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Table 2 BCHCP process evaluation framework

From: British Columbia Healthy Connections Project process evaluation: a mixed methods protocol to describe the implementation and delivery of the Nurse-Family Partnership in Canada

Process evaluation component BCHCP component operationalization
1. Identify theoretical foundations of the intervention. Construct a logic model to outline intervention components, process and outcomes. • The theoretical foundations of the NFP are well defined and include theories of human ecology [27], attachment [28] and self-efficacy [29]. The transtheoretical model of behaviour change [30] also informs the work of NFP nurse home visitors, as well as the program logic model [31].
2. Create a theory-informed public health intervention. • The NFP intervention, systematically developed and evaluated in the US, will be adapted and evaluated for the Canadian context.
3. Create an inventory of process objectives • For each of the 8 BCHCP process evaluation objectives, a comprehensive list of sub-objectives and topics to be described, measured or explored in the process evaluation, as well as the data sources to be accessed was compiled.
4. Achieve consensus on process evaluation questions to be addressed. • A multidisciplinary team of researchers with expertise in mixed methods, maternal-child health, professional nursing practice, conducting research with disadvantaged populations and home visiting was established. Building on the principles of integrated knowledge translation, the research team will collaborate and seek ongoing feedback on process evaluation objectives and procedures from the BCHCP Scientific Team, BCHCP Steering Committee, BCHCP Provincial Advisory Committee and BCHCP Regional Evaluation Advisory Committee (as required).
5. Develop quantitative and qualitative data collection tools to address objectives. • Program fidelity data to be accessed from the BC Ministry of Health.
• Reporting forms developed to gather data on team meetings and supervisory activities.
• Interview guides (for 1:1 interviews and focus groups) developed for each phase of the study.
6. Design, implement and conduct rigorous empirical investigation • The process evaluation will be conducted by adhering to consistent methodological rules and principles to guide both the quantitative and qualitative study components.
7. Collect, manage and clean data • All qualitative data to be collected by a consistent set of interviews (by the lead principal investigator, and the project Research Coordinator). Interview data to be transcribed verbatim, cleaned and all identifying information removed. Data will be stored, managed and coded in NVivo 10 software.
• Provincial and HA implementation data to be submitted at least twice a year to  the BCHCP Scientific Team.
8. Analyze data • Content and thematic analysis of the qualitative data will be conducted by designated members of the process evaluation research team.
• A codebook, with defined codes, will be developed through a process of double-coding and consensus.
• Quantitative data will be analyzed through the use of descriptive statistics and a series of nested multiple analysis of variance to examine differences between PHNs, within HAs, and across the five HAs.
9. Create user-friendly reports to summarize findings for process objectives. • Short communication briefs will be developed and disseminated following each phase of data collection (every 6 months) to communicate key findings to the BCHCP Scientific Team, all relevant BC Government and HA policy partners, and to the funder (the Public Health Agency of Canada).
• This information is one potential source of evidence that the BC Ministry of Health (who holds overall responsibility for NFP implementation in the province) can use to inform HAs about implementation and delivery issues.
10. Refine intervention • The BCHCP process evaluation data will inform future enhancements and adaptations to the Canadian NFP model which may include specific recommendations for: nurse/supervisor education, IPV interventions, strategies to effectively home visit families in rural and remote communities, and addressing the relationship between primary care, public health and the child welfare sector.