Evaluation of the Effect of Implementing an Impact Evaluation within the Idaho and Community-Based Waiver Program

Publication Date


Type of Culminating Activity


Degree Title

Master of Health Science, Health Promotion

Major Advisor

Sarah Toevs


Uwe Reischl


Gayle Gray


The purpose of program evaluation is to ensure that a program is accomplishing its goals and objectives, and to analyze the processes in which it achieves them. In effect, evaluation helps a program to realize its goals. One entity that is striving to implement evaluation and quality improvement processes is the Idaho Home and Community-based Services (HCBS) waiver program, located within the Idaho Division of Medicaid.

The focus of this thesis was to conduct a qualitative analysis of the program's evaluation processes. An interview tool was developed to gather the qualitative data. Interview questions were designed using components of the strengths, weaknesses, opportunities, and threats (SWOT) Analysis, Transtheoretical Model (TIM), and the Ecological Model. Key informant interviews of the HCBS waiver staff were used, with interviewees selected as a purposive sample, because of their expertise and involvement in the program. Data was gathered only from subjects that volunteered to be interviewed.

The results of this study revealed that the Idaho HCBS waiver staff were willing to perform impact evaluations in the future. They found the results of the evaluation very useful and have initiated some changes to the program to improve effectiveness and efficiency. Two prominent external forces motivated the HCBS waiver program to attempt an impact evaluation design were: the division administrator's encouragement and the national public health trend toward impact evaluations.

Based on the SWOT, TIM, and ecological assessment, there is evidence that the waiver program is moving toward increased utility feasibility, propriety, and accuracy in its evaluation practices. As long as well-designed impact evaluation efforts continue to ensure efficiency and efficacy of programs, it will continue to gain acceptance and maintain a lasting stronghold in the realm of public health. However, it is essential to ensure program staff is properly trained in how to utilize these methods to ensure the adoption of change.

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