Wellness professionals are increasingly required to demonstrate program impacts. But capturing the holistic impact of wellness programs can be elusive because they are contingent upon dynamic social processes of change that may not be fully understood, controllable, or predictable. In these situations, qualitative evaluation methods like Ripple Effects Mapping are well-suited for constructing information about wellness program outcomes in multiple dimensions.
The Intended and the Unintended
Wellness programs often have outcomes that were not planned. Unintended outcomes can be positive or negative in nature and take two forms: the unforeseen and the unforeseeable. Consequences that are unforeseen arise from insufficient program planning or failure to fully take advantage of past evaluation or research. These types of unintended outcomes may be preventable with intentional planning and use of social theory as a guide. Alternatively, unforeseeable consequences are not predictable through any social theory or planning because change is by nature uncertain and non-linear. To learn from and adapt to these unintended program outcomes, program decision-makers must understand not just what changed, but how and why it changed. Understanding the unintended outcomes and feedback loops of a program is advantageous for providing insight into how a program works or how to improve a program that doesn’t work. Such outcomes may provide justification for budgetary reallocations, expanded funding, program expansion, or strategic redirection. Additionally, program administrators also have an ethical obligation to do no harm. Evaluation that uncovers negative unintended outcomes can help administrators alter strategies that are found to cause harm.
Ripple Effects Mapping
Ripple effect mapping (REM) is a participatory method of qualitative data collection that seeks to identify intended and unintended effects (positive and negative) of a program using Appreciative Inquiry (AI). It is useful in situations where the results of programs occur over time within complex settings and can be used to explore outcomes at both the individual and organizational levels. In REM, participants are asked to consider the social, emotional, physical, intellectual, occupational, and spiritual dimensions of their life as they share their experiences in, and after, the program. This framework makes REM suitable for evaluating wellness programs among employees, youth, college-students, and more.
There are five phases to the REM process: interactive interviewing, group mind mapping, stakeholder interviews, data analysis, and member checking. Ripple-effect mapping may be used on its own or integrated into a mixed-method design that includes additional qualitative or quantitative components. For example, an evaluator may use a survey to examine intended outcomes among a large sample and recruit REM participants. Alternatively, the evaluator might follow the REM process with a survey to assess the theory of change that emerges from REM among a larger sample, allowing for additional revision and refinement.
Synergies with Wellness
Wellness is defined by the National Wellness Institute as an active process through which people become aware of, and make choices toward, a more successful existence. It is a process in which the social, spiritual, occupational, intellectual, emotional, and physical dimensions of individuals and groups function in harmony. Wellness promotion is a humanistic practice that leverages methods grounded in salutogenensis, self-determination, authentic relationship, inter-professional collaboration, and an inter-disciplinary knowledge base to cultivate wellness. Like wellness, Ripple Effects Mapping is a holistic, context-responsive, and person-centered evaluation method that can help understand how a program impacts the wellness journey. The Appreciative Inquiry style questioning used in REM is similar in nature to wellness coaching in that it is non-directive, strengths-based, and growth-oriented. Instead of focusing on solving problems, AI seeks to generate new ways of thinking, identify opportunities, and catalyze new patterns of behavior by cultivating "more good" instead of "less bad". Therefore, using REM in evaluation is particularly congruent with the aims of wellness promotion.
Christina Peterson is a PhD student in Evaluation, Statistics, and Measurement at the University of Tennessee. She is passionate about promoting wellness by catalyzing data-informed decision-making in through program evaluation. Her research interests include mixed-method approaches to economic evaluation and evaluation use. Christina has a MS in Nutrition, a BA in Economics. Prior to starting her PhD, Christina worked for the National Wellness Institute as the Professional Development Manager. In this role, she led program evaluation activities for NWI. Currently, Christina works as a Graduate Research Assistant where she provides statistical consulting for research projects.