74 Evaluation Lane, Direct City, E7G 5L4

1-765-290-5647

Direct.Results@evaluation.ca

The Older Adults Centres’ Association of Ontario

P.O. Box 65
Caledon East, Ontario
L7C 3L8

At Direct Results, we are the gold standard of high-quality evaluation products to suit your every
need. We are a client-driven group of professionals, with a priority to prepare results that are
ready for you to implement into your strategy and decision making for the future. We have
varied skills as a team that allow us to work on any project with which you seek direction; from
the implementation stage to the impact evaluation, Direct Results is ready to produce results.
We are pleased to submit our response to the Request for Proposals from the Older Adults
Centres’ Association of Ontario for their project: Links2Wellbeing. We feel confident that we
will be able to deliver what you seek in your evaluation needs and have outlined below what you
can expect in this package:
• An overview of the program and key stakeholders
• A draft logic model and logic model narrative
• Evaluation approach and data collection methods
• An evaluation matrix with proposed activity timestamps
• Mitigation strategies for anticipated challenges
• Canadian evaluation practice competencies

Through the evaluation process, Direct Results is dedicated to abiding by the Canadian
Evaluation Society competencies, and ethical protocols and the safety of participants is our
highest priority. We are confident our proposal will encompass all your needs and we look
forward to working with you on this evaluation project.
Thank you,
The Direct Results Team
Evaluation Proposal

Prepared for:

The Older Adults Centers’ Association of Ontario

Prepared by:

Direct Results Ltd.

Date: February 5th, 2022

Table of Contents
Program Overview ...................................................................................................................................... 4
Background ............................................................................................................................................... 4
Stakeholders .............................................................................................................................................. 4
Stakeholder Engagement....................................................................................................................... 5
Program Logic Model ................................................................................................................................. 5
Evaluation Design ....................................................................................................................................... 6
Evaluation Purpose ................................................................................................................................... 6
Evaluation Approach ................................................................................................................................ 6
Evaluation Methods .................................................................................................................................... 7
Data Analysis ..................................................................................................................................... 10
CES Competencies .................................................................................................................................... 11
Appendix B: Evaluation Matrix .............................................................................................................. 13
Appendix B: Evaluation Matrix .............................................................................................................. 14
References .................................................................................................................................................. 16
Program Overview

Background
The Older Adults Centres’ Association of Ontario (OACAO) is a not-for-profit organization that
brings together many Seniors Active Living Centres (SALCs) from across Ontario. These centres
provide programs and services with the objective of enhancing health outcomes of senior
citizens.
In light of the growing recognition of the risks associated with social isolation among older
adults living in the community, the OACAO has piloted a three-year project, Links2Wellbeing, to
support the identification of and engagement with older adults at risk of loneliness through
Health Care Providers (HCPs). The program objective is to increase social inclusion for older
adults at risk or currently experiencing social isolation by connecting them to programs of
interest at their local SALC. Health care providers refer seniors as needed to the SALC, whereby
an SALC Volunteer Link Ambassador (VLA) reaches out to the individual to connect them to
applicable programs. This program also provides access to the centres’ programs at reduced or
no cost to the referred older adults. Initiated in April 2021, the program is currently operating at
30 SALCs, with additional SALCs being added annually.
The COVID-19 pandemic has also placed renewed focus on mental health and well-being of
older adults, given the extended lockdowns and limited ability to gather in-person. Further
analyses of the impact of the COVID-19 pandemic on older adults are likely over the coming
months and years. As such, this evaluation will provide results at a critical time when there is
potential for synergies with political and civic priorities to examine and invest in programs that
address these important areas.

Stakeholders
In the figure below (Figure 1), key stakeholders of Links2Wellbeing are identified based on
Direct Results initial understanding. Key internal stakeholders include the community-based
older adults, staff, Volunteer Team Leaders, and VLAs at SALCs (hereafter referred to SALC
staff), staff at the OACAO, and HCPs who are providing referrals. External stakeholders include
local health care providers not engaged in the program, families of community-based adults,
other community based adults, other local, regional and national organizations representing and
serving older adults, and the Ontario Ministry for Seniors and Accessibility. Typically, the
program funder would also be identified as a stakeholder, however given that this individual has
opted to remain anonymous, it is assumed that they will not be engaged in the evaluation
process. This initial overview will be elaborated and confirmed once the evaluation process
begins.
Figure 1. Map of Key Stakeholders of the Links2Wellbeing

