| Abstrakt: |
Background. The specialty of emergency medical services (EMS) has been challenged to take up community prevention activities as a part of its service mission. Though outcome evaluations of these activities have been published, there are no reports of programs' process evaluations. Orange County EMS initiated, in 1998, the 'Welcome to theWorld' (WTTW) program, a home safety screening program for families with newborns. Objective. We sought to perform a process evaluation of the WTTW program. Methods. By reviewing programmatic data and records, conducting key informant interviews and focus groups, and analyzing print materials, we conducted a retrospective process evaluation encompassing recruitment, reach, context, and, to a lesser extent, 'dose delivered,' 'dose received,' and fidelity. Results. The program evaluation found that recruitment was less than optimal with a minority of participants from lower socioeconomic backgrounds. The WTTW program reached about 4% of all possible participants in the community. Context presented significant impediments for the program. The demographics of the community changed dramatically during the program, with a large influx of Spanish-speaking immigrants. Additionally, the county suffered an economic downturn during the interval, resulting in deep budget cuts. Dose delivered and dose received, while not fully evaluated, showed that the home survey and print materials were generally well received and utilized by participants. Fidelity was measured by interview and focus group and revealed general adherence to the intent of the program. Conclusions. Our process evaluation indicates the importance of good organization and management, with attention to careful program monitoring to facilitate continuous program improvement and increase fidelity to plans. We suggest that, in the future, process evaluation be built into the development of any of EMS-initiated community activity, fromthe dawn of an idea through every phase of the program. Careful attention to recruitment, reach, dose, and fidelity will provide leaders with crucial information to judge the reasons for the success or failure of the programandto identify needed modifications to ensure the future success and facilitate replication. [ABSTRACT FROM AUTHOR] |
