Context Evaluation: A Case Study in Redwood City, California

Background: Context-based evaluation includes evaluation for outcome effect,  return on the investment (ROI), social capital effect and stakeholder satisfaction. We employed this methodology to a case study intervention in health promotion aimed at a high-risk population.  Drowning is a leading cause of death among children across the world, and in the US drowning disproportionately affects non-white children, with Latinos 4-6 times at greater risk. Evidence-based methods to combat risk-of-drowning include learn-to-swim programs and parental education. Relying on health behavioral theory (health belief model) and the Precede-Proceed planning model, we designed, implemented and evaluated context effectiveness of a community-based intervention tailored to socioeconomically disadvantaged and ethnic minority population in Redwood City, California. Methods: We designed a two-part intervention tailored to parents (education) and  children (health promotion). Main outcome measure was skill acquisition, assessed with multilevel regression analysis. Geographic catchment assessed with spatial analysis in ArcGIS. ROI assessed against logic map impact and outcome objectives. Social capital effect captured through sustainability beyond pilot. Stakeholder satisfaction obtained through random sampling surveying and semi-structured interviews. Results: Mean skill acquisition change = 11.09 (95% CI: 9.5, 12.6). Catchment area was limited to low-income census tracts (85% within 1.25 mile radius of intervention). The program performed 2.3 better than objectives; yielding a positive ROI. Social capital effect obtained through new public-private-partnerships beyond pilot intervention. Conclusion: Context-based evaluation allows for a more comprehensive assessment of impact, appealing to a range of stakeholders. Context effectiveness evaluations grant stakeholders the ability to assess sustainability and set evidence-based benchmarks for subsequent efforts.