Key concepts for conducting community-based participatory evaluation in social change projects: Theoretical foundations in the Handbook for Assessing Social Change in Health

Community-based participatory research (CBPR) projects that focus on creating social change to improve health can face challenges in evaluating their effectiveness changing communities, systems, and change agents. The Handbook for Assessing Social Change in Health was created through research on these challenges in cooperation with four REACH 2010 projects. The author reviewed cooperating projects' progress reports, observed their activities, conducted semi-structured interviews with staff, and met community members. Additionally, the author improved the Handbook while providing technical assistance to the REACH Charleston and Georgetown Diabetes Coalition (CGDC) who field-tested the Handbook. We found that CBPR projects face evaluation challenges partly because of the inherent complexity of communities, systems, and change agents. We also found that community members, health professionals, and affiliates in CBPR partnerships need better access to time-tested anthropological concepts to assess social change and causality. Partners in CBPR projects benefit from having a clear, shared understanding of key concepts: 1) thinking holistically about how people's health is shaped by their context in communities, systems, and relationships with change agents; 2) conceptualizing precisely central terms (e.g., “community”); 3) seeing change as non-linear and of different types; 4) using the “culture” concept as an idea-generating tool; 5) investigating change inductively and iteratively; 6) mastering the art of asking productive questions; 7) constructing a logical framework for tracking change; 8) using triangulation methods to analyze data; and 9) applying tests of causality. The Handbook has helped CGDC understand these concepts and provided a useful framework for CGDC to apply these concepts.