A Process Evaluation Model: Documenting Fidelity and Quality of HP-DP Program Delivery

In a structural assessment of a program, an evaluator examines the resources, personnel, facilities, and equipment to deliver services and asks: Are they adequate? In a process evaluation, the ultimate questions are: What program procedures were delivered by each member and all members of a program staff to all eligible clients? Are the core procedures based on normative criteria or professional practice standards (criteria developed by a consensus of experienced peers in health education and health promotion with established professional credentials)? A process assessment, using normative performance criteria, is a direct examination of program quality.

The following section describes a model that can be used to plan and assess implementation of HP-DP program intervention and assessment procedures.

Process evaluation data provide essential data and insight about what types of client assessment and intervention procedures can (and cannot) be routinely delivered for specific settings, behaviors, types of providers, and participants. Process evaluation methods should be used as a routine quality control mechanism to assess staff provision of core program procedures. They also have a very practical function. They provide empirical evidence and information about salient structure and operational procedures within and across HP-DP programs in different sites.

Process evaluation data documenting the level of client exposure to each health education method are also critical to making a conclusion about efficacy-effectiveness, internal and external validity, and costs and cost-effectiveness of an HP-DP intervention. For example, in a meta-evaluation of 31 evaluation studies of cessation methods for pregnant smokers, serious process evaluation deficiencies were reported (Windsor, Boyd, and Orleans, 1998). Although space limitations in a publication often restrict a study from providing a complete description of its intervention methods, most of the evaluation studies lacked an adequate description and/or documentation of the delivery of experimental and control group intervention methods. Only 12 of the 31 evaluation studies reviewed adequately described the specific characteristics of core program methods, such as number, type, frequency, and duration of client counseling contacts.

The following section provides explicit practice guidelines and examples of how to systematically evaluate program implementation using (1) a framework to describe client assessment and intervention procedures; (2) a description of the program (site) flow analysis method; (3) a description of a process evaluation model (PEM); and (4) examples of applications of the PEM, using data from two different patient education projects.

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