Changing motorcycle rider safety attitudes and motives for risk taking : process evaluation of a rider training intervention

Risk-taking behaviour by motorcyclists has been shown to contribute to a substantial proportion of road crashes in Australia and abroad. Concern has been expressed that traditional motorcycle licence training programs do not sufficiently address such behaviour. Accordingly, the Three Steps to Safer Riding program was developed to address risk taking behaviour by riders as an adjunct to existing skills-based rider training. The program was designed to be delivered in a one hour classroom session at the start of training, with a 20 minute debrief to revise the key concepts at the end of training. This paper reports on the key training concepts, methodology and implementation of the pilot program with a major rider training organisation in Queensland and presents findings from a process evaluation. The Three Steps to Safer Riding intervention pilot was delivered to 518 learner riders over a three month period. Follow-up focus groups and one interview with intervention participants (N=18) five to eight months after completion of the program suggest that new riders (absolute novices) embraced and internalised many of the intervention concepts. However, some riders who had previous riding experience prior to training stated these issues were common sense, yet still expressed riding styles that were contrary to some of the key intervention messages. This is discussed in terms of raising awareness of risk issues for motorcyclists versus behaviour change. Additionally, interviews conducted with riding instructors are discussed regarding logistical challenges of implementation, training consistency, skills required to deliver the program, support for the program, and student engagement.

A process evaluation of a comprehensive school based injury prevention program

A process evaluation enables understanding of critical issues that can inform the improved, ongoing implementation of an intervention program. This study describes the process evaluation of a comprehensive, multi-level injury prevention program for adolescents. The program targets change in injury associated with violence, transport and alcohol risks and incorporates two primary elements: an 8-week, teacher delivered attitude and behaviour change curriculum for Grade 8 students; and a professional development program for teachers on school level methods of protection, focusing on strategies to increase students’ connectedness to school.

Reaching high-risk adolescents : a process evaluation of a school based injury prevention program

High-risk adolescents are a population most vulnerable to harm from injury due to increased engagement in risk taking behaviour. There is a gap in the literature regarding how universal school based injury prevention programs apply to high-risk adolescents. This study involves a component of the process evaluation of a school based injury prevention program, as it relates to high-risk adolescents (13-14 years)...

A stakeholder process evaluation of a social marketing walking intervention targeting children

One quarter of Australian children are overweight or obese (ABS, 2010), putting them at increased risk of physical and psychological health problems (Reilly et al., 2003). Overweight and obesity in childhood tends to persist into adulthood and is associated with premature death and morbidity (Reilly & Kelly, 2011). Increases in Australian children’s weight have coincided with declines in active transportation, such as walking, to school (Salmon et al., 2005). To address this problem, the Victorian Health Promotion Foundation (VicHealth), which is an independent statutory authority which advises government and contributes to promoting good health in Victoria (VicHealth, 2014), developed the Walk to School program. Walk to School aims to encourage primary school children in Victoria to walk to and from school more often. Walking to school is a low cost and effective means of reducing excess weight (Rosenberg et al., 2006) that can be easily integrated into daily routine (Brophy et al., 2011). The purpose of this paper is to present the results of the stakeholder process evaluation of Walk to School 2013, which forms part of a broader outcome evaluation that is currently in field. Although there is an emphasis on outcome evaluation of programs, process evaluation can be equally important in determining program success (Saunders et al., 2005). Further, process evaluation to assess program delivery and utilization is explicitly recommended by two social marketing frameworks (see Lefebvre et al., 1988; Walsh et al., 1993).

Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: A qualitative process evaluation

- Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. - Design A qualitative exploratory study. - Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. - Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. - Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.

A cluster randomised controlled trial and process evaluation of the early years DELTA parenting programme

This paper reports the results from a cluster randomised controlled trial (RCT) and process evaluation of the Early Years DELTA Parenting Programme; a six-week, group based intervention. The evaluation was part funded by DELTA and involved 23 primary schools and 334 parents. Results showed that intervention parents reported increased parental self-efficacy in relation to: knowledge of their child’s development and needs; self-acceptance as a good parent, and; disciplining and setting boundaries. No change was observed in the remaining outcome areas. Parent interviews indicated a high level of programme satisfaction and the main benefits reflected the outcomes measured by the RCT. This small, robust evaluation is commensurate with other similar research demonstrating the effectiveness and reach of short-term, group-based parenting programmes.

Process Evaluation of the Roots of Empathy Program

This paper presents the findings of a qualitative process evaluation of the Roots of Empathy (ROE) programme. ROE is a universal, classroom-based intervention, which aims to enhance social and emotional learning of primary (elementary) school children. Effective delivery of such complex social interventions in real-world settings requires in-depth knowledge and understanding of factors that interact to influence implementation and fidelity. A case study methodology was employed with six schools, to explore the views of key actors and stakeholders involved in the delivery and receipt of the programme. Overall, ROE was delivered with high fidelity and the programme was viewed positively across the schools. However, one issue was the varied level of interest and awareness of the programme from parents.

