Process Evaluation Of The Native Womenís Health Project (NWHP)

Eleni TOLMA, UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER , United States
ENGELMAN K. 3 , THOMAS C. 1 , STONER J. 2 , LI J. 2 , CHERY-MULLEN E. 5 , DICHKOV A. 1 , CANFIELD V. 4

1 Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
2 Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
3 Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
4 Citizen Potawatomi Nation, Shawnee, Oklahoma, USA
5 Oklahoma City County Health Department, Oklahoma city, Oklahoma, USA

Purpose: To describe the process evaluation of an innovative, culturally-sensitive, theory-based and complex intervention, the Native Women’s Health Project (NWHP). The NWHP, a community-driven program, incorporated clinic and community based intervention strategies and aimed to increase mammography rates. The intervention lasted for 4 months; however, design, implementation, and evaluation occurred over 3 years and utilized a community-based participatory research approach.  Methods: The priority population consisted of breast cancer-free American Indian (AI) women aged 52-74 years, with no recent screening mammogram, and who lived in rural Oklahoma. Process evaluation planning consisted of the construction of a comprehensive evaluation plan to address key process evaluation components (i.e. context, reach, dose received, dose delivered, and fidelity), the design of evaluation tools, and identification of relevant evaluation questions. Process evaluation data collection included focus groups with research participants, individual interviews with key informants, logs, and survey administration. Data analysis consisted of descriptive statistical analysis and content analysis. The Plan, Do, Study, Act (PDSA) change cycle was used for continuous quality improvement. Results:  Process evaluation revealed a shallow implementation of the clinical component; the community component was implemented as planned. The PDSA change cycle was helpful in refining primarily the community component. Focus group research showed participants overall were satisfied with program implementation. Weaknesses of the NWHP included contextual factors, its short duration and insufficient exposure to the broader AI community. The NWHP was feasible to implement in “real-world” settings. Conclusion: Implementation research is challenging, as one has to balance methodological rigor with practical constraints. Nevertheless, it is important in strengthening the quality of a program during implementation and thus it increases its chances of being effective. Information derived from this study can assist others in the development of similar studies promoting breast health among indigenous populations worldwide. Funding Source: Susan G. Komen®.