Stakeholder Engagement
We recommend that members of the internal stakeholder groups be involved in the evaluation
through an Evaluation Advisory Committee (EAC). Each internal stakeholder group should
have at least one representative present in the EAC to provide feedback and advise on evaluation
plans and findings. In addition, there should be representation from another seniors’ organization
with experience delivering programs across the province or nationally. It is proposed there would
be bimonthly meetings of the EAC. The EAC structure and stakeholder representation will be
reviewed and finalized with the OACAO at the beginning of the evaluation process.
To support a participatory approach, broader stakeholders (e.g. older adults referred to the
SALCs, SALC staff and volunteers, and health care professionals) from the selected sites will be
engaged at key points in the process, including at the beginning of the evaluation or when
individuals are first referred to the program, and with the evaluation results. Additional
opportunities to engage in the process will be provided to stakeholders at the selected sites,
including participating in the bi-monthly EAC meetings as well as outlining the opportunities to
contribute to the data collection.

Program Logic Model

A draft program logic model is presented in Appendix A has been developed to demonstrate
how program activities relate to program outcomes. While the linear presentation of the logic
model may not convey program complexity, it is an important evaluation tool to help visualize
the link between program activities and expected outcomes and help identify areas of evaluation
focus.
The logic model is a visual representation of program inputs e.g. SALC staff and other resources
used to conduct program activities, including outreach to HCPs and connecting referred older
adults to relevant program offerings at the SALC to achieve desired program outcomes. These
include, on a short-term basis, improved knowledge among HCPs about the program offerings
and increased referrals into the Links2Wellbeing program along with improved access to
community services among older adults in the medium-term. Long-term program outcomes are
expected to reduce social isolation and resultant ill-health among older adults.

The program is driven by the underlying assumption that there is a need to reduce loneliness
among older adults and that social prescribing is an effective model to link them to supportive
community services. Further, the involvement of HCPs is necessary as they serve as an entry
point for service access and have deep and long-lasting connections with their clients.
The logic model presents some external factors influencing the program, program assumptions,
and risks as identified by Direct Results, these are however not meant to be an exhaustive list.
There may be other issues identified in collaboration with the EAC, which would be included in
future iterations of the logic model to ensure fidelity with program operations and enhance utility
of evaluation findings.

Evaluation Design
Evaluation Purpose
The purpose of this evaluation is to understand the implementation and benefits of
Links2Wellbeing and to formulate a framework to scale and sustain the initiative by the end of
year 3 of the project and beyond.
Evaluation Approach
At Direct Results, we recognize the importance of social interaction as a large determinant of
health outcomes in older adults (Gilmour, & Ramage-Morin, 2020). We commend the OACAO
for their efforts to better engage older adults in activities in their communities to create stronger
social bonds and improved mental and physical wellbeing.
Given the complexity of this program in terms of the number of important actors, reliance on
volunteers throughout the various activities, and the need for this program to work for
beneficiaries, we feel this evaluation is best suited to a Participatory Approach with an Equity
Lens. A participatory approach is beneficial for many different reasons. It builds stakeholder
engagement and ownership of the program, creating a deeper involvement and investment into
the success and outcomes of the program. It also has the potential to yield better data with more
involvement from stakeholders, and a stronger interpretation of this data allowing for better
recommendations for the future (Guijt, 2014). This is pertinent to the goal of OACAO to
continue rolling out this program to greater communities in subsequent years. You will find that
through a strong commitment to an EAC and participatory style methods such as data parties and
arts-based methods, the participatory approach is embedded in this evaluation’s framework. Also
find our commitment to appropriate participation within CES competency 3.2.
In addition, we understand there is a large diversity of geographic locations, cultures, genders,
languages, and identities among staff, volunteers, and participants within this program. Indeed,
there is extra concern surrounding racialized, Indigenous, those with mobility challenges, and
2SLGBTQ+ older adults and their increased vulnerability to loneliness and isolation.
In this sense we understand the utmost prioritization of Diversity, Equity, and Inclusion (DEI)
within this program and the evaluation framework which has been included in our approach
through an Equity Lens. Within our methods you will find a demographic and geographic
analysis to better understand the population base, which is being served, and each participatory
method will include strategies to ensure a strong representation of an equity population base. It is
also our commitment to communicate appropriately with diverse cultures and groups within our
interpersonal practice and CES competency 5.1. For more details on our commitment to DEI and
strategies surrounding its uptake, please see the methods and challenges and mitigation sections.
Assumptions
In this evaluation we are assuming the program began in April 2021, and therefore Direct Results
will be starting this evaluation almost a year into the program’s implementation. This means
there will be almost 2 years for the evaluation to be conducted to acquire the desired results by
the end of the 3 years post implementation timeline. We are also assuming that the estimated 30
days of consultant time for the evaluation are not consecutive and can be used throughout the 2
years Direct Results will be involved in the evaluation. These days will be used as seen fit once
methods have been finalized and approved by the EAC and stakeholders.

