Communication Programs
Preventionprogramplanners sometimesfind evaluation difficult to do, and out-
O come evaluation may seem to be the most difficult. This bulletin describes how to
tr>
plan and conduct outcome evaluation and explains the benefits ofconducting
outcome evaluation to document the results ofcommunication efforts.
Evaluation is a continuous process that
The Health
begins with identifying the prevention
problem or issue to be addressed and Communications Process
who is affected by the problem.
Where does evaluationfit in?
Then, as shown in the Health Communi-
cations Process, evaluation continues
throughout the development and imple-
mentation ofthe communication pro-
gram.
Types ofevaluation include formative,
process, outcome, impact, and efficiency.
Each ofthese serves a different purpose
and requiresvarying amounts oftechni-
cal expertise and resources. In this
bulletin, these types ofevaluation are
defined as follows:
Formative evaluation (or formative
research) is conducted as a part of
program development. Collecting evalua-
tion data at this early point can help Process evaluation addresses how the
"% make decisions about target audience prevention communication program is
selection and the types ofcommunication implemented:
messages, channels, and activities to be
used. Pretesting messages and materials Is the program involving target audi-
ence members? How many?
to assure their effectiveness prior to final
production is one kind offormative Are the planned activities being con-
evaluation. ducted? Bywhom? Bywhen?
™
US DEPARTMENT OF HEALTH AND HUMAN SERVICES
M^ Substance Abuse andMental Health Services Administration August 1998
Center for Substance Abuse Prevention
^»M3al
"
dresses a more complex situation and re-
quires sustained attention and multiple
"The challenge most threatening to program strategies over time, impact evalua-
thegoal offindingsolutions to the tion is usuallythe most complex and costly
type ofevaluation.
problem ofdrug abuse is the cur-
Efficiency evaluation addresses whether
rent lack ofevaluation evidence to
the program is making the best use ofre-
demonstrate thesuccess ofindi-
sources within the context ofthe stated
vidualprograms. Thisfailure to program objectives and goals.
document results represents agreat
loss to this developingfield, where
reliable evidence ofsuccess could Outcome Evaluation
guideso many efforts. Step By Step
Planning outcome evaluation ofa communi-
U. S. GeneralAccounting Office, 1992
cation program requires several steps.
Begin With Clear andAction-Oriented
I.
Communication Program Goals and
Process evaluation data identify whether the Objectives
program is progressing as expected so that
any program components that are notwork- Appropriate goals describe the overall change
ing as planned can be adjusted. Ifthe pro- that planners expect from the program. These
gram is not being implemented as planned, goals, which address a broad substance abuse
then the chances are that the program out- problem and often describe an improvement
comes will not be met. This information is in the substance abuse situation (such as
important both to improve the operation ofa making a school drug-free or postponing the
program and to replicate it. age offirst use among youth), areprevention
goals. Reaching prevention goals often means
Outcome evaluation measures the effects of using a combination ofstrategies-such as
a program on the target population in the strengthening drug-free policies, generating
short term and provides evidence ofwhat has community support for activities, and com-
changed as a result ofthe program. At its municatingabout the efforts. Communication
best, outcome evaluation is a comparison of strategies should be interwoven with other
"before" and "after." For example: prevention strategies to reach the prevention
How much did the youth know about goals.
tobacco as an addictive drug before the Achievable objectives for a communication
program ("baseline knowledge")? What program specifically relate to what communi-
were their intentions to use tobacco? cations can reasonably be expected to con-
Whatwas their knowledge after the tribute to resolving the problem. That is.
program?Was there a change? Did their objectives for communication efforts should
intentions to use tobacco change? contribute to:
Impact evaluation measures the effects in Raising awareness
the long term, such as the prevention Increasing knowledge
program's effect on a community problem 6,
12, and 18 months after cessation ofthe Influencing attitudes and norms
program. Because impact evaluation ad- Showing benefit ofbehavior change
What Outcome Evaluation Can Do
Evaluation offers program planners the tools Gain credibility. Without more
for seeing where they are going and knowing formal evaluation, program planners
when they get there. It can help them to: have to rely on anecdotal evidence to
describe what did or did not happen.
Guide administrative decisions.
