Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box

Abstract

This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10-12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention.

Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review

“…It was unclear who intervention deliverers were in 12 studies (21.8%) [26, 39, 46, 50, 51, 55, 59–64], but in studies where this information was identifiable, deliverers were most frequently nurses (10 studies, 18.2%) [33, 35–37, 40, 47, 52, 65–67]. With regards to level and mode of delivery, interventions were most frequently delivered at the individual (25 studies, 45.5%) [27–29, 33, 34, 40, 41, 45, 46, 48, 50–52, 54, 56, 60, 63, 65, 66, 68–73] and group level (19 studies, 35.1%) [26, 31, 32, 38, 39, 42, 43, 49, 53, 55, 58, 61, 62, 64, 67, 74–77]. Face to face was the most common (28 studies, 50.9%) mode of delivery [27, 29, 31, 32, 35–38, 41–45, 49, 50, 56, 58, 60–62, 66–68, 74–78].…”

“…none of the studies included from the electronic database search reported using the BCC framework). Other frameworks that informed the studies reviewed included the process evaluation framework by Linnan and Steckler (2002) [22] in 11 (20.0%) [27, 46, 52, 53, 55, 60, 66, 68, 69, 71, 74], Lichstein et al’s Treatment Implementation Model (TIM) [21] in 4 (7.3%) studies [28, 39, 40, 67], Saunders et al’s framework [23] in 5 (9.1%) studies [26, 30, 46, 49, 59], the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework [79] in 2 (3.6%) studies [46, 70], Dane & Schneider’s framework [80] in 2 (3.6%) studies [38, 76], Dusenbury et al’s framework [81, 82] in 2 (3.6%) studies [38, 62], Baranowski et al’s framework [83] in 1 (1.8%) study [52]. A brief definition of how receipt is defined in these frameworks is available in notes below the Table in Additional file 2.…”

“…One example is the 12 studies using the Linnan and Steckler framework [22] in which dose received is defined as ‘the extent to which participants actively engage with, interact with, are receptive to, and/or use materials or recommended resources’. These studies included measures of engagement, present in 4 studies [52, 53, 55, 66] and measures relating to exposure to or use of intervention materials in 3 studies [46, 71, 74], behaviour change following the intervention in 1 study [71], intention to implement intervention in 2 studies [52, 60]. Other measures were used that were less consistent with the frameworks’ definition of receipt.…”

“…Fourteen (28.0%) of the 50 studies included a subjective assessment collected on the intervention deliverer [26, 28, 30, 33, 34, 53, 56, 57, 62, 64, 69, 73, 78, 84], 25 (50.0%) studies on the intervention recipient [27, 29, 31, 32, 35–38, 40–42, 45, 47, 51, 54, 59–61, 63, 65, 70–72, 74, 77], and 11 (22.0%) studies on both of these [25, 39, 48–50, 52, 55, 66–68, 75]. …”

“…An equal number of these assessments involved the collection of qualitative (14 studies, 25.5%) and quantitative data (14 studies, 25.5%). Qualitative data collected in 14 (25.5%) studies consisted of individual interviews, focus groups or reports in 4 studies [50, 52, 67, 69], field notes and comments in 3 studies [39, 53, 66], audio or videotapes of intervention sessions in 3 studies [66, 73, 75], participant observations in 2 studies [33, 48], documentation in participants’ care plan in 1 study [25], records of contacts kept during the intervention in 1 study [28], and active questioning to participants in 1 study [57]. Quantitative data was collected via self-report through questionnaires, surveys or checklists in 8 studies [26, 30, 49, 52, 55, 62, 68, 84], checklists or ratings completed during or following participant observations in 5 studies [34, 53, 56, 57, 78], number and length of phone contacts with participants in 1 study [64].…”