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Process evaluation comprises the set of activities surrounding project or program implementation, acceptance and population reach. It describes how the program is carried out in practice and helps to understand why it did or did not achieve its anticipated outcomes. This chapter focuses on process evaluation within efficacy/effectiveness testing. Process evaluation in subsequent stages of replication or dissemination is further considered in Chapter 7.

4.1 Assessing the implementation of health promotion projects and programs

Process evaluation is the set of activities directed towards assessing progress in the implementation of a project or program. Process evaluation describes and explains what happens once the project or program has actually started (see Figure 3.1), and contributes to an understanding of how and why interventions work and which elements contribute to their effectiveness. Process evaluation can also help explain negligible effects (why interventions do not work). It is often conducted concurrently with impact evaluation (see Figure 3.1). Planning for process evaluation occurs before the intervention starts and needs to be well established and integrated into the evaluation frameworks developed through intervention maps (IM) or logic models (see Chapter 1).

A broad range of activities comprise process evaluation. Process evaluation identifies whether target groups were exposed to and participated in the intervention and whether stakeholders and partners engaged with it. It also encompasses assessment of the short-term health promotion outcomes (described in Chapter 1, Section 1.5). The achievement of these outcomes is part of the ‘process’ leading to longer term impact and outcomes that are described in Chapter 1.

The aims of process evaluation are to understand how the program worked, what happened in ‘real life’ and how people reacted to it.

Understanding the processes of how change occurs is a fundamental aspect of any health promotion program evaluation. It is unrealistic to expect a program to succeed if it has not engaged key stakeholders, involved the community or reached the target groups as intended.

Process evaluation occurs across all stages of building evidence in Figure 2.1 and throughout intervention testing to assess effectiveness or efficacy. If a program is not delivered, endorsed or engaged with by communities, it is unlikely to have a substantial impact. It is also used to understand the replication and scale-up of programs to wider settings (stages 4 and 5, shown in Figure 2.1) to identify whether the effective parts of the program (e.g. adherence to an intervention curriculum) are maintained when the program has been disseminated in multiple field settings (see Chapter 7).

Disappointingly, process evaluation is often not carried out, or is not conducted to a high standard. For understandable reasons (such as pressure to demonstrate results), evaluation resources are often channelled into impact and outcome assessment. This means that often we do not know how well a program ...

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