13. CPH Domain 7: Formative, Process, Outcome Evaluation
After this lesson you can
- Distinguish formative, process, impact, outcome, and summative evaluation from a short scenario
- Recite the CDC framework's six steps and four standards and the main 2024 changes
- Calculate return on investment and avoid confusing it with the benefit-to-cost ratio
- Choose quantitative, qualitative, or mixed methods and a design that addresses threats to validity
- Assess an evaluation report's quality and utility and plan how results will be used
Video coming soon
Scheduled for release on November 28, 2026.
The second Domain 7 lesson, covering task statements 1 to 4. It teaches the evaluation types from formative to summative, efficiency measures including return on investment, the CDC Framework for Program Evaluation and its 2024 update, methods, designs and threats to validity, and how to judge and use evaluation reports.
Questions and answers
Questions a learner would ask about this lesson. Think through your own answer before you open each one.
- What is the difference between process and outcome evaluation?
Show answer
Process evaluation, also called implementation evaluation, asks whether the program was delivered as planned, to whom, how much, and how well, using attendance, logs, checklists, and observation. Outcome evaluation asks whether health status changed, using records, screenings, and surveillance, and it needs a baseline, follow-up, and attribution. The lesson's stem clue: verbs like delivered, attended, and held point to process; reduced, improved, and prevented point to outcome.
- What are the six steps and four standards of the CDC framework?
Show answer
The 1999 framework (MMWR 48, RR-11) has six steps in a cycle: engage stakeholders, describe the program, focus the evaluation design, gather credible evidence, justify conclusions, and ensure use and share lessons learned. Its four standards are utility, feasibility, propriety, and accuracy, and they apply at every step. The reference texts and the item bank teach the 1999 version.
- What changed in the 2024 update of the framework?
Show answer
The 2024 update (MMWR Recommendations and Reports 73, RR-6) adds a step zero, assess context, and renames step one to engage interest holders. The four standards are replaced by five federal evaluation standards, and three cross-cutting actions run through every step: engage collaboratively, advance equity, and learn from and use insights. If an item names four standards, the lesson says to answer from the 1999 list.
- How do I calculate return on investment without falling for the common trap?
Show answer
ROI equals financial return minus cost of investment, divided by cost of investment, usually reported as a percentage. A program costing $50,000 that returns $70,000 has an ROI of $20,000 divided by $50,000, or 40 percent. Dividing $70,000 by $50,000 gives 1.4, which is the benefit-to-cost ratio, and reading it as 140 percent is the most common error.
- Why is a pre-post design alone not enough to show a program worked?
Show answer
A pre-post design shows that the same group changed, but it cannot attribute the change to the program, because history, maturation, and testing can mimic a program effect. Adding a similar comparison group measured before and after helps, since countywide events affect both groups. Without randomization, selection remains a risk.
Practice quiz
- Question 1Before launch, Harbor County pretests its curriculum with ten residents to see what needs to change. This is:
- Question 2A program costs $40,000 and returns $50,000 in avoided costs. Using the lesson's formula, what is its return on investment?
- Question 3In the 1999 CDC Framework for Program Evaluation, what is step one?
- Question 4Which CDC framework standard asks whether the evaluation is realistic, prudent, diplomatic, and frugal?
- Question 5Harbor County got follow-up surveys back from 41 of its 68 enrollees. The response rate is about:
- Question 6What did the 2024 update to the CDC framework add to the front of the cycle?
- Question 7An analysis puts both a program's costs and its benefits in dollars and reports a benefit-to-cost ratio. This is:
- Question 8Participants score better on a knowledge posttest partly because taking the pretest itself changed them. Which threat to validity is this?
- Question 9An evaluator first analyzes survey numbers, then runs interviews to explain why the numbers look the way they do. This mixed methods design is:
- Question 10A foundation must decide whether to continue, expand, modify, or stop a program at the end of the grant. The evaluation that serves this decision is:
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