Real World Evaluation for Cardiovascular Health Programs. Gilles Paradis, Direction de la sante publique de Montreal-Centre, McGill University Health Center, Montreal, Canada.

Early cardiovascular disease prevention programs developed sophisticated evaluation methods to optimize the validity of the estimates of effect. However, these methods are often not directly transferable to public health programs because they are costly, complex to implement and because they respond to imperatives of hypothesis testing (program efficacy) whereas public health programs are concerned with issues of feasibility, acceptability, implementation, compliance and impact in the "real world" (program effectiveness). The ultimate goal of program evaluation is to support decision making and accountability, improve program, and enhance community mobilization and participation. Needs analysis identifies community health problems and can uses surveillance data, focus groups, key informant and population surveys and community inventories. Formative evaluation assesses the relevance, comprehension and acceptability of programs or specific interventions and uses similar data collection methods. Implementation evaluation provides information on barriers and facilitators and on resources required for the implementation of the program, on whether the target population was reached and on whether the activities implemented corresponded to the activities planned. Methods include interview with key informants, activity registration forms, staff journals, participant satisfaction questionnaires and repeat cross-sectional surveys. Finally, impact evaluation measures achievement of objectives and any unanticipated side effects. Methods can include simple quasi-experimental designs including pre-post designs with or without control groups as well as simple data collection instruments. Simple, inexpensive evaluations can yield useful public health information and should be an integral part of program planning.