Casestudy
Casestudy
Casestudy
Created: 2013
Evaluating Public Health Programs. Atlanta, GA: Centers for Disease Control and
Prevention (CDC), 2013.
EVALUATING PUBLIC HEALTH PROGRAMS
Table of Contents
Please note: While this case study was inspired by real data, the people and events
described in this case study are fictitious. This exercise is intended for educational
purposes only.
BACKGROUND: PART I
A number of studies have reported the increasing prevalence rates of hypertension
among adults in Country X over the past 30 years. This increase in hypertension has also
been marked by a significant increase in reported prevalence rates of cardiovascular
diseases. In response, the Country X Centers for Disease Control and Prevention
(XCDC) of the Country X Ministry of Health funded the health bureau of City Y to deliver a
hypertension self-management program for adults aged 35 and older with uncontrolled
high blood pressure (≥140/90 mmHg). This evidence-based community intervention helps
patients take responsibility for managing their hypertension with assistance from health
care professionals, and support from families and the community.
The XCDC was the lead agency for the development, implementation and evaluation of
the hypertension self-management program. The City Y Health Bureau implemented the
program and was responsible for coordinating and communicating the program’s goals
and objectives with interested parties such as neighborhood groups and community
health center physicians. To ensure a successful and collaborative process, the City Y
Health Bureau convened multiple stakeholders from different levels – health care,
community, and patient – to plan the implementation and evaluation of the self-
management program.
1
Assumes four small working groups. Review time may take longer if there are more than four groups.
PARTICIPANT GUIDE/CASE STUDY |3
EVALUATING PUBLIC HEALTH PROGRAMS
In the initial phases of the program planning, the City Y Health Bureau identified and
recruited stakeholders through health center flyers, cardiovascular health care
newsletters, by word of mouth, and announcements at neighborhood group meetings.
The City Y Health Bureau invested significant time meeting with stakeholders to
appreciate their concerns about implementing the program. They relied on formal and
informal communication to ensure all perspectives were understood.
After the program began, new stakeholders became involved, including a pharmaceutical
company and representatives of the government health care insurance system. These
stakeholders were concerned with health care costs associated with medications and
hypertension screening. These interests were important to the project; therefore, XCDC
and City Y Health Bureau updated the program plan and focused the evaluation to
include these views.
As these stakeholders met and shared their ideas, the following concerns emerged:
Country X Center for Disease Control and Promoting national level policies that
Prevention prevent cardiovascular disease and risk
factors
Answer the following questions for Step 1 only. (40 minutes, including reading of
previous pages)
Step 1: Engage Stakeholders
1. Identify the stakeholders for whom you will involve in a program evaluation. Consider
the Utility standard when filling out the three columns in the table below. In particular,
think about:
• Who will use the results of the evaluation?
• Who can influence the use of the findings?
2. Refer to your completed table (question 1) and answer the following questions. Who
among the stakeholders will
a. Enhance credibility of the program:
_________________________________________________________
BACKGROUND: PART II
Statement of Need (Statement of the problem): Hypertension is a major risk for
cardiovascular disease. Prevalence of hypertension (≥140/90 mmHg) was 39% among
residents aged 35 and older. A high percentage of patients with hypertension were
unaware of their condition, lacked access to proper and consistent treatment, and had
uncontrolled hypertension.
• Health Care: Within the community health care system and among physicians,
the self-management model promoted comprehensive systems to support
patient self-management, which included physician telephone follow-up,
linkages to home blood pressure monitoring, and pharmacists trained to
provide self-management support and counseling. Additionally, community
1. Based on the background information, identify and list the following elements of the
project on the table below OR as a logic model on the following page (or a flip chart):
• A minimum of three inputs
• A minimum of three activities
• A minimum of three outputs
• A minimum of one short-term outcome, one intermediate outcome, and one
long-term outcome
Before offering this program at other community health centers, the participating
community health center director and surrounding community health centers wanted to
learn from the evaluation whether the training program was effective, and make any
necessary improvements.
1. What is the purpose of this evaluation, as described in the text above? Please
circle all that apply.
a. Show accountability
b. Examine program implementation
c. Determine program improvement
d. Facilitate judgment about a program’s fate
2. Consider the purposes of the evaluation. What type of evaluation is this? Please circle
your answer.
a. Process evaluation
b. Outcome evaluation
c. Both process and outcome evaluation
5. Based on the utility and feasibility standards, is what you are being asked to evaluate
a reasonable request? Yes or no? Please explain. If you answered no, what can you
evaluate that is related to the request?
6. Based on your responses to the above questions, please give a minimum of two
examples of process and outcome evaluation questions you would need to ask.
BACKGROUND: PART IV
The main objective of the self-management program is to demonstrate a 25% increase in
the proportion of patients with diagnosed hypertension at participating community health
centers with blood pressure under control. Twelve months after the start of the program,
the interim evaluation findings indicated an 11% increase among participating patients. It
was discovered that all of the participating community health centers adopted systems-
level changes within their healthcare delivery system to promote patient self-management.
However not all of the sites adopted a comprehensive self-management model.*
Figure 3 illustrates data collected over the two year period summarizing the number of
community health centers in City Y with policy or systems-level changes to encourage
patient self-management of hypertension. It was noted that Site A experienced the
highest level of participation in the self-management training sessions among their
patients.
3
Number of systems-level
2
Site A
changes
Site B
1 Site C
0
Baseline 2012 2013
1. Identify at least two evaluation results and write a corresponding recommendation for
each evaluation result in the space below.
2. Refer to your recommendations from the previous question, and consider the four
standards for evaluation. Then complete the following table and justify your answers.
2. In the table below, list the two stakeholders you identified in question 1 and then
complete the remaining columns with regards to communicating the evaluation results
to each stakeholder.
3. What will you do to make sure that the evaluation is reported in a manner that
encourages follow-through by the stakeholders?