Evaluation Strategies and Considerations for SDOH Programs

Rural social determinants of health (SDOH) programs can be complex, involving multi-sector partnerships and focusing on policy, systems, or environmental changes that seek to achieve long-term outcomes (for example, reduced poverty or health inequities). When developing programs to address SDOH, rural communities should assess and plan for future evaluation needs before the program begins collecting data. To capture the effects of a project that addresses SDOH, rural communities may need to consider a range of evaluation strategies. The Rural Community Health Toolkit provides an overview of evaluation strategies that can guide rural communities in designing their evaluation plans. This section provides several evaluation strategies and considerations that may be particularly important for rural communities addressing SDOH.

Rural communities developing programs to address SDOH may also benefit from evaluation strategies outlined in the following topic-specific toolkits that focus on issues related to the SDOH:

Demonstrating the Value of SDOH

Evaluation is critical to demonstrating the value of addressing SDOH. In planning an evaluation of a program that addresses SDOH, rural communities should create a rationale for how program activities, policy, systems, and environmental changes will ultimately achieve desired outcomes. Rural communities may develop logic models or theories of change to identify measurable results for each desired goal. For example, a rural clinic seeking to implement a transportation program to improve access to healthcare and health outcomes may choose to track changes in the rate of patient no-shows and emergency department visits.

Demonstrating these improvements can help build a business case for continued investment in upstream factors that affect health and well-being. Measuring a return on investment (ROI) for addressing SDOH can help funders and other stakeholders see the financial value of investing in rural SDOH. For example, rural communities can calculate how partnerships between community-based organizations, social services, and medical systems can decrease costly healthcare utilization.

Promoting Community Participation in Evaluation Activities

Rural communities addressing SDOH often emphasize the importance of involving diverse community perspectives and engaging community members in project planning and implementation. Programs can involve community members in evaluation activities in order to ground findings in the lived experience of rural residents.

For example, rural SDOH programs may involve community members in data collection and analysis through a range of community-based participatory research strategies:

Photovoice involves asking community members to capture and share images about their communities, environments, and experiences. Photovoice can help amplify the voices of rural residents who are traditionally not included in the research process. For example, the UNC Center for Reduced Cardiovascular Disease Disparities' Heart Healthy Lenoir study sought to better understand the SDOH that contribute to disparities in cardiovascular disease in rural Lenoir County, North Carolina. As part of the study, the project team engaged community members in a Photovoice project to explore ecological facilitators and barriers to cardiovascular health, such as segregation and poverty.
Most Significant Change (MSC) is a strategy that solicits stories that demonstrate significant change from community members. Once gathered, a panel of stakeholders collectively identifies which stories demonstrate the most significant change. This method requires investigators be willing to accept unexpected results; part of the value of MSC resides in identifying where different groups and individuals find meaning. MSC is about the process of change (how change happened, what change looked like, and on what timeline that change occurred) as much as it is about collection and reporting of stories.
Storytelling is an effective qualitative method of collecting and sharing nuanced information with the purpose of effecting change. It can be used to share success stories as well as identify needs in communities. Elected officials and other decision-makers appreciate the humanity of storytelling that is not evident in statistics and trends. Storytelling may be used on its own and can be used in conjunction with quantitative data methods.

Considerations for Special Populations

Promoting community participation and ownership of data can be particularly important for rural communities engaging in research with populations who have been historically harmed by unethical research practices, including tribal communities. Rural communities seeking to address SDOH among tribal communities can engage in tribally-driven participatory research to guide issues of ownership and consent, enhance trust, and ensure that evaluation findings accurately reflect tribal contexts. Rural communities that are addressing issues of racial and ethnic inequities through their SDOH programs may also benefit from evaluation resources focused on racial equity.

Resources to Learn More

The Challenge of Assessing Civic Engagement Efforts: Toward a Useful Framework and Measurement Approaches
Document
Describes difficulties in evaluating activities and programs focused on civic engagement. Provides suggestions for measuring civic engagement.
Organization(s): Organizational Research Services

Grassroots Action and Learning for Social Change: Evaluating Community Organizing
Document
Describes considerations for evaluations of community organizing efforts, including key challenges and suggestions for framing the evaluation.
Author(s): Foster, C.C. & Louie, J.
Organization(s): Center for Evaluation Innovation, Blueprint Research & Design, Inc.
Date: 3/2010

Methods for Evaluating Rural Food Access Initiatives
Document
Provides high-level overview of evaluation techniques that could be used to measure different aspects of rural food access programs.
Organization(s): The University of Minnesota Rural Health Research Center, NORC Walsh Center for Rural Health Analysis, Rural Health Information Hub
Date: 1/2018

Implementing Photovoice in your Community
Website
Explains the concept of Photovoice and provides an overview of when and how using Photovoice may benefit a given community.
Author(s): Rabinowitz, P.
Organization(s): Community Toolbox, University of Kansas Center for Community Health and Development