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Abstract
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 the World” (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 andrecords, conducting key informant interviews andfocus groups, andanalyzing print materials, we conducted a retrospective process evaluation encompassing recruitment, reach, context, and, to a lesser extent, “dose delivered,” “dose received,” andfidelity. 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 anddose received, while not fully evaluated, showed that the home survey andprint materials were generally well received andutilized by participants. Fidelity was measured by interview andfocus group andrevealed general adherence to the intent of the program. Conclusions. Our process evaluation indicates the importance of good organization andmanagement, with attention to careful program monitoring to facilitate continuous program improvement andincrease fidelity to plans. We suggest that, in the future, process evaluation be built into the development of any of EMS-initiated community activity, from the dawn of an idea through every phase of the program. Careful attention to recruitment, reach, dose, andfidelity will provide leaders with crucial information to judge the reasons for the success or failure of the program andto identify needed modifications to ensure the future success andfacilitate replication.