Based on this information below, describe what type of evaluation it is the most appropriated to use to evaluate the program. The evaluation types include implementation/process, outcome and mixed-methods (qualitative and quantitative). Select only one to use for this evaluation. Indicate why the selected evaluation type is appropriate given the program stage of development. Please provide examples of how you will use that type of evaluation. Justify why this type of evaluation will help meet the identified goals of the evaluation.

The Public Health Issue Addressed by the WISEWOMAN Program

Like other regions, the WISEWOMAN Program in Coloradoaddresses the risk of stroke and heart disease by providing free screenings for critical markers like glucose, cholesterol, and blood pressure. Pueblo is a predominantly Hispanic/Latino low-income community with a higher prevalence of heart disease and stroke than the state average (US Census Bureau, 2022). The program also provides lifestyle interventions for treating and preventing stroke and heart disease, including nutrition and physical activity education, plus provides follow-up care and referral medical services for patients.

Heart disease is a general term that refers to multiple conditions that affect the heart. The commonest category of heart disease is CAD (cardiovascular artery disease), which affects blood flow to the heart. Heart attack, arrhythmia, and heart failure are adverse events associated with CAD. Heart disease risk factors include excessive alcohol use, physical inactivity, unhealthy diets, obesity and overweight, diabetes, genetics, and other social determinants of health (SDOH), such as household income and education or literacy levels.

On the other hand, stroke or "brain attack" occurs when the blood supply to the brain is blocked when a blood vessel ruptures in the brain, causing parts of the brain to die and, ultimately, leading to long-term disability damage or death. Heart disease and stroke are prevalent in the US and Colorado-and are the leading causes of death. Approximately 697,000 and 137,000 Americans die from heart disease and stroke annually (CDC, 2022b). About 7,060 and 1,988 people die in Colorado-annually from heart disease and stroke (CDC, 2018).

The Program's Stage of Development

The public health issues addressed by the WISEWOMAN Public Health Program in the community have progressed to the stages of intervention and prevention.The WISEWOMAN program in Pueblo, Colorado, is in the implementation stage.According to the CDC's evaluation guide, the implementation stage involves delivering the program as planned and ensuring it reaches the intended population (CDC, 2022a).In this stage, the program has been planned and designed, and its activities have been initiated. The WISEWOMAN program in Pueblo is operational, providing screenings, lifestyle interventions, follow-up care, and referrals to medical services to low-income, uninsured, and under-insured women enrolled in the Colorado Women's Health Check program.

At the initial stage, there was recognition of the problems of cardiovascular disease, hypertension, and stroke in women in Pueblo, Colorado.It was followed by the planning stage where it was developed a program to address the issue, which involved identifying the risk factors and providing screening and counseling services to women in the community.

The program successfully identified women with risk factors and provided them with appropriate interventions-this can be considered the implementation stage. Colorado's WISEWOMAN initiative implemented two unique, innovative interventions during the implementation phase. For the first strategy or intervention, Colorado's Department of Health partnered with multiple organizations to perform outreach to women in Pueblo and other counties and connect them to WISEWOMAN services. Specifically, the state partnered with the Ute Mountain Ute Tribe and the Somali American Community Center to increase their outreach initiatives headed by CHWs (community health workers) to include WISEWOMEN services in the community of Pueblo (CDC, 2020c). For the second intervention, Colorado engineered and supported bidirectional referrals between healthcare systems and community programs by assisting WISEWOMAN clinics to roll out the CRISeR (Community Resource Inventory Service for Patient e-Referral) system and making contributions toward the state's inventory of referral resources. The state's department of health curates and uploads cardiovascular health-linked data to the state's referral database, which is principally funded via the CDC's 1817 grant program and operated by a faction of not-for-profit organizations (Colorado Department of Public Health & Environment, n.d.).

The program is ongoing, and efforts being made to sustain it can be regarded as the maintenance stage. Several positive strategies implemented in Colorado show the positive outcomes of this program. For instance, from 2018 to 2021, more than 3,000 women were screened and referred to the appropriate specialist (CDC, 2022). However, the community in Pueblo, Colorado is still in need of such services locally. Qualifying women need to drive out of the city to access the services they need.

Community Stakeholders

Community stakeholders for the WISEWOMAN program evaluation may include women enrolled in the program, community-based organizations, healthcare providers, local government officials, local health departments, and community leaders. These stakeholders can provide valuable insights into the program's impact, implementation, and sustainability. The stakeholders will be crucial in the support and effectiveness of this program.

The evaluation program of the WISEWOMAN Public Health Program in Pueblo, Colorado is expected to achieve several goals:

1. Assess the program's effectiveness: The evaluation will determine if the WISEWOMAN program has achieved its intended outcomes, such as improving health behaviors and reducing the risk factors associated with cardiovascular disease among low-income, underinsured, or uninsured women in Pueblo, Colorado. This goal is based on a study, which proved its effectiveness in improving behaviors in women to prevent heart disease (Ali, 2002).
2. Identify areas for improvement: The evaluation will help identify areas of the program that need improvement or modification to meet the needs of the target population better. For instance, a study conducted by the CDC showed that by focusing on preventive health screening for a targeted population rather than a more general population has more positive results in the implementation of a program, and it is more effective to find areas for improvement (Bloom et al., 2023).
3. Provide feedback to stakeholders: The evaluation will provide valuable feedback to stakeholders, including program staff, funders, and community partners. This feedback can be used to improve the program and make informed decisions about future program planning.
4. Inform future program planning and replication: The evaluation will provide insights into what has worked well in the WISEWOMAN program and what can be improved. This information can be used to inform future program planning and replication in other communities. This goal is based on the effectiveness of the WISEWOMAN program, where in other states it has shown a decrease on cholesterol levels in women using the program services (Finkelstein et al., 2006).

The evaluation would be most relevant for program stakeholders, including program staff, funders, and community partners. It can also be useful for policymakers and public health professionals interested in cardiovascular disease prevention among underserved populations. The evaluation results can be shared through peer-reviewed publications, reports, and presentations at conferences and meetings, allowing other communities to learn from the experiences of the WISEWOMAN program in Pueblo, Colorado.