Conceptualizing, Implementing, and Monitoring a Structural Health Promotion Intervention in an Organizational Setting

Abstract

This article presents a framework for developing and carrying out an implementation monitoring plan of a complex structural intervention in an organizational setting and describes seven steps for analyzing and reporting results for fidelity and completeness of implementation. This process is illustrated using the Environmental Interventions in Children's Homes (ENRICH) Wellness Project. ENRICH aimed to promote physical activity and healthful nutrition behaviors among children residing in children's group homes by working collaboratively with organizational staff. A comprehensive implementation monitoring plan was developed based on the particulars of the setting, context, and the program framework and used multiple data sources, criteria for evidence of implementation, and data triangulation to examine evidence for organizational implementation. Eleven of 17 organizations (65%) met the criteria for nutrition implementation whereas 9 of 17 (53%) met the criteria for physical activity implementation. Implementation data can be used descriptively, as described here, and may also be used in future outcome analyses to better understand project outcomes. The framework and evaluation approach are applicable to complex interventions in other organizational settings.

Process evaluation methods, implementation fidelity results and relationship to physical activity and healthy eating in the Faith, Activity, and Nutrition (FAN) study

“…The processes of planning the FAN intervention and process evaluation were based on guidelines for developing a program implementation monitoring plan (Saunders, Evans, & Joshi, 2005) and methods for assessing organizational level implementation (Saunders et al, 2006, 2012, 2013), derived from the frameworks presented by Linnan and Steckler (2000) and Baranowski and Stables (2000). The steps for designing and carrying out process evaluation applied to this study are: describing the setting, context, and program; describing “fidelity and dose” for the program; developing implementation monitoring methods to address process evaluation questions; examining the mean implementation for each intervention component; and using implementation data to understand outcomes (including the use of mediation analyses, which allows researchers to understand how an intervention exerts its effects on program outcomes).…”

“…Therefore, they pose evaluation design and execution challenges which necessitate a comprehensive approach to program evaluation and implementation monitoring (Durlak & DuPre, 2008; Medical Research Council, 2008). Previous reports have described implementation monitoring for complex structural interventions in organizational settings including LEAP in schools (Saunders, Ward, Felton, Dowda, & Pate, 2006; Saunders et al, 2012) and ENRICH in children’s group homes (Saunders et al, 2013). This report applies this approach to a CBPR intervention to promote physical activity and healthy eating in churches, which have some unique features.…”

Using process data to understand outcomes in sexual health promotion: an example from a review of school-based programmes to prevent sexually transmitted infections

“…A logic model is a tool which programme planners can use to systematically plan the resources needed to deliver an intervention, the intervention activities and the intended outputs and outcomes [19,20]. Logic models are also used in the monitoring and evaluation of interventions [21,22], particularly complex interventions, and can also be a valuable framework for systematic reviews of the literature [23,24]. A visual schematic is often used to illustrate the relationships between the components of a logic model (e.g.…”

Improved nurse–parent communication in neonatal intensive care unit: evaluation and adjustment of an implementation strategy

“…() and Saunders et al . (). The central themes of the framework were as follows: (1) GFCC knowledge, (2) GFCC delivery, (3) GFCC practice uptake and (4) GFCC certification.…”