Running head: Process and Outcome Evaluation Plan 1
Concordia University Nebraska
Mazalo Looky
Professor Lea Pounds
MPH 588 fall section 1 2013
Process Evaluation and Outcome Evaluation:
Conducting program evaluations is an integral part of operating and managing a program because it helps to examine whether planners are meeting the needs of their audience base and achieving the overall goals of their program. It is important to know that organizations that receive funding from either government or foundations are often required to design and conduct a process and or outcome evaluation of their programs. The plan can include a comprehensive needs assessment, clearly stated goals and objectives (short-term, intermediate, and long-term) that link program activities and objectives, clearly defined performance measures, information on all of the resources that will be devoted to fulfilling this requirement and a plan to address the requirements related to data confidentiality and the protection of human subjects who may be involved in a needs assessment and or program evaluation (Guides to Performance Measurement and Program Evaluation, 2010).
According to Resnick & Siegel (2013), outcome evaluation is conducted to see if the project achieved what it set out to achieve. Most of the time, outcome evaluation is conducted after a project is finished, but perhaps can occur periodically throughout the life of a program. Outcome evaluation shows whether a project had the effects it was planned to have. It can serve as a management tool by helping identify how objectives, target audiences, strategies and implementation can be revised and improved. In the following paragraphs, I will describe what and how we conduct and measure in childhood obesity and give rationales. I will also describe what and how we conduct outcome and measure and give rationales of childhood obesity (Resnick & Siegel, 2013),
Nutrition Measures:
According to Summar, Dreyer and Hampl (2008) a study shows that children age 2 to 19 were selected to conduct a process evaluation on reducing or eliminating childhood obesity. Planners first, used surveys to evaluate the Middle school Youth health behavior. There were 49 questions with 7 related to body weight and eating patterns. The survey was done in the state and local level and conducted by departments of health and education to determine the prevalence of health risk behaviors, to assess whether health risk behaviors increase, decrease, or stay the same over time, to examine the co-occurrence of health risk behaviors, to provide comparable national, state, and local data, to provide comparable data among subpopulations of youth and to monitor progress toward achieving the Healthy People 2010 objectives and other program indicators.
The questionnaire was free, but cost was associated with staff time to administer the questionnaire, collect them, and analysis of the results.
Next, they selected High School students. The time used to administer was 45 minutes and the survey was easy to administer. The cost of this survey was free of cost. The objectives of these surveys were the same as the middle age youth from middle schools, except now, they had 87 questions instead of 49 questions.
Next, they have Youth/Adolescent Questionnaire (YAQ) for the adolescents’ age 9 to 18 years old. The YAQ is a food frequency questionnaire designed for older children through adolescents. It is 12 page self-administered food frequency questionnaires (FFQ) that are based on intake over the past year. Cost and estimates of intake over the past year are subject to recall bias. Intake from self-reported data can be highly inaccurate. Schools or community programs are the settings used.
Next they used questionnaire to Block Kids FFQ 2004 including 77 food items. It took them 25 minutes to completethe survey. The cost is $1/booklet plus processing charges which vary based on number. The survey was also provided in Spanish and in electronic format and was easy to administer.
Block Kids Food Screeners were also surveyed. Age 4 to 17. The time to administer the survey was 10 to12 minutes and was easy to do. There was a purchase cost per double-sided form; $0.75 processing cost per form and $4.50 for batches of 20 or more.
Block Kids Questionnaire age 2 to 7. 90 questions were asked about children usual eating habits in the past 6 months. It took interviewer approximately 30 minutes to complete the survey. In the survey, individual portion size is asked for beverages, but no other foods. Estimates of intake are subject to recall bias and intake from self-reported data can be highly inaccurate. Analysis needs to be done by Nutrition Quest.
And last, measures description involved Food, Physical, Activity, and Heart Health I.Q.
Food questionaries’ survey was given to children age 6 to 11 to determine food knowledge and behavior. Thereis $12.50 for a single copy of guide (booklet only) and was easy to administer. Questions including:
- Which food is better for your health?
Circle one of the two foods thought to be better for health
- What foods do you eat most of the time?
Circle one of the two foods you eat most often
- What would you do?
Circle one of two food choices
Physical activities measures:
- Pedometers:
There are used on children age 8 years old to count steps. They quantify free-living physical activity in children and adolescents. They count cumulative steps and new models have memories for storing data for many days. They are the most accurate and reliable. It is advised to place it on waistband or belt on the right side. It should then be aligned with the midline of the right thigh. Cost-effective alternative to accelerometers and heart rate monitors. It provides valid assessments of the relative volume of activity performed and is useful for documenting changes in activity or rank ordering children on physical activity participation. It can be used while doing activities such as cycling and climbing stairs.
It is important to allow for more accurate data collection. For a precise assessment, it is also important to collect data for at least four consecutive days including at least one weekend day.
- Accelerometers:
These instruments are used on children age 2 years old and up. They are the best available measure of physical activity for youth. They are worn on the waist to assess vertical motion and are sensitive to the intensity level of activity. They can be worn for many days at one time and can be used with virtually all ages. Data storage capabilities allow for the assessment of the frequency,intensity, and duration of physical activity. They can detect the intermittent activity patterns of children because of the sampling interval. They can also be used while cycling and climbing stairs. They are very expensive and can take a lot of time to collect and analyze datadepending on the information desired (Raczynski et al, 2009).
Heart rate monitoring device:
There are made to measure heart rate. They include a chest strap and watch like band worn on the wrist. They are appropriate for measuring vigorous activity but are poor indicators of moderate intensity activity. They can be useful for short-term assessments, such as during a PE class. They can be useful for intervention and educational purposes, but are rarely used for program evaluation. Heart rate monitors can be helpful in determining if subjects are achieving appropriate intensity of physical activity.