Evaluation Questions
Based on the objectives outlined in the RFP, Direct Results is proposing a hybrid process and
outcome evaluation to help direct an evaluation congruent with the needs of OACAO as clients,
and have identified the following overarching questions:

Process evaluation
1. What is the uptake of the program?
2. What have been barriers and facilitators for program implementation?
Outcome evaluation
3. To what extent has the initiative contributed to intended and unintended outcomes for
program stakeholders (clients, SALC Staff and health care providers)?
4. To what extent is there evidence of program sustainability and spread?
In consultation with the EAC, the above evaluation questions will be appropriately refined to
ensure that we are meeting the evaluation needs of OACAO for Links2Wellbeing.

Evaluation Methods
Direct Results proposes a mixed-method evaluation design with integrated innovation, which
involves a multidisciplinary team using elements of both quantitative and qualitative data
collection and analysis (Bamberger & Mabry, 2020). We recommend this approach as it tends to
produce more comprehensive coverage and more valid findings than either quantitative or
qualitative methods alone (Bamberger & Mabry, 2020). As well, Direct Results will be
employing an intersectional approach to data collection and analysis, as outlined in
Christoffersen, 2017. See Appendix B for the Evaluation Matrix.
Data Collection
Document Review
A document review will be used at various stages of the evaluation. During the process
evaluation documents such as the intake form and attendance records will be used to compile
information about participants’ demographics and participation in activities to support the
evaluation of program uptake. During this intake and attendance record taking, we will suggest
an evaluation information sheet be given to participants to ensure their understanding that an
evaluation is taking place and their participation is encouraged. Stakeholders can participate in
the bi-monthly EAC meetings, as well as in participatory methods.
A focus of this analysis will be to assess the extent to which program reach is diverse, equitable
and inclusive, by focusing on demographic characteristics related to race/ethnicity, gender,
sexual orientation, and mobility. The intake form will also be used to gather information about
referral sources and perceived barriers and strategies to overcome those barriers as they relate to
program participation and implementation. During the outcome evaluation the document review
will allow for the analysis of the Assessment of Loneliness that is completed at 3-, 6-, and 12-
months, to understand how the program has impacted clients. Finally, a document review from
sources such as budget, spending and funding reports, as well as literature review of the costs
associated with loneliness, can support the analysis of cost-effectiveness.
Geographic Analysis
Geographic Information Systems (GIS) such as ArcMap or GeoDa, will be used for both the
process and outcome evaluations, to create multilayered maps to support the identification of
patterns or relationships between the program’s environment and the effectiveness of their
implementation and performance. This will provide a more holistic view of the program, its
context and the evaluation results (Azzam and Robinson, 2013). In the process evaluation the
focus will be on identifying patterns in referral sources which can inform more tailored and
targeted outreach strategies with local healthcare providers. The focus will also be on identifying
patterns of participation which can help inform how equitable the uptake of the program is. Both
foci can support decision-making about which sites to interview for both process and outcome
evaluations, by allowing evaluators to choose a handful of programs that vary in referral and
participation rates, as well as demographic make-up and rurality/urbanity.
GIS is a tool that can be used for program planning and decision-making, in this case around
sustainability and spread, as it allows for a deep understanding of conditions and factors that may
impact the program and its objectives (Moise, Cunningham and Inglis, 2015). This can help to
inform the evaluation of the extent to which the program is reaching its objectives through the
observation of patterns of participation changing over time, while also assessing the potential
scalability and sustainability of the program. A final look at equity can be assessed by examining
patterns of participation and comparing it to the Ontario Marginalization Index (Matheson & van
Ingen, 2016). This can help to assess the relationship between area-level marginalization and
participation, which can support future strategies to promote a diverse, equitable and inclusive
spreading of the program.
Interviews
As part of the process evaluation, interviews will be conducted with VLAs, SALC staff and
healthcare providers to understand their perceived barriers and facilitators of the initiative
implementation. As part of the outcome evaluation, interviews will be conducted with SALC
staff, healthcare providers and families to understand the benefits and unintended outcomes of
the program. The interviews with VLAs, SALC staff and healthcare providers will also
encompass what environmental factors influence the spread of the program. Interviews allow
evaluators to gather in-depth information to gain a deep understanding of the program and its
impact through multiple perspectives (Bamberger & Mabry, 2020). Interviews are helpful when
combined with quantitative methods as they can provide clarification of quantitative data
(Bamberger & Mabry, 2020), such as the data that will be collected and analyzed through the
document review and geographic analysis. Although interviews require more time than other
methods, this burden will be mitigated through short interviews, and the use of snowball
sampling, whereby those who are interviewed first will be asked to provide suggestions for other
interviewees to keep the numbers low.
Participatory
Arts-Based Methods
As part of the outcome evaluation a qualitative arts-based approach will be used to understand
the perceived physical and mental wellbeing and social connectedness of participants through a
participatory drawing method. Research by Noice et al. (2014) highlights the benefits of older
adults’ participation in arts, including positive cognitive, affective, and quality of life outcomes.
These benefits extend not only to participation in visual arts (painting/drawing), but also to
dance, creative writing, singing, instrumental music, and theatre. As generally low-cost
endeavors, participatory arts-based activities have been associated with documented
improvements in memory, creativity, and problem-solving (Noice et al., 2014).