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention

Overweight and obesity has doubled among children in Australia. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. The aims of this paper are to describe a randomized controlled trial (‘Switch-Play’) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Children from three government primary schools were randomized by class to one of four conditions: a behavioural modification group (BM; n = 69); a fundamental motor skills group (FMS; n = 73); a combined BM and FMS group (n = 90); or a control (usual classroom lessons) group (n = 61). Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours, and identified physical activity alternatives. The FMS group participated in 19 lessons that focused on mastery of six skills: run, throw, dodge, strike, vertical jump and kick. The combined group participated in all the BM and FMS activities. The intervention specialist teacher reported that the children showed high enjoyment and engagement (88% lessons attended) in most aspects of the programme. At-home tasks were completed by 57–62% of the children, and 92% completed the in-class tasks. Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV. Most of the children reported high enjoyment of the programmes, and only a small proportion (7–17%) reported difficulties in switching off their nominated TV shows. More than half the children reported reducing their TV viewing; however, less than half reported increasing their physical activity. It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ‘Switch-Play’; that the programmes were delivered as intended; and that the programmes were favourably evaluated by participating children and their parents.

The mental health Risk Assessment and Management Process (RAMP) for schools: II. Process evaluation

The Risk Assessment and Management Process (RAMP) is a whole-school process for the assessment and management of student’s mental health and wellbeing in primary and secondary schools. A process evaluation revealed that RAMP was implemented as intended across six primary and three secondary schools in Melbourne, Australia. Using the RAMP risk and protective factors monitoring form and screening processes, each school identified ‘at-risk’ students who had not previously been identified or received assistance from welfare staff at the school. School staff and mental health workers from local agencies reported improvements in their knowledge of risk and protective factors, and their ability to identify at-risk students following RAMP. They also reported satisfaction in outcomes for at-risk students managed within the school using RAMP. All the primary schools and one of the
secondary schools continued to use some RAMP processes in their school up to 6 months after the initial implementation of the program.

The process evaluation of it's your move!, an Australian adolescent community-based obesity prevention project

Background
Evidence on interventions for preventing unhealthy weight gain in adolescents is urgently needed. The aim of this paper is to describe the process evaluation for a three-year (2005-2008) project conducted in five secondary schools in the East Geelong/Bellarine region of Victoria, Australia. The project, 'It's Your Move!' aimed to reduce unhealthy weight gain by promoting healthy eating patterns, regular physical activity, healthy body weight, and body size perception amongst youth; and improve the capacity of families, schools, and community organisations to sustain the promotion of healthy eating and physical activity in the region.

Methods
The project was supported by Deakin University (training and evaluation), a Reference Committee (strategic direction, budgetary approval and monitoring) and a Project Management Committee (project delivery). A workshop of students, teachers and other stakeholders formulated a 10-point action plan, which was then translated into strategies and initiatives specific to each school by the School Project Officers (staff members released from teaching duties one day per week) and trained Student Ambassadors. Baseline surveys informed intervention development. Process data were collected on all intervention activities and these were collated and enumerated, where possible, into a set of mutually exclusive tables to demonstrate the types of strategies and the dose, frequency and reach of intervention activities.

Results
The action plan included three guiding objectives, four on nutrition, two on physical activity and one on body image. The process evaluation data showed that a mix of intervention strategies were implemented, including social marketing, one-off events, lunch time and curriculum programs, improvements in infrastructure, and healthy school food policies. The majority of the interventions were implemented in schools and focused on capacity building and healthy eating strategies as physical activity practices were seen by the teachers as already meeting students' needs.

Conclusions
While substantial health-promoting activities were conducted (especially related to healthy eating), there remain further opportunities for secondary schools to use a whole-of-school approach through the school curriculum, environment, policies and ethos to improve healthy eating, physical activity and healthy body perceptions in youth. To achieve this, significant, sustained leadership will be required within the education sector generally and within schools specifically.

Process evaluation of a community-based adolescent obesity prevention project in Tonga

Background: The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma’alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention.
Methods: MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models.
Results: While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns.
Conclusions: The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity.

A combined impact-process evaluation of a program promoting active transport to school: understanding the factors that shaped program effectiveness

This mixed methods study was a comprehensive impact-process evaluation of the Ride2School program in metropolitan and regional areas in Victoria, Australia. The program aimed to promote transport to school for primary school children. Qualitative and quantitative data were collected at baseline and followup from two primary schools involved in the pilot phase of the program and two matched comparison schools, and a further 13 primary schools that participated in the implementation phase of the program. Classroom surveys, structured and unstructured observations, and interviews with Ride2School program staff were used to evaluate the pilot program. For the 13 schools in the second phase of the program, parents and students completed questionnaires at baseline (N = 889) and followup (N = 761). Based on the quantitative data, there was little evidence of an overall increase in active transport to school across participating schools, although impacts varied among individual schools. Qualitative data in the form of observations, interviews, and focus group discussions with students, school staff, and program staff provided insight into the reasons for variable program impacts. This paper highlights the benefits of undertaking a mixed methods approach to evaluating active transport to school programs that enables both measurement and understanding of program impacts.

Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation

The importance of using research evidence in decision making at the policy level has been increasingly recognized. However, knowledge brokering to engage researchers and policymakers in government and non-government organizations is challenging. This paper describes and evaluates the knowledge exchange processes employed by the Translational Research on Obesity Prevention in Communities (TROPIC) project that was conducted from July 2009 to April 2012 in Fiji. TROPIC aimed to enhance: the evidence-informed decision making skills of policy developers; and awareness and utilization of local and other obesity-related evidence to develop policies that could potentially improve the nation’s food and physical activity environments. The specific research question was: Can a knowledge brokering approach advance evidence-informed policy development to improve eating and physical activity environments in Fiji.