	Tools for Behavior Change Communication
January 2008 Issue No. 16	The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org

Types of Evaluation: Purpose, Questions Answered, and Sample Indicators

How to use this tool: Evaluation spans the life of a BCC program. A program begins with formative research or evaluation, progresses to monitoring, and closes with evaluation. The resulting findings help guide program design, determine whether program implementation is occurring as planned, suggest midcourse improvements, provide evidence that the program influences behavior, help guide the design of future programs, and demonstrate accountability to partners and funding agencies. The table below can help program managers consider how to measure progress towards objectives and which indicators to use. Ideally, program managers should work hand-in-hand with researchers and evaluators to identify appropriate measures and assist with measurement.

Type	Broad Purpose	Main Questions Answered	Sample Indicators
Formative research	• Learn more about all aspects of the health issue, the affected population, and its context. • Help guide program design. • Establish the baseline status of the health behavior. • Pretest materials.	• What is the current situation in the country/region regarding the health issue? • What groups of people are most affected and why? • What current behaviors influence this aspect of health? • What are the barriers to improvements in behavior? • Is development of materials on the right track?	• Prevalence/incidence data for the health problem • Percentage of audience with access to health care services • Percentage of audience with exposure to various media, by type • Percentage of audience with a favorable/ unfavorable attitude toward materials • Sample indicators listed below under “evaluation”
Monitoring	• Quantify what has been done; when, where, and how it has been done; and who has been reached. • Identify how the audience is reacting to the messages. • Identify problems and areas for adjustment as implementation proceeds. • Help to explain why the expected changes did (or did not) occur.	• Are activities being implemented according to schedule or as planned? • What problems have arisen during implementation? • Which components of the program are or are not working? • What is the audience’s reaction?	• Number of times messages aired on radio or television in a reference period • Number of materials disseminated, by type, during a reference period • Number of audience members participating in community mobilization events • Percentage of audience who recall hearing or seeing a specific message
Evaluation*
Outcome evaluation	• Measures change in outcomes (for example, knowledge, self-efficacy, skills, attitudes, behaviors) against BCC objectives. (Changes may or may not be due to the program.)	• Did the desired changes in outcomes take place? • How much did knowledge, attitudes, and behavior change?	• Percentage of audience who know of the recommended behavior • Percentage of audience with a specific attitude (favorable or unfavorable) toward the recommended behavior • Percentage of audience who are confident they could perform the recommended behavior • Percentage of audience who practice the recommended behavior
Impact evaluation	• Measures the extent to which program activities changed outcomes (consistent with BCC objectives).	• Are changes in outcomes due to the BCC program? • Did communities with the program have better results than communities without the program? • Did people with greater exposure to the program experience better results than people with little or no exposure?

* Two types of evaluations—outcome and impact—answer different questions but use the same set of indicators. Impact evaluation, which assesses causality, requires skilled evaluators and resources that may be beyond the scope of many BCC programs.

Sources: Bertrand 2005 (1), Bertrand and Escudero 2002 (2), Cabañero-Verzosa 2003 (3), Freimuth, Cole, and Kirby 2001 (7), Hyer and Covello 2005 (11), National Cancer Institute 2001 (13), O’Sullivan et al. 2003 (14), Piotrow et al. 1997 (15), and UNICEF and WHO 2000 (24)

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Tools for Behavior Change Communication

Types of Evaluation: Purpose, Questions Answered, and Sample Indicators