President’s Challenge involves school age and older children. The physical fitness test measures students’ level of physical fitness in five events: including curl-ups, shuttle run, endurance run or walk, right angle push-ups and sit and reach. Three awards were given to students who meet the program qualifications including:
• The Presidential Physical Fitness Award: for boys and girls who score at or above the 85th percentile on all five events.
• The National Physical Fitness Award: for boys and girls who score above the 50th to 84th percentile on all five events.
• The Participant Physical Fitness Award: students whose scores falls below the 50th percentile for one or more events receive this award for taking part in all five events. Children often compare fitness scores and those with low scores may be embarrassed, feel defeated, or be teased and this test is free of cost.
Clinical measures including children 2 and older are free of cost:
Planners used Body mass index (BMI) that is an indirect measure of body fat for children and adults. They discovered that elevated BMI in the adolescent years was associated with increased likelihood of obesity, obesity-related illness, and death in adulthood, used as a measure in individual children, BMI can assist staff in obesity treatment and prevention programs in determining whether or not their interventions will be affecting body fat. BMI can be used as a tracking mechanism for the prevalence of underweight, normal weight, overweight or obesity. BMI can be used to determining trends in weight status in a group of children and youth over time. To obtain BMI, accurate measurement of weight and height are essential.
It is important to measure a child or teen’s height in bare or stocking feet with a stadiometer. Weight should be measured with the bare- or stocking-footed child or teen in light clothing or a gown, using a calibrated scale. Body Mass Index (BMI) is a calculated value that is determined by dividing the individual’s weight by their height squared and multiplying that factor by a certain value.
Outcome Measurements:
School-level Outcomes Measures:
Study showed that if a childhood obesity prevention program has school policy and environmental change as a component, then one should assess the degree of change that affected student-level and school-level outcomes, and what happens to the outcomes over time. Both process and outcomes evaluations should be performed. Some possible avenues for study include the following policy evaluation studies. These studies include:
• Correlational analysis: Analysis of student self-reported nutrition intake and physical activity, and school nutrition and physical activity policies to determine relationships between student behavior and policies
• Summative/process analysis: Determining the key components of a school policy, assessing the school environment to determine the degree of policy implementation, surveying stakeholders to gather opinions, satisfaction, methods of policy development, perceived success of implementation, and degree of support (Summar, Dreyer and Hampl, 2008).
• Impact analysis: it determines the impact that the policy change has made on level of academic achievement, presence of healthier foods/beverages, food/beverage marketing practices, absenteeism, discipline issues, number of minutes/week of PE, time in PE spent being physically active, other opportunities for physical activity during the school day, financial status of the school, and its food service department.
It is important to know that research studies of policy have an impact on studentnutrition and physical activity behaviors. One should make sure that the policy is fully implemented before assessing these factors including:
• Food and beverage consumption data
• Physical activity and fitness data
• Health indicators, such as BMI, BP
Surveillance systems analysis including:
Tracking individual and environmental outcomes over time to assess long-term impact of changes and Tracking development and implementation of new policy changes.
Dietary Assessment:
It can be done to know how little eating habits actually affect body weight. Things that cab increase obesity such as eating fast food in restaurants, fruit juice and other sugared drink consumption, portion sizes for age, lack of fruit and vegetable consumption, breakfast consumption (frequency and quality), consumption of highly energy dense foods and meal frequency and snacking. So 24-hour dietary recalls and food is the best way to assess meals intake.
Physical Activity Assessment:
Planners showed that measuring physical activity is the most feasible method of indirectly measuring energy expenditure, the other component of the energy balance equation. Physical activity includes organized sports, free play, and general activities of daily living. Methods of assessing physical activity vary in their validity, reliability, cost and feasibility. These questions can be used to assess physical activity in clinical area.
- In home Environment:
• TV in bedroom
• Family physical activity routines
• Willingness of family members to be active with patient
• Encouragement from parents
• Options and access for free play and organized sports
- In school Environment:
• Physical education classes and recess
• Affordability/socioeconomic status
• Safety
- Lifestyle physical activity:
• Walking or biking to school
• Taking the stairs
• Running errands
In the clinical setting it is important to determine baseline level and the amount of sedentary time, compare both with established recommendations and reassess levelsover time when assessing actual levels of physical activity, so that patterns can be determined (Summar, Dreyer and Hampl, 2008).
Community-level Outcomes Measures:
Some communities’ environments can influence the success of obesity prevention and treatment programs. When the project is associated with nutrition and or physical activity policy change.
Environments to consider including policy environment: presence or absence of state legislation affecting school food or beverage sales or PE, social/demographic environment: ethnic, linguistic, education and economic demographics, community norms, and social beliefs surrounding food and physical activity, physical environment: access to quality, safe parks, recreation and after-school programs, access to healthy, affordable food, proximity of schools to neighborhoods, stores, restaurants, conveniencestores, overall retail density of neighborhoods withinthe community, walkability/bike ability to and fromschool, and other public venues(Summar et al, 2008).
References:
Guides to Performance Measurement and Program Evaluation. (2010).Retrieved from
Raczynski, J. M., Thompson, J. W., Phillips, M. M., Ryan, K. W., & Cleveland, H. W. (2009). Arkansas Act 1220 of 2003 to Reduce Childhood Obesity: Its Implementation and Impact on Child and Adolescent Body Mass Index. Journal Of Public Health Policy, 30S124-S140
Resnick, E., & Siegel, M. (2013). Marketing public health: strategies to promote social change. (3rd ed.). Burlington, MA, Jones & Bartlett Learning, LLC
Summar,S., Dreyer,M,L and Hampl,S.(2008) .Childhood Obesity Program Evaluation TOOLKIT. Retrieved from