The systematic evaluation of effective health behavior interventions is critical for addressing overweight and obesity. Process evaluation assesses whether critical intervention components are delivered as intended and can enhance our understanding of program effects by linking participant program exposure to outcomes. The purpose of this study was to conduct a process evaluation of PROACTIVE, an intervention program to prevent and reduce obesity in clinical settings, and to explore associations between measures of dose, fidelity, and session quality with participant outcomes in an effort to explain gender differences in PROACTIVE program response observed at 24 months. Overweight and obese men (n = 74) and women (n = 175) were randomized into the 24-month health behavior counselling intervention. Outcomes of waist circumference (WC) and physical activity (PA; 7-Day PA Recall) were measured at 12 and 24 months. Process outcomes were distilled from Session Summary Forms completed by Health Educators after each session. Dose was a significant predictor of WC (β = -.12, p < .01) and PA (β = -.16, p < .05) at 24 months. Fidelity predicted 12 month WC (β = -.11, p < .05) and PA (β = .21, p < .05). Quality was significantly associated with 12 month (WC: β = .07, p < .05; PA: β = -.18, p < .01) and 24-month outcomes (WC: β = .10, p < .01; PA: β = -.15, p < .05). No gender differences were found for complete program adherence (dose; p = .51) or treatment implemented (fidelity; p = .06). Men and women were exposed to a similar amount of PROACTIVE session content and maintained similar levels of adherence throughout the 24-month intervention, therefore the difference in program success between men and women could not be attributed to unequal program exposure between the two groups. Insight yielded into the relationship between program exposure and participant outcomes via this process evaluation can help guide and refine future program implementation along with providing areas for future research. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2013-01-29 17:29:48.89

Introduction: The prevalence of childhood overweight and obesity has steadily increased in recent decades, presenting a serious risk to public health and significant burden on individuals, healthcare systems, and society more broadly. Early intervention family-based lifestyle programs are an efficacious intervention for addressing childhood obesity. However, many studies have not included a process evaluation which can limit future scale-up of efficacious interventions. The Family Healthy Living Program (FHLP), an evidence-based, stakeholder-informed family-based healthy living intervention for children with a BMI-for-age ≥85th and their families was developed and piloted in British Columbia. The free 10-week program, based on the multi-process action control theory, utilized a blended delivery model consisting of 90-minute weekly group sessions plus online lessons, four community-based activities and four maintenance sessions. Topics included healthy eating, physical activity, sleep, screen-time, positive mental health, food and physical literacy, and behavior change techniques. Eleven programs ran in seven BC communities (September 2018-April 2019). Purpose: To evaluate the recruitment, intervention content, delivery, and implementation of the FHLP for quality improvements and to inform decisions about potential scale-up. Methods: A mixed-methods concurrent triangulation process evaluation design with equally-weighted qualitative and quantitative data was used and represented one component of a Type I hybrid effectiveness trial for the FHLP Study. Implementation was evaluated at both family and program delivery levels. Family measures were reach, recruitment, dose received, satisfaction, and facilitators and barriers to participation. Program delivery measures were adoption, fidelity, acceptability, feasibility, compatibility, and facilitators and barriers to program implementation. Qualitative data was collected through interviews and focus groups with parents, program leaders, recreation centre managers, and program support team. Quantitative data was collected from parent and child satisfaction surveys, weekly program leader surveys, attendance forms, and online lesson analytics. Quantitative descriptives were generated using SPSS. Qualitative interviews were recorded and transcribed using Transcriptive™ software, and analysis conducted using NVIVO. A framework analysis approach was applied. Results: 132 families were eligible (n=211 enquiries), and 79 families (88 children) registered (42%). 55 families (63 children) started the program and 80% completed. Of those, 82.5% of families attended 70% of sessions. 26% of families accessed 30%+ of core online lesson content. Average contact time was 17.7 hours (range 12.78-25.02). Family participation facilitators were: free of cost, location, sibling inclusion, and complimentary recreation passes. Participation barriers were: other commitments, illness, transportation, and scheduling. Program acceptability/satisfaction across parents and children was high, with satisfaction ratings over 4/5 for all measures. Seven of the nine (78%) communities originally identified as pilot sites implemented the program. Fidelity was 73.5% across program components (range 42-95%). At the delivery-level, implementation facilitators were high compatibility and feasibility, context (support from recreation centre, having qualified staff), and resources (room availability, manual, equipment, grant funding). Barriers to implementation were recruitment, small group size, attendance, and limited time to deliver material. Interviews showed program leader acceptability/satisfaction across all sites. Conclusions: The FHLP was acceptable and feasible for families and program delivery partners, but recruitment, attendance, and on-line engagement were implementation challenges. Program adjustments are recommended prior to scale-up. / Graduate / 2021-08-26

