Evaluation In Health Care and Nursing

Afza.Malik GDA

Evaluation In Health Care and Nursing

What Is Evaluation,Evaluation Methods or Types,Measuring the Effectiveness of Interventions ,Benefits or Purposes.

What Is Evaluation

    Evaluation is a method for measuring the effect of some purposeful action on a particular situation. It is often described as an assessment of worth. In evaluation, both anticipated and unanticipated outcomes are important and are included in the discussion of findings and the publication of results. The purpose of evaluation is to provide information for decision makers who usually have some stake in the outcome of the intervention.

Evaluation Methods or Types

    Evaluation methods have been categorized along a continuum ranging from simple assessment, in which informal practices are used to look for indication of outcome, to evaluation research, in which research methods are used to allow for generalization to other comparable situations. In actuality, the use of informal practices for determining intervention outcome is never appropriate. Consequently, the term evaluation should suffice for all efforts in which a systematic process is used to determine the effect of some intervention on some anticipated outcome. The research component of the term is assumed. No matter what the purpose of the evaluation, the issue of rigor is always foremost, and the methods and measurement approaches used should involve the same level of attention given to any research method.

First Type Evaluation

    According to Rossi and Freeman (1985), evaluations serve one of three purposes: (1) to conceptualize and design interventions, (2) to monitor implementation of some intervention, or (3) to assess the utility of some action. In the first type of evaluation, studies focus on (a) the extent of the problem needing intervention, (b) who should be involved in or targeted for the intervention, (c) whether the proposed intervention will address the problem or the needs of individuals, and (d) whether the chance for successful outcome has been maximized.

Second Type Evaluation

    In the second type of evaluation, studies focus on what is done; they generally are referred to as process evaluation studies. These studies also determine whether the intervention is reaching the targeted population and whether what is done is consistent with what was intended. Process evaluations are essential for determining cause and effect, although they are not sufficient by themselves for measuring impact. That is where evaluation researchers often get into trouble. They stop collecting data once they describe what was done; therefore, process evaluation methods have tended to be viewed with disfavor, which is unfortunate. Although they are insufficient by themselves, they are absolutely necessary for determining whether the intervention caused the outcome and if so, how and if not, why not.

Third Type Evaluation

    In the third type, studies determine both the degree to which an intervention has an impact and the benefit of the intervention in relation to the cost. The degree of impact is referred to as the intervention's effectiveness, and the degree of cost is referred to as its efficiency (Rossi & Freeman, 1985).

    Recent writings on evaluation focus on the need for theory to guide the investigation and frame the results. Authors have identified theories that range from those targeted solely for the purposes of designing evaluations to those directed at the expected relationships between intervention and outcome. For example, behavioral theories are often used to develop interventions targeted at changing health behaviors; they also are used to select measures for determining impact. Evaluation theories, on the other hand, focus on the purpose of the study-whether it is for determining what goals or outcomes should be examined, how the treatment should be developed and delivered, or under what conditions certain events occur and what their consequences will be. HT Chen (1990) has defined these two types of evaluation theory as normative (the first type) and causative (the second), normative theory is derived from prior knowledge, usual practice, or theory. Causative theory is empirically based and specifies causal relationships between intervention and outcome.

Measuring the Effectiveness of Interventions 

    Measuring the true effect of the intervention is often difficult. Evaluation studies are subject to the same measurement and analysis problems associated with other designs. In addition, Ingersoll (1996) has summarized several others that are important to evaluation research. Among these is the need to measure the extent of the intervention introduced, which is frequently absent from reports of evaluation studies. This information assists in demonstrating cause-and-effect relationships and clarifies what magnitude of the intervention is required before an effect is seen. It also helps to prevent the potential for Type III, IV, and V evaluation errors, which affect statistical conclusion validity and generalizability validity.

    Type III evaluation error is an error in probability and results in solving the wrong problem instead of the right problem. It usually occurs when the program is not implemented as planned and when insensitive measures are used to determine effect. Type IV error occurs when the evaluator provides information that is useless to stakeholders. Type V error involves confusing statistical significance with practical significance, which ultimately leads to Type IV error (Ingersoll, 1996).

Benefits or Purposes

    Evaluation is key to measuring intervention magnitude and effect. To assure that evaluations are useful, however, steps must be taken to design them according to some meaningful conceptual framework; and close attention must be paid to maximize the rigor of the methods, analysis, and rejection of alternative hypotheses. Approaches to quality control recommended for other non-experimental, quasi-experimental, and experimental designs are appropriate. With attention to these aspects of the evaluation process, evaluations become an effective means for extending nursing science.

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