Evaluation of Selected Aspects of the National Medicare Education Program: Final Design Report. 3.2 Specifying Outcomes


Program evaluation typically focuses on measuring processes and outcomes (Kotler et al ., 2002Kotler et al., 2002). Process measures focus on campaign activities and assess how well the campaign was implemented as intended. Outcome measures assess specific results that can be attributed to the campaign (Kotler et al., 2002Kotler et al., 2002). Table 3-2 presents common process and outcome measures used in evaluating health communication programs.

Process Measures

Outcome Measures

Table 3-2. Examples of Common Process and Outcome Measures
  • Program reach Table 3-2. Examples of Common Process and Outcome Measures

  • Knowledge

  • Media coverage

  • Attitudes and/or beliefs

  • Number of materials disseminated

  • Awareness

  • Changes in program policy or infrastructure

  • Behavioral intentions

  • Assessment of implementation

  • Behavior

Total impressions or Gross Rating Points (GRPs)


Partner participation and/or contributions

Responses to campaign components

Source: Kotler et al. (2002).

Recognizing that there are limited resources with which to implement health communication campaigns, cost-effectiveness analysis (CEA) can inform policy makers ’ resource allocation decisions (Frick, 2006Frick, 2006). CEA can answer questions such as the following:

What is the cost per person reached by different channels or any channel of the campaign? Which channel produced the greatest change for the cost?

What is the incremental change in outcome expected from a specific increase in cost? What is the incremental cost -effectiveness of different combinations of communication activities?

Which types of health communication interventions are most cost -effective? How does the health communication program rank in cost-effectiveness relative to other programs and interventions seeking to effect behavior change?

What specific factors help or hinder cost-effectiveness of health communication campaigns?

However, to date, it has been rather uncommon for evaluations of health communication campaigns to include CEA (Hutchinson and Wheeler , 2006Hutchinson and Wheeler, 2006). Several challenges to conducting CEA on health communication campaigns include obtaining appropriate estimates of costs, agreeing on a single primary outcome, and measuring the effectiveness of the campaign in bringing about the desired change (Bertrand, 2006Bertrand, 2006; Frick, 2006Frick, 2006). Randomized control trials are the gold standard for evaluating cost-effectiveness. However, randomized experiments are only feasible and appropriate for interventions in which the researcher can control who receives an intervention and at what level of intensity. Exposure to an intervention cannot be easily controlled or randomized in many health communication interventions, especially those that use mass media. Nevertheless, if there is a direct link between the communication program and the outcome (e.g., exposure or program reach), CEA can still be fairly straightforward. On the other hand, CEA can become much more complex if the link between the program and the outcome is less direct. In this case, attributing behavior change to campaign exposure becomes more tenuous because the campaign may be only one of multiple factors that influenced individual behavior change (Guilkey, Hutchinson and Lance, 2006Guilkey, Hutchinson and Lance, 2006). In practice, data for conducting CEA are collected at the same time as other data being collected to evaluate the effectiveness of the health communication program. However, CEA should follow the assessment of program effectiveness because if the program is found ineffective, there is no reason to conduct CEA (Frick, 2006Frick, 2006).

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