Yes / Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co-designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient-held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Twenty one-to-one semi-structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co-analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patients were involved in the study design, as qualitative data co-analysts and as co-authors. / Programme Grants for Applied Research. Grant Number: RP-PG-0514-20009.

Yes / Abstract: Background: Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co-designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient-held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Design: Twenty one-to-one semi-structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co-analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Results: Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Conclusion: Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patient or Public Contribution: Patients were involved in the study design, as qualitative data co-analysts and as co-authors. / Programme Grants for Applied Research. Grant Number: RP-PG-0514-20009

Yes / The Pillar Integration Process was developed to facilitate integration of mixed method data, but there is limited historical application of this approach in complex intervention evaluation. To test the applicability of the technique, this paper presents two case studies examining the efficacy of a workplace intervention. The research included a pilot RCT and process evaluation. The case studies illustrate the benefits of applying the Pillar Integration Process to elicit a comprehensive understanding of intervention efficacy and to design better interventions. This paper contributes to the mixed methods research by advancing the technique through considering inherent philosophical assumptions, and evidencing the value of integrating methods within, as well as across, “qualitative” and “quantitative” categories. / Macmillan cancer support part-funded this research and were one of the participating organizations. Ergotron Inc. provided 25 sit-stand desks for use within this research. The research formed part of the lead author’s PhD study, which was funded by a School of Sport and Education, Brunel University London, PhD bursary.

Background The Community Voice program is designed for African-Americans and explores key factors that can contribute to African-American infant mortality. This program was implemented in Henrico County based on Virginia Health Statistics that the White infant mortality rate average during the years of 2001-2005 was 5.3 deaths per 1,000 live births and in the same time period the infant mortality rate for African-Americans was 13.7 deaths per 1,000 live births. At the time of implementation of the program, no plans to evaluate the program had been made. Objective This evaluation was designed to develop guidelines regarding the evaluation process of the Community Voice program and develop evaluation tools that can be used by the agency to insure the fidelity of the program. Methods For the purposes of this project and the needs of Henrico County, six concepts are the focus of this process evaluation. These concepts are fidelity, dose delivered, dose received, reach, recruitment, and context. The developed evaluation guide includes information on data sources, the timing of data collection, tools to evaluate the six concepts, and a guide for data analysis and data synthesis. Conclusion By conducting a process evaluation, the Community Voice team will be able to determine if program objectives are being achieved, document strengths and weaknesses of the program, establish quality assurance, monitor performance, improve staff skills, promote community awareness, and meet public and fiscal requirements of accountability.

Over the past twenty years, the number of grandparents raising grandchildren has increased substantially. In many cases, raising grandchildren can be stressful and may aggravate pre-existing health conditions. Grandchildren in these kinship relationships often experience poor health outcomes as well. Typically, both grandparents and grandchildren do not engage in positive health behaviors. Thus, there is a need to develop intergenerational health promotion interventions for grandparents raising grandchildren. This study used the community-based participatory research approach to develop and implement an eight-week intergenerational program for kinship families. The specific goals of this descriptive study were to understand the process and feasibility of developing and implementing the intervention from the perspective of key stakeholders. Content analysis of observational, focus group, and interview data from grandparents, nurses, exercise consultants, and recreation staff provided an in-depth account of the intervention's process (i.e., recruitment, dose delivered, dose received, fidelity, and context) and feasibility (i.e., acceptability, demand, practicality, and integration). Repeated measures ANOVAs were used to determine if the intervention had an effect on participants' health outcomes (i.e., depression, blood pressure, waist circumference, heart rate, weight, balance, and BMI) over time. Although analyses did not result in statistically significant effects on health outcomes, the data trends indicated the possibility of health improvements given a larger sample size. The distinct details gleaned from this study can provide researchers, community organizations, and practitioners with guidance on how to use community partnerships and existing strengths to develop and implement effective community-based intergenerational interventions.