In order to decrease burden on clients and facilities, these evaluation activities can be
incorporated as part of the Centres’ regular programming taking place over a few sessions. In
this way, this method will benefit both the participants through social activity, expressiveness,
and connectedness, while also eliciting information helpful to the evaluation of the program.
Participants will be informed that this group is part of an evaluation and will provide informed
consent. As a suggested activity in this regard, participants will be asked to create drawings
related to their perceived physical, mental wellbeing and social connectedness, with drawings
related to before their participation and after they enrolled with the program. Pre-post
intervention participatory arts-based studies with seniors have been conducted by Beauchet et al.
(2020), finding positive impacts on older adults’ physical and mental health.

A Cost Analysis
A cost analysis will be conducted by compiling and analyzing program documents related to
program budget, spending and funding. A comprehensive literature review will also be
completed to understand the costs associated with the health outcomes that are impacted by this
program. This information can then be used to conduct a cost-effectiveness analysis which would
involve the examination the costs and health outcomes of Links2Wellbeing by comparing the
program to another program (or the status quo) and estimating the cost of gaining a unit of a
health outcome (Cdc.gov, 2022). The result of this analysis would be presented as a cost-
effectiveness ratio which is the net cost divided by the changes in health outcomes, with a
negative net cost suggesting that the program is less costly and more effective (Cdc.gov, 2022).
Data Analysis
Triangulation will be used to enhance the accuracy of data and the validity of the evaluation
findings by comparing multiple sources of information, methods, and perspectives (Bamberger
& Mabry, 2020). We will be using triangulation by method (involves using multiple data
collection), by source (involves gathering data from multiple data) and by time (involves
repeatedly collecting data over time to examine patterns) (Bamberger & Mabry, 2020). In
keeping with a DEI lens, an intersectional approach to data analysis will be conducted, whereby
examining the multi-dimensionality of identity and its impacts (Unpacking Intersectional
Approaches to Data, 2021).

Challenges and Mitigation Strategies

Direct Results has taken care to develop a practical and useful evaluation plan in response to the needs of
Links2Wellbeing program. We recognize a number of challenges may present themselves throughout the
evaluation process. These are identified below, along with proposed mitigation strategies to appropriately
respond to and address any such challenges that may arise.

Potential Mitigation Strategies

Challenge
Digital Access and • To optimize participation from rural and remote program participants, Direct Results will
Connectivity work with program staff to identify locations that may have digital connectivity issues
and/or technological barriers. Telephone or other communication options will be explored
to facilitate participation from individuals affected by this situation.

