Using document analysis methods and implementation science frameworks to conduct a process evaluation of the
Ashley A Lowe1,2, Priyanka Ravi3, Bryan Hudson4
1Nursing and Health Sciences Division, College of Nursing, University of Arizona, Tucson, AZ, United States.
Translational Behavioral Medicine
|September 30, 2025
Summary
This study evaluated the Community Asthma Program (CAP) for Diné (Navajo) children. Findings highlight the need for comprehensive process data collection to assess intervention effectiveness in diverse community settings.
Area of Science:
- Public Health
- Health Services Research
- Community-Based Interventions
Background:
- Asthma disproportionately affects socioeconomically disadvantaged minority children, with over 20% prevalence among Diné (Navajo) children on the Navajo Nation.
- The Community Asthma Program (CAP) is a 7-year, multicomponent, evidence-based intervention developed in partnership with the Navajo Nation.
- CAP aims to improve asthma management in Indian Health Service facilities and Diné K-12 schools.
Purpose of the Study:
- To evaluate the implementation processes and outcomes of the Community Asthma Program (CAP) using the RE-AIM and CFIR frameworks.
- To describe data sources, coding methods, and their contribution to understanding CAP implementation.
- To discuss strengths, limitations, and implications for process evaluation of community-based asthma interventions.
Main Methods:
- Document analysis of CAP research materials from 2017 to 2023.
- Inclusion of additional data sources like emails and meeting minutes, especially during COVID-19 disruptions.
- Utilized RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Research) frameworks for guided analysis.
Main Results:
- Multiple data sources, including RE-AIM forms and staff interviews, identified key process indicators and explanatory factors for CAP implementation.
- Valuable contextual information was gathered regarding intervention activities, experiences, and attitudes.
- Gaps were identified in system- and provider-level fidelity indicators needed for a complete assessment of intervention reach and quality.
Conclusions:
- Emphasizes the critical importance of collecting process data throughout the entire implementation period.
- Highlights the value of utilizing diverse data sources to comprehensively capture the local implementation context.
- Informs future community-based public health interventions by stressing robust process evaluation.
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