Preparation

Plan your evaluation methods and measures

  • Consider your evaluation strategy

In order to determine if your injuries from falls environments and policies are working, you will need to evaluate your efforts. It is important to design your evaluation in the planning phase of your intervention because you will need to be able to measure the impact of environment and policy changes that have been made.

Work with members of the population to identify community needs and gain support from local government officials, policy-makers, community members, and other community decision-makers through participatory approaches or focus groups.  Environments and policies related to injuries from falls might include an assessment of current policies or environments in order to examine what changes need to be made or what new policies or developments need to occur to meet the needs of the community. You can also assess the benefits of behaviors related to the prevention of injuries from falls (e.g., being more aware of surroundings, using handrails, using a cane/walker). Others have also included an assessment of the existing access to resources and places to support the prevention of injuries from falls. To develop an effective policy or environment initiative, the specific historical, cultural, and political contexts as well as the economic impacts of changes related to injuries from falls are important to understand and evaluate.

As with all interventions, it is useful to consider process, impact and outcome evaluation. Process evaluation enables you to assess if your program is being implemented as intended. Environments and policies might include an assessment of how the policy was implemented and enforced. It may also be useful to assess the process used to develop and plan the environments and policies. This may include an assessment of the coalition processes (e.g., decision making, conflict management) and well as specific logistics (e.g., time of meeting, location of meeting).

Impact evaluation enables you to determine if you are achieving your intermediate objectives. For environments and policies, as with other types of interventions, it is important to assess exposure to the intervention. This can be done for example through a telephone survey to the targeted audience regarding their awareness of a new or amended environment or policy. Environment and policy surveys can be used to measure exposure factors and also to assess changes knowledge, attitudes, or behaviors (e.g., nutrition, physical activity, monitoring glucose levels, complying with medication regimens). Alternately, it is possible to track the use of facilities (e.g., walking trail counters) or changes in food purchasing patterns (sales data) when special tools are used or existing data is collected and summarized. 

Remember it is important to focus the evaluation on the objectives of the intervention. If the objective was to change access by increasing the availability of particular resources, it is important to assess access. Alternatively, if the intent was to improve enforcement of a policy, then it is important to assess enforcement and factors that influence enforcement.

  • Challenges to evaluating environments and policies

There are several challenges in evaluating injuries from falls environments and policies that should be considered:

  • It is very challenging to establish causality (e.g., the addition of handrails resulted in fewer injuries from falls). Some individuals may have changed their self-management behaviors because of pressure from family and friends, and some may have changed their behavior on their own. It is important to get as much information as possible about the reasons for behavior changes.
  • The exact combination of intervention strategies (environmental changes, policies, individually adapted strategies, etc) that will be best to change rates of injuries from falls is unknown. 
  • When environments and policies are used, it is difficult to figure out which intervention strategies led to the changes that were observed in the evaluation.

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