Pre Intermediate Outcomes

[Rosita Westhouse]

Ifdata are collected about these intermediate outcomes, and they can be linked to final impacts, it is possible to check whether all cases that achieved the final impacts achieved the intermediate outcomes.

In conjunction with options that address other tasks related to understanding causes (analyze counterfactual, and investigate exceptions) this provides a stronger causal analysis than simply reporting totals for outcomes and impacts.

Orange-colored varieties of sweet potato have been bred to increase vitamin A intake, particularly among children in Latin America. After the introduction of these varieties to a district, and an advertising campaign to explain their value, they were sold in local markets. The quantity of orange sweet potatoes sold was measured, as was the improvement in terms of reduced numbers of cases of Vitamin A deficiency. The evaluation would be strengthened if it were possible to collect and analyze data to check whether those children with improved health were in families that had bought the sweet potatoes and fed them to the children.

What is important here is both measuring intermediate outcomes (families feeding sweet potatoes to children) and also being able to link it to impacts in a crosstabulation. This provides better information than simply being able to report, for example, that 60% of families fed the sweet potato to their children and 60% of children showed clinical improvements in their level of vitamin A.

This table shows results that are consistent with a cause-effect relationship. All the children where families fed them sweet potato improved their vitamin A levels, and none of the other children did.

The following table shows results that are largely consistent with a cause-effect relationship. Most of the children where families fed them sweet potato improved their vitamin A levels, and few of the other children did. In this scenario it would be important to follow up these exceptions

The following table shows results that would not be consistent with a cause-effect relationship. There appears no relationship. Children not fed sweet potato were as likely to improve as those who were. (50% of both groups improved). In this scenario it would be important to investigate what else families were doing that might be increasing vitamin A levels outside the program.

The following table shows results that would not be consistent with a cause-effect relationship. Even where intermediate outcomes were achieved (feeding the sweet potato), final impacts were achieved by very few. In this scenario it would be important to use other methods to explore possible explanations.

It would also be important to Investigate exceptions by gathering more detail if possible about the families which achieved the final impacts, including checking dose-response - seeing if they were feeding more sweet potato than other families.

This type of pattern is sometimes seen when people adjust their behaviour in ways that undercut the way the intervention is supposed to work - for example, if after medical make circumcision men engage in riskier sex than previously. This can balance out any gains from the intervention.

The following table shows results that would not be consistent with a cause-effect relationship where the intervention contributes to producing the impacts. In this case it shows a pattern where those engaging in the intervention have worse outcomes than those who do not. In this scenario, children who were not fed sweet potato were more likely to improve their vitamin A levels. This is the reverse of the results that the logic model would predict and some investigation would be needed to explore possible explanations.

BetterEvaluation is part of the Global Evaluation Initiative, a global network of organizations and experts supporting country governments to strengthen monitoring, evaluation, and the use of evidence in their countries. The GEI focuses support on efforts that are country-owned and aligned with local needs, goals and perspectives.

One difference could be the length of time between the program intervention and the measured outcome, however the most important difference is the effect the intervention has on the outcome. Short-term outcomes can be directly tied to the intervention, while long-term outcomes can be less directly attributed to the program. In general, short-term outcomes are measured at the end of the program or soon after the program has finished. Short-term outcomes refer to changes in knowledge, attitudes, or behaviors and can include reports of behaviors that participants intend to change or motivation to change. Intermediate outcomes are usually measured within several months after the end of the program and include actions by participants based on what they learned. Long-term outcomes are measured a year or several years after program completion and include changes in conditions, policies, or organizational structure. For example, a short-term outcome for a smoking prevention program for teenagers could be the number of teens who report that they do not plan to start smoking. An intermediate outcome could be the number of teens who report not smoking at six months, and a long-term outcome could be a reduction in the smoking rate among teens in a city, county, state or region. Short-term, intermediate, and long-term outcomes are related and build on each other.

This work is supported in part by New Technologies for Agriculture Extension grant no. 2020-41595-30123 from the USDA National Institute of Food and Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture.

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Methods: Consecutive patients with open-angle glaucoma (OAG) and no previous filtering surgery received an ab externo SIBS microshunt with MMC from July 2015 to November 2017. Main outcome measures were proportion of eyes at 1-year with (1) no 2 consecutive IOP readings >17 mm Hg or clinical hypotony without (complete) or with glaucoma medications (qualified); and (2) at least a 20% reduction from decision IOP. Secondary outcomes included upper IOP thresholds of 14 mm Hg and 21 mm Hg with and without a 20% IOP reduction from baseline, median IOP, medications, risk factors for failure, interventions, complications, and reoperations.

Conclusions: One-year results of the ab externo SIBS microshunt demonstrated promising rates of qualified and complete success, decreased drop use, few complications, and infrequent postoperative interventions.

Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS) is a multicentre observational study of chronic obstructive pulmonary disease (COPD) designed to guide future development of therapies for COPD by providing robust criteria for subclassifying COPD participants into groups most likely to benefit from a given therapy during a clinical trial, and identifying biomarkers/phenotypes that can be used as intermediate outcomes to reliably predict clinical benefit during therapeutic trials. The goal is to enrol 3200 participants in four strata. Participants undergo a baseline visit and three annual follow-up examinations, with quarterly telephone calls. Adjudication of exacerbations and mortality will be undertaken.

At this point, your knowledge exchange initiative should be anchored in the development goal and a change objective. While it is possible to reach some change objectives just using knowledge exchange, it is not very common. Since knowledge exchange is almost always a part of a larger development effort, it is more likely to catalyze progress towards the change objective than to achieve the objective on its own. This progress is measured by the achievement of intermediate outcomes.

Intermediate outcomes are what we most commonly expect to see, measure, and report after a knowledge exchange initiative. They reflect what participants want to learn, how and with whom they want to work, and how they want to act.

Think of intermediate outcomes as stepping stones leading to the change objective. Knowledge exchange can move your participants toward the objective by helping them address cognitive (know why), relational (know who), and behavioral (know how) gaps. Work with your counterparts to determine what gaps to tackle first and how knowledge exchange can address them.

When defining the intermediate outcomes, think first about what personal or group dynamics are preventing progress towards the change objective. Perhaps participants are not sure about how to address a challenge. Or it maybe they disagree on the way forward. Another possibility is that your counterparts seek ways to take an already successful situation to the next level.

Along with defining the intermediate outcomes, you will need to figure out how to measure their achievement. That is, you will need to identify indicators that show participants have learned or changed in the desired way. Table 2 will help you think through possible intermediate outcomes and indicators.

New Knowledge: Baseline and follow-up surveys with Honduran stakeholders will reveal improved knowledge of legal frameworks, stakeholder roles, consultation procedures, and governance of communal lands.

Enhanced Skills: Representatives of key public agencies responsible for implementing land titling and land regulation will develop proficiency in the process of demarcation and titling of indigenous territories.

Improved Consensus: There is greater agreement and trust between the Miskito people and the Honduran government (the deep seated distrust is dismantled) leading to drafting of the action plan to address contentious land issues.

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