10c. Developing Indicators for Population Health Evaluation: Four Levels of Measurement

Although population health evaluations can benefit from the plethora of available population health indicator data, customized indicators invariably need to be developed for individual population health interventions.

All public health interventions can be defined in terms of inputs, activities, outputs, and outcomes:¹

Inputs are the resources (time, money, equipment, person-power) needed to implement and maintain the intervention;
Activities are what the intervention provides to individuals and communities in order to achieve its goals/objectives;
Outputs are the direct products resulting from the implementation of intervention activities;
Outcomes are the benefits (for individuals, groups, and communities) arising from the implementation of population health interventions (outcomes can sometimes overlap with outputs, depending on the type of intervention).

Ideally, a comprehensive population health evaluation includes measures or indicators of inputs, activities, outputs, and outcomes.

The following table lists sample indicators for a child immunization program.

Table 1. Sample Indicators for Evaluating a Child Immunization Program (adapted from Stoto and Cosler, 2008)¹
Inputs	Activities	Outputs	Outcomes
money (e.g., cost of vaccines) staff time facilities equipment monitoring compliance with immunization regulations	educate parents or caregivers educate providers distribute vaccines to providers establish an immunization registry provide technical assistance to providers about notification/reminder systems monitor coverage and compliance	number of brochures delivered number of parents notified doses of vaccine delivered % of parents complying with vaccine requirements	parental awareness of vaccine benefits percentage of parents with positive attitudes about child immunization reduced incidence of vaccine preventable diseases in children reduced prevalence of vaccine preventable diseases in children reduced cost of treating vaccine preventable diseases

When developing outcome indicators, it’s especially important to link them explicitly to the goals and objectives of your intervention.When developing outcome indicators, it’s especially important to link them explicitly to the goals and objectives of your intervention.

References

Stoto, M.A., & Cosler, L.E. (2008). Evaluation of public health interventions. In L.F. Novick, C.B. Morrow, & G.P. Mays (Eds), Public Health Administration: Principles for Population-Based Management (2nd ed., pp. 495–544). Sudbury, MA: Jones and Bartlett.