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Structuring Process Evaluation to Forecast Use and Sustainability of an Intervention: Theory and Data From the
Cindy Roberts-Gray1, Sara J Sweitzer2, Nalini Ranjit3
11 Third Coast R&D, Inc., Galveston, TX, USA.
Insights
The Lunch Is in the Bag intervention improved preschool lunch packing, but process evaluation forecasts showed low sustainability. Structuring evaluations can aid intervention dissemination and translational health science.
Area of Science:
- Translational science
- Health behavior interventions
- Process evaluation
Background:
- The "Lunch Is in the Bag" intervention aimed to improve preschool children's lunchbox contents.
- A cluster-randomized trial involved 30 early care and education centers.
Purpose of the Study:
- To assess the utility of process evaluation in forecasting intervention use and sustainability.
- To determine the intervention's readiness for wider dissemination.
Main Methods:
- Pretrial user experience simulation to forecast intervention use.
- Multiattribute evaluation during the trial to assess use and sustainability.
- Posttrial interviews to evaluate sustained use and dissemination readiness.
Main Results:
- Intervention use was moderate and generally aligned with forecasts, with higher newsletter readership than predicted.
- Forecasts indicated near-zero likelihood of sustained use at the center level.
- Posttrial interviews confirmed zero centers sustained intervention use.
Conclusions:
- Structuring efficacy trials with user experience assessments can accurately forecast intervention use and sustainability.
- This approach aids in interpreting trial outcomes and guiding intervention dissemination strategies.
- The findings contribute to translational science for improving public health.
Background:
A cluster-randomized trial at 30 early care and education centers (Intervention = 15, waitlist Control = 15) showed the Lunch Is in the Bag intervention increased parents' packing of fruits, vegetables, and whole grains in their preschool children's bag lunches (parent-child dyads = 351 Intervention, 282 Control).
Purpose:
To examine the utility of structuring the trial's process evaluation to forecast use, sustainability, and readiness of the intervention for wider dissemination and implementation.
Method:
Pretrial, the research team simulated user experience to forecast use of the intervention. Multiattribute evaluation of user experience measured during the trial assessed use and sustainability of the intervention. Thematic analysis of posttrial interviews with users evaluated sustained use and readiness for wider dissemination.
Results:
Moderate use was forecast by the research team. Multiattribute evaluation of activity logs, surveys, and observations during the trial indicated use consistent with the forecast except that prevalence of parents reading the newsletters was greater (83% vs. 50%) and hearing their children talk about the classroom was less (4% vs. 50%) than forecast. Early care and education center-level likelihood of sustained use was projected to be near zero. Posttrial interviews indicated use was sustained at zero centers.
Discussion:
Structuring the efficacy trial's process evaluation as a progression of assessments of user experience produced generally accurate forecasts of use and sustainability of the intervention at the trial sites.
Conclusion:
This approach can assist interpretation of trial outcomes, aid decisions about dissemination of the intervention, and contribute to translational science for improving health.
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