Evaluation provides objective data or
Evaluation involves making decisions
documented facts. Anecdotes are
about value, worth, and merit. For ex-
important, too; but credibility is
ample, will teaching styles affect the earned by being able to explain how
impact ofthe program on students? The
each activity resulted in change.
answer to this question can help deter-
mine the types ofteachers to hire or Support replication. Outcome
whether itwill be worthwhile to invest in evaluation explains that the strategy or
teacher training. programworks. When coupled with
process evaluation (which shows how
Refine the program. Outcome evalu-
the programwas implemented), the
ation findings can clarifywhat has hap-
steps needed to replicate the program
pened, andwhat can realistically be
and to reproduce the results can be
accomplished. The program can then be
described.
reframed and/or its objectives revised
based on documented progress made. Advance the field. It takes concerted
efforts among many prevention
See concrete results. Evaluation find-
specialists to be successful in reaching
ings help provide reasons for involve-
ment to community groups and others prevention goals. So it is important to
identify and share "whatworks and
participating in the program, help with
what doesn't" to increase the use of
recruitment, and bolster staffmorale.
communication strategies that prove
Prove to funders the value oftheir successful, and modify or replace
investment. This is important for pro- those that are not.
gram continuation!
Reinforcing positive knowledge, attitudes, Attainable - to increase the probability
and behavior ofsuccess
Demonstrating skills Prioritized- to direct the allocation of
resources
Suggesting/prompting an action
Quantified- to specify how much
Increasing demand for services
change is desired
Refuting myths and misconceptions.
Measurable - to assess progress
First, identifywhat communications will Targeted- to identify who should
contribute to the broader prevention pro-
change
gram. Then, write communication objectives
that are: Time specific - to tell when the objec-
Specific - written to point the way to tive is to be reached
action
evaluation is writing outcome objectives, such
Six Steps for Outcome as the following:
Evaluation: By 1997, increase the knowledge of 50
percent ofhealth clinic counseling staff
1. Beginwith clear and action on five key effects ofusing crack.
oriented communication program
By the end ofthe program, increase by 75
goals and objectives
percent the number of 13 to 18-year-old
2. Turn the communication program girls who know the five immediate effects
outcome objectives into outcome oftobacco smoking on their bodies.
evaluation questions
At the end ofthe presentation, 90 percent
3. Design the outcome evaluation ofthe runaway youth will be able to list
an agency where a friend with an alcohol
4. Gather data
or other drug problem can get help.
5. Analyze data andwrite the evalua-
tion report 2. Turn the Communication Program
6. Use the findings. Outcome Objectives Into Outcome
Evaluation Questions
The questions an outcome evaluation is
Useful- to contribute to accomplishing designed to answer should be based on the
program's outcome objectives. For example:
the program goals.
Outcome objective
Establishing realistic, measurable objectives is
important. Information on recent trends can By the end ofthe program, increase by 75
provide some clues to what is possible. For percent the number of 13 to 18-year-old
example, ifnegative attitudes toward cocaine girls who can articulate the five immediate
use have increased by 3 percent among youth effects oftobacco smoking on their
in the pastyear, program planners may bodies.
decide to set a goal in the same range for the
Evaluation questions
nextyear.Just make sure that the change
aimed for is reasonable - and remember that What does the target audience currently
expecting 100 percent ofany group ofpeople know about the immediate effects of
to change is not reasonable. smoking tobacco? (This is the "baseline.")
The goals and objectives for the Nation set What do those who participate know after
forth in the HealthyPeople2000 report can the program?
provide some guidance, (as can those devel- During this same time, what do nonpar-
oped by many States and communities). Some ticipants within the target audience know?
national substance abuse prevention objec-
tives relate to communications, others to Ifmore than one target audience (such as
broader prevention goals to which a commu- youth leaders and otheryouth) is involved,
nication program can contribute. measure changes with each group. And if
others such as teachers are involved, add
Communication program objectives may
evaluation questions to address their role
describe whatis expected to happen or (such as identifying changes in teaching
change (outcome objectives), and others may
methods). Before moving ahead to evaluation
relate to howit will happen (process objec- design, make sure that the evaluation ques-
tives). The first step in planning outcome tions focus on the most important issues for
the program.
Case Study 1 stress or anxiety, self-perception, fre-
quency ofsubstance abuse, reactions to
Across Ages: An Intergenerational persuasion to use substances, knowledge
Mentoring Approach to Drug Preven- about older persons, and personal sense
tion (Philadelphia, PA) matches elder ofwell-being.
mentors to help sixth grade students in
Newly designed evaluation instruments
high-risk environments. Across Ages also
looked at attitudes toward school, elders,
includes community service for students,
and the future; knowledge about sub-
workshops for parents, and a classroom
stance abuse; and problem-solving skills.
curriculum. Program evaluation includes
Also measured was the extent to which
both process and outcome evaluation
students actively participated in the
components.
activities (to determine how much each
The outcome evaluation design includes studentwas exposed to the program).
