A process evaluation model for patient education programs for pregnant smokers

Objective-To describe and apply a process evaluation model (PEM) for patien t education programs for pregnant smokers. Methods-The preparation of a process evaluation plan required each program to define its essential "new" patient assessment and intervention procedure s for each episode (visit) of patient-staff contact. Following specificatio n of these core implementation procedures (p) by each patient education pro gram, the PEM, developed by the Smoke-Free Families (SFF) National Program Office, was applied. The PEM consists of five steps: (1) definition of the eligible patient sample (a); (2) documentation of patient exposure to each procedure (b); (3) computation of procedure exposure rate (b/a = c); (4) sp ecification of a practice performance standard for each procedure (d); (5) computation of an implementation index (c/d = e) for each procedure. The ag gregate of all indexes (e) divided by the number of procedures (P-n) produc ed a program implementation index (PII = Sigma e/P-n). Participants and settings-Data from four SFF studies that represent differe nt settings were used to illustrate the application of the PEM. Results-All four projects encountered moderate to significant difficulty in program implementation. As the number and complexity of procedures increas ed, the implementation index decreased. From initial procedures that includ ed patient recruitment, delivery of the intervention components, and conduc ting patient follow ups, a variety of problems were encountered and lessons learned. Conclusion-This process evaluation provided specific insight about the diff iculty of routine delivery of any new methods into diverse maternity care s etting. The importance of pilot testing all procedures is emphasised. The a pplication of the PEM to monitor program progress is recommended and revisi ons to improve program delivery are suggested.