CHAPTER 1
INTRODUCTION TO EVALUATION IN HEALTH EDUCATION AND HEALTH PROMOTION

KEY CONCEPTS

• Certified Health Education Specialist (CHES®)
• Certified in Public Health (CPH)
• cost–benefit evaluation
• cost‐effectiveness evaluation
• Dunning–Kruger effect
• effectiveness
• efficacy
• empowerment evaluation
• evaluation
• formative evaluation
• goal‐free evaluation
• goal‐oriented evaluation
• hatchet evaluation
• health education
• health promotion
• illuminative evaluation
• impact evaluation
• ingratiating evaluation
• intervention
• Master Certified Health Education Specialist (MCHES®)
• outcome evaluation
• participatory evaluation
• process evaluation
• summative evaluation
• transactional evaluation

CHAPTER OBJECTIVES

• Define health education, health promotion, and evaluation
• Identify the focus areas in Healthy People 2030
• Describe the evaluation competencies for health educators
• Self‐assess your perception of competency in evaluation and compare it with the basic knowledge you have about evaluation
• Describe the purposes of the evaluation
• Narrate the salient historical milestones in the evolution of evaluation in health education and health promotion
• Define basic terms related to evaluation in health education and health promotion

The Field of Health Education and Health Promotion

Health education professionals facilitate the modification of health behaviors in target populations. Health education has been defined in several ways. The 2000 Joint Committee on Health Education and Promotion Terminology (Gold & Miner, 2000, p. 3) defined health education as “any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions.” The World Health Organization (WHO, 1998, p. 4) defined health education as “compris[ing] consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health.” Green and Kreuter (2005, p. G‐4) defined health education as “any planned combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups, or communities.”

From these definitions some things are clear. First, health education is a systematic and planned application. Second, the delivery of health education involves a set of techniques rather than just one, such as preparing health education informational brochures, pamphlets, and videos; delivering lectures; facilitating role‐plays or simulations; analyzing case studies; participating and reflecting in group discussions; reading; and interacting in computer‐assisted training. In the past, health education encompassed a wider range of functions, including community mobilization, networking, and advocacy, which are now embodied in the term health promotion. Third, the primary purpose of health education is to influence antecedents of behavior so that healthy behaviors develop in a voluntary fashion (without any coercion). Examples of antecedents of behavior include awareness, information, knowledge, skills, beliefs, attitudes, and values. Finally, health education is performed at several levels. It can be done one‐on‐one, such as in a counseling session; it can be done with a group of people, such as in formal classroom instruction; it can be done at an organizational level, such as through an employee wellness fair; or it can be done at the community level, such as through a multiple‐channel, multiple‐approach campaign. Since the publication of Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention (U.S. Department of Health and Human Services [USDHHS], 1979), the term health promotion has gained popularity. This term has been used in the Objectives for the Nation (USDHHS, 1980), Healthy People 2000 (USDHHS, 1990), Healthy People 2010 (USDHHS, 2000),

Healthy People 2030 addresses five social determinants of health: (a) economic stability, (b) education access and quality, (c) health care access and quality, (d) neighborhood and built environment, (e) social and community context.

—USDHHS (2021)

Healthy People 2020 (USDHHS, 2012), and Healthy People 2030 reports (USDHHS, 2021). Table 1.1 summarizes the 14 focus areas for health behavior objectives in Healthy People 2030, which underscore the importance of health promotion.

Table 1.1 Focus Areas for Health Behavior Objectives in Healthy People 2030

Health education is a subset of health promotion. Green and Kreuter (2005, p. G‐4) defined health promotion as “any planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living conducive to the health of individuals, groups, or communities.” The 2000 Joint Committee on Health Education and Promotion Terminology (Gold & Miner, 2000, p. 4) defined health promotion as “any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities.” The Ottawa Charter for Health Promotion (WHO, 1986, p. 1) defined health promotion as “the process of enabling people to increase control over, and to improve their health.” The Ottawa Charter identified five key action strategies for health promotion:

• Build healthy public policy.
• Create physical and social environments supportive of individual change.
• Strengthen community action.
• Develop personal skills such as increased self‐efficacy and feelings of empowerment.
• Reorient health services to the population and partnership with patients.

These action areas were confirmed in 1997 in the Jakarta Declaration on Leading Health Promotion into the 21st Century (WHO, 1997). In addition, the Jakarta Declaration identified five priorities for health promotion:

• Promote social responsibility for health.
• Increase investments for health development.
• Expand partnerships for health promotion.
• Increase community capacity and empower the individual.
• Secure an infrastructure for health promotion.

“Health for all: The attainment by all people of the world of a level of health that will permit them to lead a socially and economically productive life.”

—World Health Organization (1986), p. 4

These definitions of health promotion have some themes in common. First, just like health education, health promotion is a systematic, planned application that qualifies as a science. Second, it entails methods beyond mere education such as community mobilization, community organization, community participation, community development, community empowerment, networking, coalition building, advocacy, lobbying, policy development, formulating legislation, and developing social norms. Third, unlike health education, health promotion endorses voluntary change in behavior, but also utilizes measures that compel an individual's behavior to change. These measures are uniform and mandatory. Often the behavior change in health promotion comes from measures that an individual may not like, such as an increase in cigarette taxes or insurance premiums for a smoker. Finally, health promotion is done at the group or community level.

Defining Evaluation

Evaluation is essential for assessing the value of health education and health promotion interventions. The word evaluate is derived from value, which in turn is derived from the Latin word valere meaning “to be strong” or “to have worth.” The American Evaluation Association defines evaluation as that which “involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness” (American Evaluation...