Process evaluation in the field

global learnings from seven implementation research hypertension projects in low-and middle-income countries

Felix Limbani, Jane Goudge, Rohina Joshi, Marion A. Maar, J. Jaime Miranda, Brian Oldenburg, Gary Parker, Maria Amalia Pesantes, Michaela A. Riddell, Abdul Salam, Kathy Trieu, Amanda G. Thrift, Josefien Van Olmen, Rajesh Vedanthan, Ruth Webster, Karen Yeates, Jacqui Webster, Global Alliance for Chronic Diseases, Process Evaluation Working Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). METHODS: Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. RESULTS: The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. CONCLUSION: This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts.

Original languageEnglish
Article number853
Number of pages11
JournalBMC Public Health
Volume19
Issue number1
DOIs
Publication statusPublished - 16 Jul 2019

Keywords

  • Complex interventions
  • Hypertension
  • Implementation science
  • Low and middle-income countries
  • Mixed-methods
  • Process evaluation

Cite this

Limbani, F., Goudge, J., Joshi, R., Maar, M. A., Miranda, J. J., Oldenburg, B., ... Global Alliance for Chronic Diseases, Process Evaluation Working Group (2019). Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries. BMC Public Health, 19(1), [853]. https://doi.org/10.1186/s12889-019-7261-8
Limbani, Felix ; Goudge, Jane ; Joshi, Rohina ; Maar, Marion A. ; Miranda, J. Jaime ; Oldenburg, Brian ; Parker, Gary ; Pesantes, Maria Amalia ; Riddell, Michaela A. ; Salam, Abdul ; Trieu, Kathy ; Thrift, Amanda G. ; Van Olmen, Josefien ; Vedanthan, Rajesh ; Webster, Ruth ; Yeates, Karen ; Webster, Jacqui ; Global Alliance for Chronic Diseases, Process Evaluation Working Group. / Process evaluation in the field : global learnings from seven implementation research hypertension projects in low-and middle-income countries. In: BMC Public Health. 2019 ; Vol. 19, No. 1.
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abstract = "BACKGROUND: Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). METHODS: Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. RESULTS: The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. CONCLUSION: This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts.",
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author = "Felix Limbani and Jane Goudge and Rohina Joshi and Maar, {Marion A.} and Miranda, {J. Jaime} and Brian Oldenburg and Gary Parker and Pesantes, {Maria Amalia} and Riddell, {Michaela A.} and Abdul Salam and Kathy Trieu and Thrift, {Amanda G.} and {Van Olmen}, Josefien and Rajesh Vedanthan and Ruth Webster and Karen Yeates and Jacqui Webster and {Global Alliance for Chronic Diseases, Process Evaluation Working Group}",
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Limbani, F, Goudge, J, Joshi, R, Maar, MA, Miranda, JJ, Oldenburg, B, Parker, G, Pesantes, MA, Riddell, MA, Salam, A, Trieu, K, Thrift, AG, Van Olmen, J, Vedanthan, R, Webster, R, Yeates, K, Webster, J & Global Alliance for Chronic Diseases, Process Evaluation Working Group 2019, 'Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries', BMC Public Health, vol. 19, no. 1, 853. https://doi.org/10.1186/s12889-019-7261-8

Process evaluation in the field : global learnings from seven implementation research hypertension projects in low-and middle-income countries. / Limbani, Felix; Goudge, Jane; Joshi, Rohina; Maar, Marion A.; Miranda, J. Jaime; Oldenburg, Brian; Parker, Gary; Pesantes, Maria Amalia; Riddell, Michaela A.; Salam, Abdul; Trieu, Kathy; Thrift, Amanda G.; Van Olmen, Josefien; Vedanthan, Rajesh; Webster, Ruth; Yeates, Karen; Webster, Jacqui; Global Alliance for Chronic Diseases, Process Evaluation Working Group.

In: BMC Public Health, Vol. 19, No. 1, 853, 16.07.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - global learnings from seven implementation research hypertension projects in low-and middle-income countries

AU - Limbani, Felix

AU - Goudge, Jane

AU - Joshi, Rohina

AU - Maar, Marion A.

AU - Miranda, J. Jaime

AU - Oldenburg, Brian

AU - Parker, Gary

AU - Pesantes, Maria Amalia

AU - Riddell, Michaela A.

AU - Salam, Abdul

AU - Trieu, Kathy

AU - Thrift, Amanda G.

AU - Van Olmen, Josefien

AU - Vedanthan, Rajesh

AU - Webster, Ruth

AU - Yeates, Karen

AU - Webster, Jacqui

AU - Global Alliance for Chronic Diseases, Process Evaluation Working Group

PY - 2019/7/16

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N2 - BACKGROUND: Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). METHODS: Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. RESULTS: The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. CONCLUSION: This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts.

AB - BACKGROUND: Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). METHODS: Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. RESULTS: The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. CONCLUSION: This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts.

KW - Complex interventions

KW - Hypertension

KW - Implementation science

KW - Low and middle-income countries

KW - Mixed-methods

KW - Process evaluation

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U2 - 10.1186/s12889-019-7261-8

DO - 10.1186/s12889-019-7261-8

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