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An Evaluation Framework for Obesity Prevention Policy Interventions

Center TRT’s evaluation framework includes the 4 components of a standard logic model: inputs, activities, outputs, and outcomes. These components are embedded within the Centers for Disease Control and Prevention’s evaluation framework, which includes continuously engaging stakeholders and intended users, describing the program, focusing the evaluation design, gathering credible evidence, justifying conclusions, and disseminating and using findings. The activities section of the framework includes each of the stages of the policy-making process: formulation, enactment, implementation, and maintenance/modification. The outputs section of the framework addresses the reach, adoption, implementation, and maintenance components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The outcomes section of the framework includes short-term changes to the environment, intermediate changes to social norms and health behaviors, and long-term changes in population-level health outcomes that are equitably distributed and cost-effective.

Figure 1. Center TRT’s evaluation framework incorporates elements from multiple policy-making and evaluation frameworks (9,15-19). The framework is intended to support practitioners as they develop logic models to describe and evaluate policy making initiatives. Shaded portions of the figure represent the Centers for Disease Control and Prevention’s Evaluation Framework (16).

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The logic model presents the formulation stage of a state farm-to-school policy. Inputs include assessment data on obesity and dietary intake, local activities such as school gardens, and stakeholders such as the Departments of Agriculture and Education, Farmers Association, parent/teacher associations, and ecological advocacy organizations. Activities include creating a coalition, recruiting legislators, generating press releases, testifying to legislature, organizing grass roots, collecting endorsements, and writing policy briefs. Outputs include the number of partners engaged, media coverage, public awareness and support, policy-maker support, and the policy that was drafted. The example also describes potential future activities, outputs, and outcomes that may occur after the policy is formulated. Activities include enacting, implementing, and maintaining the policy. Outputs include the policy that is enacted, the number of schools and farmers who participate, the cost to schools, the number of schools with gardens, and the number of children reached. Outcomes include access to healthier foods (short term), intake of healthier foods (intermediate), and equitably distributed improvements in body mass index (long term).

Figure 2. The emergent logic model presents inputs, activities, outputs, and outcomes that might be included in a farm-to-school policy initiative during the formulation stage of the policy-making process. Solid lines depict components that apply to the current state of policy. Dotted lines depict potential future activities, outputs, and outcomes.

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