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Outcome Evaluation Form

Download Outcome Evaluation Form pdf document (63k) handout.

Outcome Evaluation Form
Strategy Forms Use This Form Outcome Evaluation
1. Train the Trainer Promotores Train the Trainer Pretest and Posttest
  • Before and after the training
  • Number and percentage of participants who change their knowledge levels
  • Number and percentage of participants who change their attitudes
2. Community Education
a. Teach the educational manual only.
My Health Habits Pretest and Posttest
  • Before and after teaching the manual
  • Number and percentage of participants who change knowledge, attitudes, and behaviors
2. Community Education
b. Teach the educational manual, and screen project participants.
My Health Habits Pretest and Posttest
  • Before and after teaching the manual
  • Number and percentage of participants who change knowledge, attitudes, and behaviors
Screening Form
  • Before and after teaching the manual
  • Number and percentage of participants referred to a health care professional
  • Number and percentage of participants who actually followed up with a health care professional
3. Lifestyle and Clinical Management My Health Habits Pretest and Posttest
  • Before and after delivering the manual
  • 12 months after collecting initial data (baseline data)
  • Number or percentage of patients who change knowledge levels, attitudes, and behaviors
Clinical Measures and Followup
  • Before delivering the manual (baseline)
  • 6 months after baseline
  • 12 months after baseline
  • Number and percentage of patients who change clinical values
  • Number and percentage of patients who are taking their medications
Promotores Activities Tracking Form
  • First followup encounter (after the manual is taught)
  • 3-month followup
  • 6-month followup
  • 12-month followup
  • Number and percentage of patients contacted for followup

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Information on this page is taken from the English print version of “Your Heart, Your Life, A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.

Last Updated March 2012

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