Based on the information below: Please address the following: specify 5 questions that are appropriated for the program stage development and address stakeholders questions about the program.

-List the five evaluation questions that will be used for this project. use this link for guidance htps://www.cdc.gov/evaluation/guide/step3/index.htm#checklist

-Indicate which program elements will be examined by each question

-summarize how the questions address each of the CDC standards including utility, feasibility, propriety, and accuracy.

The WISEWOMAN Public Health Program is a CDC-funded program that assists women between the ages of 40 and 64 to reduce their risk of heart disease and stroke (The Centers for Disease Control and Prevention [CDC, 2022 a). WISEWOMAN is a mnemonic for Well-Integrated, Screening and Evaluation for Women Across the Nation. The initiative is funded and supported by the CDC and is implemented in all 50 states and tribal organizations participating in the NBCCEDP (National Breast and Cervical Cancer Early Detection Program). Since its inception, the program has served more than 1.3 million women and has been shown to reduce health disparities by providing access to care for underserved populations. The WISEWOMAN is a comprehensive and evidence-based approach to improving heart disease and stroke prevention among low-income women.

This project evaluation specifically focuses on Pueblo's WISEWOMAN program. In Pueblo, Colorado, the WISEWOMAN program is specifically designed for low-income, uninsured, and under-insured women enrolled in the Colorado Women's Health Check program, which provides heart disease and stroke prevention services. The program offers various services, including health coaching, group education sessions, blood pressure, and cholesterol screenings, and referrals to lifestyle programs and community resources (CDC, 2022a). The screenings are free and conducted by trained health professionals at community health clinics, community centers, and other outreach sites. Furthermore, women with high-risk factors for heart disease and stroke are referred to appropriate health services, such as primary care physicians, nutritionists, and other specialists. The program works with local healthcare providers to ensure women receive timely and appropriate care.

The Public Health Issue Addressed by the WISEWOMAN Program

Like other regions, the WISEWOMAN Program in Colorado-addresses 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 Coloradoannually 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 WISEWOMAN 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.

EvaluationType

The form of assessment used for the WISEWOMAN Public Health Program in Pueblo, Colorado, is an outcome evaluation due to the implementation stage of development. This program is acceptable for outcome evaluation because it will assist in identifying if its stated results, which include changing health behaviors and reducing cardiovascular disease risk factors among low-income, underinsured, or uninsured women in Pueblo, Colorado, have been accomplished (CDC, 2018). The program has already completed its installation phase and has provided services for a long time. Hence, an outcome evaluation is necessary to determine the program's impact and efficacy in attaining its objectives. The outcome evaluation can measure the program effects in the selected population by assessing the progress of the goals that the program wants to achieve (CDC, n.d.). Furthermore, the outcome evaluation will help to determine if it is an improvement in the health behaviors and the reduction of the risk factors associated with cardiovascular disease among women in Pueblo, Colorado.

Reasons for Evaluation Selection

An outcome evaluation is typically conducted after a program has been implemented and is aimed at assessing its effectiveness in achieving its intended outcomes. This type of evaluation is appropriate for the WISEWOMAN program since it has been implemented and running for several years.To determine if the WISEWOMAN program is achieving its intended outcomes, an outcome evaluation is the most appropriate type of evaluation to use. This type of evaluation involves collecting data on the program's impact on the target population, comparing the baseline data with the data collected after the program's implementation to determine if there have been any changes in the target population's health behaviors and risk factors associated with cardiovascular disease.

Data collection for an outcome evaluation may include surveys, interviews, and medical record reviews. Using the outcome evaluation will help the implementation stage to collect data on the number of women who were screened and referred to the appropriate specialist, changes in blood pressure, glucose, and cholesterol levels, and changes in health behaviors, such as physical activity and healthy eating habits. These data points will help determine if the program has successfully improved the health outcomes of the target population.The evaluation will compare the baseline data with the data collected after the program's implementation to determine if there have been any changes in the target population's health behaviors and risk factors associated with cardiovascular disease.

The program's primary goals are to improve health outcomes such as healthy behaviors, reduce the incidence and prevalence of heart disease, and decrease mortality rates among the target population (CDC, 2022c). An outcome evaluation will assess how much the program has achieved these goals. Additionally, the WISEWOMAN program has already undergone a formative evaluation, which was used to assess the program's design, implementation, and feasibility (Hamilton & Finley, 2019). The formative evaluation provided information on how the program can be improved to increase its effectiveness.

Therefore, an outcome evaluation is more appropriate at this stage of the program's development to determine if the program has achieved its intended outcomes and is meeting the needs of the target population. Moreover, an outcome evaluation will provide valuable information on the program's cost-effectiveness and resource utilization (Hamilton & Finley, 2019). This will help determine if the resources used in the program are being used efficiently and if any modifications need to be made to increase the program's effectiveness. An outcome evaluation is appropriate for the WISEWOMAN program at this stage of development since it will provide valuable information on its effectiveness in achieving its intended outcomes, cost-effectiveness, and resource utilization.

The outcome evaluation will also involve stakeholder engagement, including women enrolled in the program, community-based organizations, healthcare providers, local government officials, local health departments, and community leaders. Their feedback will help to identify areas of improvement and sustainability of the program. An outcome evaluation is appropriate because the WISEWOMAN program is already in the implementation stage, 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. This evaluation type will help meet the identified goals of the evaluation by determining if the program is achieving its intended outcomes and making a positive impact on the target population's health.