A process evaluation model for patient education programs for pregnant smokers
Richard A Windsora, H Pennington Whiteside Jra, Laura J Solomonb, Susan L Prowsc, Rebecca J Donatelled, Paul M Cinciripinie, Helen E McIlvainf
a Smoke-Free Families
National Program Office, University of Alabama at Birmingham,
Birmingham, Alabama, USA, b University of Vermont, Burlington, Vermont, USA, c Corvallis Clinic Foundation,
Corvallis, Oregon, USA, d Oregon
State University, Corvallis, Oregon, USA, e MD Anderson Cancer Center, Houston, Texas, USA, f University of Nebraska
Medical Center, Omaha, Nebraska, USA
Correspondence to: H Pennington Whiteside, Jr, Smoke-Free Families Program, University of Alabama at Birmingham, Department of Obstetrics and Gynecology, CIRC 320, 1530 3rd Avenue South, Birmingham, AL 35294-0021, USA; hpw{at}uab.edu
Received 6 December
1999; Revision received 20 March 2000;
Accepted 24 April 2000
OBJECTIVE
To describe
and apply a process evaluation model (PEM) for patient education
programs for pregnant smokers.
METHODSThe
preparation of a process evaluation plan required each program to
define its essential "new" patient assessment and intervention procedures for each episode (visit) of patient-staff contact. Following specification of these core implementation procedures (p) by
each patient education program, 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) specification
of a practice performance standard for each procedure (d); (5)
computation of an implementation index (c/d = e) for each procedure.
The aggregate of all indexes (e) divided by the number of procedures
(Pn) produced a program implementation index
(PII = 
e/Pn).
PARTICIPANTS AND
SETTINGSData from four SFF studies that represent
different settings were used to illustrate the application of the PEM.
RESULTSAll four
projects encountered moderate to significant difficulty in program
implementation. As the number and complexity of procedures increased,
the implementation index decreased. From initial procedures that
included patient recruitment, delivery of the intervention components,
and conducting patient follow ups, a variety of problems were
encountered and lessons learned.
CONCLUSIONThis
process evaluation provided specific insight about the difficulty of
routine delivery of any new methods into diverse maternity care
setting. The importance of pilot testing all procedures is emphasised.
The application of the PEM to monitor program progress is recommended
and revisions to improve program delivery are suggested.
Keywords: process evaluation model; patient education program; pregnancy; smoking cessation
© 2000 by Tobacco Control
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