Accessibility of • Given the diversity of program participants (e.g. age, abilities/strengths), a thorough
Evaluation Materials analysis will be undertaken to optimize comprehension of evaluation materials.
and Processes • Readability assessments will be performed for any written materials produced throughout
the evaluation process
• Innovative methods (e.g. art-based forms) and visual communication tools will be
employed to support ease of participation, especially where literacy and/or language
barriers may present

Budget and Time • To help offset possible time challenges associated with a participatory approach, Direct
Constraints Results will leverage data that has already been collected and that is available through the
program, existing program activities, and other sources that do not require additional draws
on stakeholder time. The intent will be to minimize time demands on the various
stakeholders, including staff and volunteers, program participants and their families, and
healthcare providers
• Direct Results is mindful of program resources and stakeholder availability, and a timetable
has been developed with these considerations in mind
• Staffing shortages or competing demands on time may mean there are constraints on
stakeholders’ availability to participate in interviews. To address this challenge, Direct
Results will utilize an extreme/deviant case sampling strategy (e.g. 1-2 interviews,
 especially for stretched healthcare professionals) and will work with stakeholders to
identify most suitable timing for interviews and will be flexible to accommodate staff
schedules
• Minimal additional ongoing data collection (e.g. log and year-end data) will be required of
staff and teams outside of already established practices

Data Collection- • Informed consent will be obtained prior to engaging with participants for the purpose of
Ethics and this evaluation, and Direct Results will ensure all participants are aware that they can stop
Confidentiality or pause participation in the evaluation at any time.
• Direct Results will de-identify participant information in evaluation results, which will be
stored in a secure database.
• CES competencies will be upheld at all times.
• Data collection methods will be reviewed with the EAC for contextual and situational
appropriateness.
• Translation services will be available in multiple languages to facilitate interview data
collection.
• Direct Results will provide coaching to program staff and volunteers on the process of
responding to questions and collecting diversity, equity and inclusion data
• To help address potential concerns from program participants about sharing information for
the evaluation, volunteers will be provided with support from the Direct Results team to
explain to program participants from the outset that their data may be collected as part of
evaluation. Handouts and resources will be developed to reinforce messaging about
participant information being anonymous and de-identified. This information can be
provided either in writing or verbally in the language with which program participants are
most comfortable.

Ongoing presence of • All interactions necessary to carry out the evaluation will be conducted in accordance with
COVID-19 applicable public health guidelines in place at the time of the evaluation
• Telephone or virtual interviews through an online platform will be used wherever and to
the extent possible

CES Competencies
Direct Results is committed to following the principles and competencies outlined in the Canadian
Evaluation Society (CES) Competencies for Canadian Evaluation Practice. Direct Results has identified
three specific evaluation competencies from which it will draw in conducting the evaluation.

2.8 Collects, analyzes and interprets data using appropriate methods

Technical
Practice Leveraging this competency, Direct Results carefully considered the specific characteristics,
needs, and strengths of potential informants when designing the evaluation. This meant
Domain
ensuring Direct Results integrated tailored and, in some cases, unique methods that would be
suitable in responding to each evaluation question and that would also be appropriate for the
specific evaluation context.
3.2 Identifies stakeholders’ needs and their capacity to participate, while
recognizing, respecting and responding to aspects of diversity
Situational
Practice Direct Results took great care to identify and incorporate ways to uphold stakeholder rights,
Domain interests, and needs within the evaluation design, while also recognizing the wealth of diversity
among and between potential evaluation participants and stakeholders. Direct Results
considered ways in which volunteers and staff could build capacity to participate in the
evaluation and utilize their skills to contribute to ongoing evaluation activities. The Direct
 Results team took into account intersecting elements of diversity among program participants,
including age, culture, ability, and other variables impacting diversity in recognition of
multiple factors impacting on individuals’ lived experiences.
5.1 Uses communication strategies appropriate to the cultural, linguistic, social,
and political context
Interpersonal
Practice Direct Results crafted elements of this proposal, including the logic model, with an eye toward
Domain accessibility and inclusivity for various and diverse stakeholder groups. This approach will be
maintained in the development of evaluation communication material, handouts, and final
reports generated throughout the evaluation. Any feedback from stakeholders on emerging
needs as they relate to communication or presentation of evaluation materials will be swiftly
acted upon to ensure usability and respect for all parties involved.
Appendix B: Evaluation Matrix