two randomized intervention groups and a
Ofthe 13 measures, evaluators found
control group using pretest (before the
very good results in the pretest for four in
intervention) and posttest (after the inter-
both the experimental and control
vention) measures. Within each school,
groups. For example, students already
three sixth grade classes (from among
had the desired attitudes toward drug
those with teachers who agreed to partici-
use. Therefore, less change could be
pate) were assigned to the control group
expected in these areas. For the other
(no program intervention), the moderate
nine measures, however, there was
intervention group (all program compo- significantly more improvement among
nents except mentoring), or the full inter-
students in the experimental groups than
vention group (all program components students in the control group, with most
including mentoring). The groups were improvement among students who
demographically comparable.
received the full intervention. The use of
Previously tested evaluation instruments a control group permitted comparisons
were used to measure attitudes toward and demonstrated the positive effects of
alcohol and cigarette use, reactions to both classroom interventions and
situations involving drug use, reactions to mentoring.
3. Design the Outcome Evaluation experimental or intervention group), and the
otherwill not (the control group).
There are various research designs that can
Ask the same set ofevaluation questions to
be used for outcome evaluation. Basic text-
both groups before the program begins.
books on evaluation provide detailed expla-
wnaotrikonwsiotfhtahneseex.pHeorwieevnceerd,eitvamlauyatborewusheofuclatno Aknnsowwelresdgteo tohreastetiqtuuedsetsitohnesp(er.ogg.,raomnwtahents to
affect) serve as the baseline, or starting point.
suggestwhich research design is best applied
underwhich conditions. Then, ask both groups the same questions
The best outcome evaluation uses a random- after the program is finished. Presumably, any
significant differences in the responses from
ized "experimental" design. This means that
the intervention group, as compared with the
individuals within the target audience are
control group, can be attributed to the pro-
assigned into two equivalent groups: one
gram. Randomized experimental designs
group will be a part ofthe program (the
Outcome Evaluation Options To Match Resources
Available resources, experience, and Modest Resources. Pre- and
expertise all help guide program planners postassessments ofdesired changes in
to the most practical evaluation design for program participants (self-reported or
their program. The rule ofthumb forwell- observed, questionnaires filled out by
planned intervention programs is to participants, telephone or in-person
allocate at least 15 percent ofthe program interviews, third-party observation/
budget to evaluation. assessment); for media programs, a
media content analysis by monitoring
Some type ofoutcome evaluation, how-
and analysis ofcoverage (content and
ever, is possible for almost any budget:
quantity) appearing in the media
Minimal resources. Activity assess- before/during/after the program.
ments (numbers ofpeople who Substantial resources. Use ofexperi-
participate and their responses to mental design with intervention and
questions aboutwhat they learned, control groups, pre- and
thought, and/or did as a result oftheir postassessment to measure change after
involvement). the program exposure.
provide the best evidence ofoutcomes. It is works best for short programs, such as a
the kind ofoutcome evaluation that is most training session, where program planners
acceptable to people looking for "hard can be reasonably sure that the program
evidence" ofsuccess. Using an experimental caused or contributed to the change.)
design will also:
Looking for sources ofexisting baseline
isolate outcomes to determine ifcertain information and conducting postinter-
changes, when controlled for, affect the vention data collection only (for example,
result using existing community or State surveys
ofknowledge and/or attitudes toward
minimize or prevent conditions that
substance use/abuse).
obscure clear interpretation ofresults
Sorting other information already gath-
address potential problems and biases
ered from participants and nonpartici-
that could become barriers to understand-
pants (such as classroom attendance,
ing whether the program is responsible
school grades).
for the outcomes.
Collecting information only after the
However, for some community communica-
intervention to see ifparticipants are
tion programs, this type ofevaluation be-
where program planners want them to be
comes practical only ifevaluation expertise
(for example, ready to be peer counselors
can be accessed.
to others). This does not tell planners if
Other types ofdesigns include: participants obtained that status as a result
ofthe program.
Collecting information pre- and post-
intervention (the activity or program) only Most outcome evaluation methods are based
from participants to see what happened to on collecting data about participants through
them as a result ofthe program. (This a questionnaire, interview, or observation.
