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Types of Evaluation
The term evaluation implies a variety of different things to different people. The recent report of the Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences defines the area through a series of questions (Turner, Miller, and Moses, 1989:317-318):
Evaluation is a systematic process that produces a trustworthy account of what was attempted and why; through the examination of results—the outcomes of intervention programs—it answers the questions, "What was done?" "To whom, and how?" and "What outcomes were observed?'' Well-designed evaluation permits us to draw inferences from the data and addresses the difficult question: ''What do the outcomes mean?"
These questions differ in the degree of difficulty of answering them. An evaluation that tries to determine the outcomes of an intervention and what those outcomes mean is a more complicated endeavor than an evaluation that assesses the process by which the intervention was delivered. Both kinds of evaluation are necessary because they are intimately connected: to establish a project's success, an evaluator must first ask whether the project was implemented as planned and then whether its objective was achieved. Questions about a project's implementation usually fall under the rubric of process evaluation . If the investigation involves rapid feedback to the project staff or sponsors, particularly at the earliest stages of program implementation, the work is called formative evaluation. Questions about effects or effectiveness are often variously called summative evaluation, impact assessment, or outcome evaluation, the term the panel uses.
Formative evaluation is a special type of early evaluation that occurs during and after a program has been designed but before it is broadly implemented. Formative evaluation is used to understand the need for the intervention and to make tentative decisions about how to implement or improve it. During formative evaluation, information is collected and then fed back to program designers and administrators to enhance program development and maximize the success of the intervention. For example, formative evaluation may be carried out through a pilot project before a program is implemented at several sites. A pilot study of a community-based organization (CBO), for example, might be used to gather data on problems involving access to and recruitment of targeted populations and the utilization and implementation of services; the findings of such a study would then be used to modify (if needed) the planned program.
Another example of formative evaluation is the use of a "story board" design of a TV message that has yet to be produced. A story board is a series of text and sketches of camera shots that are to be produced in a commercial. To evaluate the effectiveness of the message and forecast some of the consequences of actually broadcasting it to the general public, an advertising agency convenes small groups of people to react to and comment on the proposed design.
Once an intervention has been implemented, the next stage of evaluation is process evaluation, which addresses two broad questions: "What was done?" and "To whom, and how?" Ordinarily, process evaluation is carried out at some point in the life of a project to determine how and how well the delivery goals of the program are being met. When intervention programs continue over a long period of time (as is the case for some of the major AIDS prevention programs), measurements at several times are warranted to ensure that the components of the intervention continue to be delivered by the right people, to the right people, in the right manner, and at the right time. Process evaluation can also play a role in improving interventions by providing the information necessary to change delivery strategies or program objectives in a changing epidemic.
Research designs for process evaluation include direct observation of projects, surveys of service providers and clients, and the monitoring of administrative records. The panel notes that the Centers for Disease Control (CDC) is already collecting some administrative records on its counseling and testing program and community-based projects. The panel believes that this type of evaluation should be a continuing and expanded component of intervention projects to guarantee the maintenance of the projects' integrity and responsiveness to their constituencies.
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