Links2Wellbeing Program Goal Primary audience: Health Care Providers (HCPs) &
To promote holistic health for seniors in Ontario by connecting socially isolated older adults to social and Older Adults
recreational opportunities Secondary audience: SALC staff

External Factors Assumptions Risks

• Changes in government priorities • Local HCPs & older adults will participate in the • Loss of SALC volunteer base affecting program
concerned with care of older adults program operations
• Research guiding social prescribing practices is valid • Limited access to OACAO micro-grants

INPUT ACTIVTIES OUTPUT OUTCOMES

What are the results & changes?
What are we
investing in the
program? What do we do in the program? Short-Term

• Increase in knowledge among HCPs about the

• SALC staff & Outreach to HCPs HCP outreach Links2Wellbeing program
volunteers for • SALC connects with HCPs & • # of HCPs reached • Increase in number of HCPs participating in the
program activities shares program materials & • # HCPs connected to the Links2Wellbeing program
referral stationery program
• HCPs referring • Increase in # of clients referred to Links2Wellbeing
older adults to program
Links2Wellbeing •
HCPs refer clients Medium-Term
program Client referral
• HCPs identify potential clients & • # of clients referred to
• Funding to discuss SALC program SALC program • Improved access to community services among Older
initiate & • HCPs refer clients to SALC • # of clients refusing Adults
continue program program referral • Increase in participation of enrolled Older Adults in
activities SALC programs
• Improved HCPs referral practices to community
• Supplies & programs
Referral review Referral review
Equipment for
• SALC staff review referral & • # of referred clients
program activities
connects client with VLA connected with VLA Long-Term
• Time to plan &
initiate program
• Reduced social isolation & loneliness among Older
activities
Client Outreach & Connectivity Client Outreach Adults
• VLAs assist clients identify & • # of referred clients • Reduced adverse health outcomes among Older
enroll in SALC program connected with SALC Adults
program
 Appendix B: Evaluation Matrix

Evaluation Questions Indicators Data Sources Data Collection Methods Timeline

Process Evaluation
1. What is the uptake of -demographics Program documents (Intake Document Review Start of evaluation (end
the program? -# of participants in form, attendance records) of yr 1) - Review
activities available data from yr 1
to inform selection of
study sites
At 2.5 yrs)
-referral source Program documents (Intake Geographic analysis Start of evaluation (end
-aggregate participation form) of yr 1) - Review
rate available data from yr 1
At 2.5 yrs)
2. What have been -perceived client barriers Program documents (Intake Document review At 2.5 yrs
barriers and facilitators
to participation form)
for program - client strategies to
implementation? overcome barriers
-perceived barriers and VLAs, SALC staff, Health Interviews At 2.5 yrs
facilitators to care providers
implementation
Outcome/Impact Evaluation
3. To what extent has -trends of loneliness Program documents Document Review At 2.5 yrs
the initiative over time among (Assessment of loneliness)
contributed to intended participating older adults
and unintended -perceived lack of
outcomes for program companionship
stakeholders (clients, -perceived feeling of
SALC Staff and health isolation
care providers)? -perceived physical and Older Adults (clients) Participatory Arts-Based At 2.5 yrs
mental wellbeing Method
-perceived social
connectedness
 -perceived benefits of SALC staff, health care Interviews At 2.5 yrs
the program providers, families
-perceived unintended
outcomes
-changes in referral and Program documents (Intake Geographic Analysis At 2.5 yrs
participation rates across form)
geographic areas
4. To what extent is there evidence of program sustainability and spread?
4.1 What -identified areas with Program documents (Intake Geographic Analysis At 2.5 yrs
environmental factors lower referral and form)
will influence the participation rates
spread of the program?
-identified factors VLAs, SALC staff, Health Interviews At 2.5 yrs
associated with high care providers
levels of referrals and
low levels of referrals
4.2 What are the costs -program budget Program documents Cost-Analysis At 2.5 yrs
associated with -reported spending (budget, spending, funding)
program sustainability Literature Review (related
and spread? to the cost of health
4.3 How sustainable is -funding outcomes that are
the funding? associated with the
program)
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