Case Study 2
assess advertisements critically, perception
Right Turns Only! (Prince Georges offamily, conflict resolution, self-efficacy
County, MD) is a video-based drug in peer relationships, and behavioral
education series produced by the Prince intentions related to substance use/abuse
Georges County School System with prevention. Changes were measured using
CSAP funding. The effect ofthis video a questionnaire completed by students
series (including collateral print material) before and after the interventions, and the
on student knowledge, attitudes, and questionnaires were analyzed to identify
behavioral intentions was tested at 12 any differences based on gender, race,
schools among approximately 1,000 grades (self-reported), and teacher.
seventh grade students assigned to four
As hypothesized, groups receiving drug
groups. One group received only the
education scored higher on all measures
video-based education; a second group
except self-esteem in the posttest than did
received the program in addition to a the control group. On two ofthe seven
traditional drug education curriculum; a measures, the group receiving the video
third group received only the traditional series and traditional curriculum scored
curriculum; and a fourth group - the
significantly higher than other groups.
control group - received no drug abuse
Thus evaluators were able to demonstrate
prevention education during the time of
that instructional television (in particular
the study. All interventions were com- when used in conjunction with print
pletedwithin a 3- week period. materials and teacher guidance) can be an
Outcomes measured included knowledge effective tool for delivering drug education
ofsubstance abuse terminology, ability to in the classroom.
The type ofdata collection method selected is tion consultation and hands-on assistance
based on how to best answer the evaluation include university faculty, graduate students
questions, access to the target audience, and (for data collection and analysis), local mar-
resources. (See the case studies included in keters and other businesses (staff, computer
this bulletin for ideas.) time), State and local health and social service
agencies, and organizations with experience
Some ofthe decisions made in designing an
in evaluation.
outcome evaluation include what data will be
What Data
collected, fromwhom, how, andwhen. These
data help answer the program's evaluation The data collected and the measures used to
questions. determine whether a change has occurred
Remember that the more complex the evalua- should directly relate to the evaluation ques-
tion design, the more expert assistance may tions. Specific questionnaires or other data
be needed to design and conduct the evalua- collection instruments should be compared to
tion. the questions they intend to ask with the
evaluation questions (Step 2) and outcome
Ifthere is no evaluator on staff, seek help to objectives (Step 1). For example, ifthe pro-
decide what type ofoutcome evaluationwill gram is intended to change knowledge, all of
best serve your program. Sources ofevalua- the measures should be knowledge related.
"
Ensure the validity ofthe data collection
instruments used. Valid instruments should "Positive resultsfrom an outcome evalu-
—
measure what they are supposed to measure. ation showing morefavorable results
Sources for help in developing a question- fromparticipants than similarnonpar-
—
naire include examples used by other pro- ticipants offerhard, objective evidence
grams, evaluation reports from NCADI [see thata socialprogram truly makes a
Resources], evaluation design manuals, and
experienced stafffrom other prevention difference and thus is apositive invest-
programs oruniversity graduate programs. mentofhuman capital.
Such sources can provide guidance on how to
U. S. GeneralAccounting Office, 1992.
develop data collection measures and instru-
ments that are reliable andvalid.
Ifcollecting baseline data is beyond existing
capability, check for available data. Has
someone already collected this information? personal information to interviewers? The
Ifit was not for the program's geographic answers mayvary according to age, culture,
area, is it reasonable to use it as an approxi- levels ofliteracy, and setting, so pilot testing
mation ofthe baseline measures? data collection instruments is vital.
From Whom When: The Outcome Evaluation Plan
Think about from whom information should The decisions made about what data to
be gathered. Different data collection instru- collect, from whom, and how are all con-
ments and methods may be needed for each nected. Completing the Worksheet: Outcome
group. For example, ifone or more interven- Evaluation Plan (see page 13) will help
tion groups and a control group are being program planners think through their evalua-
followed, each may need to be asked the tion plan. Developing a timeline and task
same questions in a different way in order to schedule is crucial. The collection ofprepro-
get at a common construct or concept. Or, if gram-intervention data must be completed
more than one culture is involved, different before the prevention communication pro-
methods to capture adequately the experi- gram starts. The more complex the evaluation
ences ofeach culture may be needed. design, the more important the timeline and
task schedule become.
How
When program planners complete the
Data can be collected in many ways; for worksheet, it provides a written guide to the
example, through qualitative methodssuch as outcome evaluation plans. The plan also can
focus groups, open ended questionnaires, help identify where there is a need for evalu-
personal interviews, and observation or ation help.
through quanitative methodssuch as struc-
tured surveys and questionnaires. The design ofprocess evaluation is not the
focus in this bulletin, but process measures
Deciding how data will be collected is an- are important for any program conducting
other resource question. Does the program outcome evaluation. Information from pro-
have access to skilled interviewers? cess measures will help identify parts ofthe
Consider how comfortable the participants program that work, parts that did not work,
will be with the planned means ofcollecting and the reasons why the outcome was orwas
data. Will they be willing and able to fill out not positive.
