Accelerating Best Practices in Peer Support Around the World

Program Development Guide

Identifying Indicators and Measures

In this Chapter:

1. Selecting an Evaluation Type

2. Planning Your Evaluation

3. Identifying Indicators and Measures

4. Cost-Effectiveness Analysis and Business Case

5. Data Collection


Identifying Indicators and Measures

An indicator is a quantitative or qualitative variable that provides a simple and reliable means to measure achievement, reflect changes connected to an intervention, or help assess the performance of an intervention or its components. A general rule of thumb for a quality indicator includes five SMART criteria:

Measurable (and also reliable, comparable and contextually appropriate)
Achievable (and also cost-effective)
Time-bound (and also sensitive)


WHO Evaluation Report
A 2007 WHO report has identified indicators measuring peer support programs in diabetes as follows:Outcome evaluation indicators include clinical parameters (e.g., present or absence of symptoms, HbA1C, cardiovascular risk factor control, hospitalizations and ER visits, healthcare resource consumption, presence or development of long term diabetes or cardiovascular complications, expenses and savings associated with the program) and additional indicators(e.g., BMI, cholesterol, blood pressure)

Impact Evaluation Indicators are self-reported quality of life and emotional distress. Examples are adherence to behavioral and medication prescriptions, knowledge, attitudes, self-efficacy, autonomy and ability to function in their day-to-day roles.

Featured Example Measures: Peer for Progress Consensus Measures

Peers for Progress funded eight evaluation grants to test the effectiveness of peer support in management of type 2 diabetes. These individual sites also pooled data into a cross-site evaluation. Investigators and key staff collaborated with the Peers for Progress Program Development Center at the University of North Carolina at Chapel Hill to identify key evaluation indicators of their peer support programs that could be applied across all projects. The goal was to establish a core set of shared evaluation indicators that could strengthen evidence from, yet not add burden to, their individual and collective projects assessing the impacts of peer support.

The consensus set of shared measures from the Peers for Progress Evaluation grants include clinical, behavioral, quality of life, process evaluation, mediator/moderator, and cost items. These measures are selected due to their (or can be readily modifiable) general applicability beyond diabetes management to adult health care, chronic disease management, and health promotion.View the complete version of the Peers for Progress Consensus Evaluation for Research on Self- Management and Peer Support in Diabetes (Figure 8 below).


Figure 8. Peers for Progress' Consensus Measures

Figure 8. Peers for Progress’ Consensus Measures


Monitoring & Evaluation Survey Instruments

The Robert Woods Johnson Foundation Diabetes Initiative’s Assessment Materials Forms & Instruments Resources under Evaluation of Programs and Services have project participant assessment, pre-test and post-test questionnaires and other program evaluation tools. These can be adapted for peer support programs.
Revised Summary of Diabetes Self-Care Activities Scale; Perceived Diabetes Self-Management Scale (PDSMS); Self-Efficacy for Diabetes Management; Diabetes Support Scale (DSS) (in appendix of article); Diabetes Empowerment Scale (outlined in Table 3) These example survey instruments can be used to assess behavioral measures for diabetes peer support programs.
WHO Quality of Life Scale This is a commonly used tool for assessing quality of life.
Diabetes Distress Scale (in English and Spanish); Patient Health Questionnaire also known as the PHQ-9 (Depression) These example instruments can be used to assess quality of life for diabetes peer support programs.
The Peer Education Evaluation and Resources Center (PEER Center’s)HIV Treatment Adherence Survey for clients This survey is administered to clients at regular intervals at the Kansas City Free Health Clinic to assess changes in the client's knowledge about HIV after working with a peer.
Stanford Self-Management Programs’ Program Fidelity Manual This manual provides resources and guidelines for monitoring program fidelity.
STAR Center’s Cultural Competency in Mental Health Peer-run Programs and Self-help Groups This tool was created to help mental health, consumer-operated programs and self-help groups assess their own cultural competency.

Quality Improvement

Peers for Progress' Quality Improvement for Peer Support Program – Putting QI into Daily Practice This set of slides addresses why and how to do quality improvement in the context of peer support programs. Resources and examples are included as well.
USAID Health Care Improvement ‘s Community Health Worker Assessment and Improvement Matrix (CHW AIM) This toolkit addresses how to improve CHW programs and services. It emphasizes using certain instruments to demine if a change is needed.
Continuous Quality Improvement (CQI) by the NPSCLN Quality Improvement Workgroup This fact sheet describes how CQI can benefit peer support programs, some areas that may be addressed in CQI, and factors that affect CQI initiatives. Additionally, you will find resources, protocols, tools, and methodologies for conducting CQI.
IHIs Resource for Public Health Quality Improvement This list of resources can be helpful to public health leaders and practitioners to apply QI to programs and processes. It covers various topics, including national frameworks and initiatives supporting public health QI, performance management and QI resources, and community data resources.
Duke University Medical Center's What's Quality Improvement This page provides a brief definition of quality improvement and commonly-used models of QI


© 2015 | Peers for Progress

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