This thesis is an exploratory study of the Kitchener John School Diversion Program. As a primarily community-based initiative, this program has been developed in response to a particular social problem, street prostitution. The primary focus of the program is to address the problem by targeting the clients of prostitutes. Using a contextual constructionist framework, eight qualitative, semi-structured interviews and three participant observation sessions were conducted to explore and understand how the John School works within the context of its objectives and mandate. Four research questions have been developed to achieve this and focus on (1) how program objectives are implemented within the operation of the diversion program, (2) how stakeholders problematize prostitution and its social actors, (3) what the social conditions and characteristics related to the social construction of prostitution are, as perceived by the social actors, and finally, (4) how the diversion program addresses the problem of prostitution. Through analysis of the data collected, key findings emerge that help to contextualize the diversion program within a broader understanding of its mandates and operations. Specifically, four objectives are identified as the primary goals of the school, being knowledge dissemination, accountability, diversion and change. There are notable discrepancies, however, in terms of how program staff interpret these objectives within the context of their program lectures and materials. Additionally, while strong themes and typifications emerge with respect to how prostitution and its social actors are problematized by the program staff, these themes and typifications have a tendency to conflict with one another when presented to the participants. For example, where prostitution is understood to be a social problem with a number of victims and perpetrators, the participants are frequently typified simultaneously as both victim and villain. In light of these discrepancies, however, it appears that the intended objectives and the actual operation of the diversion program both work towards the same, ultimate goal: change.

Introduction: Prevalence of obesity and overweight in children is growing in Canada and worldwide. In recent years multiple approaches have been utilized to treat childhood obesity. Multidisciplinary and family-based approaches have been shown to be successful in the management of obesity and overweight in children however, there is limited evidence about their use with younger children. Therefore the purpose of this thesis was to explore the translation of a family-based intervention, MEND 5-7, for the British Columbia (BC) context using the RE-AIM framework. Methods: A mixed methods design was used. Twenty-four children and their families who were enrolled in MEND program across 3 cities participated in the study. Anthropometrics and self-reported lifestyles and attitudes were measured for both children and parents pre and post program. MEND staff completed recruitment and registration tracking, and session feedback forms; were interviewed about implementation and meeting minutes were analysed for the process evaluation. In addition parent feedback surveys and site visit feedback forms were also included. Data were organized and analysed based on the RE-AIM framework. Results: The sample was too small to be representative but the demographics of the group appeared to be similar to the BC population. A number of significant improvements were seen related to physical activity (screen-time, p = .002; parent self-efficacy for increasing play and enjoyment, p = .05) and eating habits (parent fruit and vegetable consumption, p = .009). The small number of participants made in difficult to draw a valid conclusion about the changes in anthropometry. Data on implementation showed that families and group leaders were highly satisfied with the program. The program was found to be feasible and facilitators included team work, flexibility, participants’ engagement, community relations, preparation and planning, and support. Barriers to implementation included were time, recruitment, parental involvement, diversity, lack of flexibility in manual and location. Conclusion: MEND 5-7 appeared feasible for the BC population, however recruitment remains a significant challenge to program operations. Further research using an experimental design is needed. / Graduate

This paper presents the process evaluation of the Community Challenge, a pilot community-based health promotion program targeting high-school students launched by the Austin, TX-based organization, ACTIVE Life. Aspects of the implementation evaluated include fidelity, program delivered, program received, reach, recruitment, and content. Recommendations are made for future implementation of the Community Challenge. Generally, these recommendations include website improvements and structural changes to the program. / text