the forms? Will they be willing to provide
4. Gather Data 6. Use the Findings
Think through the logistical issues involved to An evaluation report that resides in the office
make sure that all ofthe information (data) bookcase is not supporting the program. The
needed is actually gathered from the partici- distribution plan might include:
pants. It is important to ensure that data Project staff(for discussion about implica-
gatherers are well-trained so that they do their
tions for the program)
job thoroughly. Uniform data collection
strategies should be employed throughout the Managers and other influential people in
process. the agency or organization
Funding sources (outcome data may be
5. Analyze Data and Write the
crucial to further funding)
Evaluation Report
Other citizens groups, agencies, and
Once information is gathered, it should be businesses thatwere involved in the
analyzed according to a carefully thought out program
approach (analysis plan).
Others that program planners might want
"Analysis" means looking methodically at the to work with in the future
information and determiningwhat answers it Local or State legislators
provides to the evaluation questions. It is also
important to write down any reasons why the Prevention specialists and similar pro-
program did or did not work as expected, and grams in other locations
what should be changed or evaluated differ- NCADI (see Resources).
ently in the future.
Ifthis process is new to program planners,
they may need the help ofan evaluation
specialist to guide them through data collec- Cultural Competence in
tions and analysis. Evaluation
Once analysis is complete, think about how Planning for prevention communication
the evaluation report will be used before programs requires forming a set ofassump-
writing it. And as with all communication tions aboutwhat should happen to contribute
materials, it is important to considerwho the most effectively to substance use prevention,
readers (target audiences) will be. A report who should be involved or affected, andwhat
prepared forjournal publication may look results may be expected. These assumptions
very different from one shared with the must take into consideration the norms,
community. values, and expectations ofthe community
Consider: and its cultural/ethnic groups. Among these
different groups, for example, norms con-
Preparing different versions for different cerning who is in the best position to influ-
readers and purposes ence youth and to lead the community may
Using visuals to highlight important vary.
findings Planning for evaluation must also take cul-
Incorporating information from other tural considerations into account, particularly
studies, programs, or sources to add in selecting methods for gathering informa-
weight to findings (such as national data tion and in interpreting the results. Consider,
that are comparable, other studies that for example, that:
came to similar conclusions).
.
Case Study 3 week after seeing the video. For students
who understood enough spoken English
to understand the video but did not have
La Esperanza del Valle (Yakima Valley,
sufficient skills to read the questionnaire
WA) is a multimedia prevention soap in English, the questions were read in
opera campaign targeted to Latino adoles-
English and repeated in Spanish.
cents and families at risk thatwas devel-
oped by Novela Health Education and the The evaluation identified some positive
University ofWashington Health Educa- changes in youth attitudes regarding
tion andTraining Center. The video alcohol from pre- to post-viewing, includ-
componentwas shown to students in the ing significant changes in intentions to
classroom. To evaluate the efficacy ofthe drink. The majority (74%) ofresponding
video in changing attitudes and behaviors students indicated that ifthey used
related to alcohol use, students com- alcohol they would probably or definitely
pleted a pretest 1 to 2 weeks before the change their drinking behavior based on
viewing and a posttest form within 1 whatwas shown in the video.
In some cultures speaking out in a group cluded school attendance and progress,
(such as a focus group) or revealing change in family/individual behavior, and
negative feelings about an activity is not nonverbal, self-reported measures.
appropriate. Thus observing nonverbal
The cultural outlook ofthe evaluator may
cues may be more revealing than oral
inadvertently affect the objectivity of
communications
evaluation reports on program activities.
Some groups distrust or fear providing Thus finding a member ofthe community
information to a person from a different to conduct the evaluation or making sure
culture. Thus the ethnicity ofthe data to involve a culturally competent evalua-
gatherer may inadvertently influence the tor may be important.
information provided.
Programs that cut across cultures and
Some groups may lack familiaritywith adapt their evaluation methods to fit
how to fill out a printed questionnaire, or different groups may find it difficult to
they may face difficulties due to limited compare results across groups. Thus these
English skills. The Asian Drug and Alco- types ofevaluations are more complicated
hol Prevention Team (Utah) found it and usually require more evaluation
difficult to use pre- and posttest instru- expertise.
ments with an Asian student population
Ifevaluation materials are translated into
living in a high-risk environment: "In
another language, have them translated
most cases, the problem was limited
back to the original prior to use. This will
English; in other cases, participants simply
ensure that the original meaning has not
were not familiarwith the testing proce-
dures or the concepts... we were attempt- been lost.
ing to gauge." The team decided instead
to measure outcomes in ways that in- •
10
