2 Jun 2022


Formative and Process Evaluation

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The study to be reviewed is titled 'A Process Evaluation of an HIV/STI Intervention for Rural African American Youth' by Albritton, Hodge-Sallah, Akers, Blumenthal, O'Brien, Council, Muhammad, and Corbie-Smith (2014). The study evaluates the fidelity and implementation of an intervention for HIV/AIDS and sexually transmitted infections for rural African American youth. This includes identification and addressing of several challenges that affect the implementation of these interventions. 

Content Summary 


In this section, Albritton et al. (2014) assess the existence of HIV/AIDS and sexually transmitted diseases within the rural African American community. The challenge of accessing rural communities leads to a limitation of the accessibility of HIV/AIDS interventions. Due to various problems, the implementation of HIV/AIDS outreach programs becomes increasingly difficult. Almost 60% of newly diagnosed AIDS cases are African Americans. 

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Moreover, the rate of STI infections has also been continuously greater in the South as compared to various locations. Adolescents are also impacted by STIs at a higher rate while accounting for almost 50% of the rates. These rates place the youth at a more advanced risk for HIV. 


The research method chapter of the study is divided into four separate sections. 

Intervention Background and Description 

This includes a description of how the basis on which the intervention was started, along with a definition of what the intervention entails. It was created through project GRACE (Growing, Reaching, Advocating for Change, and Empowerment) as a way of addressing HIV/AIDS and STI disparities within the rural African American communities in eastern North Carolina. Project Grace is a collaboration between several communities between partnerships to eliminate health issues within this community. A separate youth curriculum was structured with a focus on several issues. This article only focused on healthy dating, and the session was piloted from October to December 2018. The intervention was made up of 13 sessions, with every session being led by identified facilitators and co-facilitators. Each session was designed to last for about 90 minutes, with each session being held in a predominantly African American church. The participants went to the sessions each Saturday for nine weeks, with four of the sessions were doubled. 

Facilitator Selection and Training 

In this section, the authors outline how they selected their facilitators and conducted the training. There was an advertisement for facilitators in two different newspapers, and through word of mouth. The employees involved in the research and the subcommittee structured the interview schedule. The interviewing process was made up of two rounds. The first round involved coordinating skills while the second round involved the facilitation of a sample TORO session. The interview team then presented different recommendations for candidates after the completion of the interviewing procedure. A 5-day facilitator workshop was then used to train facilitators, which included a lesson about the general objective of the process, the research procedure and ethical considerations. 

Youth Participants 

The sample size was made up of 12 African American youth that live in the identified geographical locations.. Recruitment was done through partnerships established by local firms, and agencies. An eligibility criteria was also established to identify the appropriate participants. The parents presented written consent for the participants and the participants gave informed consent before they participated in the intervention. 

Process Evaluation Components 

Treatment fidelity was evaluated to assess how effective the implementation was and how efficiently components were integrated as according to the plan. The social learning theory was utilized to direct the intervention materials. Facilitator effectiveness was also evaluated with the way in which the session content was delivered. 

Process Evaluation Instruments 

Data was collected from various sources, with the inclusion of observations and surveys. For every process evaluation component, different data sources and procedures were utilized. However, the most common data source used was the program staff and the procedure most commonly applied was observation guides. 

Data Analysis 

The data collected underwent coding and analysis through the use of qualitative data-management software. Major categories and codes were obtained through the use of keywords in the text, and axial coding was utilized to establish thematic categories. Any issues in coding underwent discussion until a consensus was established between the coders. 


In the reach component, only 12 pairs had eligibility for participation in the program. Only a maximum of 4 participants did not attend each session, and the attendance was between 62% and 100%. Several challenges were associated with the component of fidelity, such as the late arrival of the participants and that some content needed a considerable amount of time to complete than the time structured. As concerning the dose delivered, several implementation shifts took place across he lesson. Lastly, in regards to the dose received, the facilitators described youth engagement as higher response by participants. 


Several significant factors were identified as being necessary for successful integration. First, it is essential to have well-trained facilitators as they are aware of when and how to make a modification to the lesson content when needed. Secondly, timing is critical to implement an intervention. The authors suggested that during the implementation of separate sessions for two groups at the same, with the balancing of the content and the period chosen.. 

Strengths and Weaknesses 


The study has several strengths in its application of methods and theories. One of its main strengths is the sampling methods and populations that were used. The eligibility criteria were clearly defined in five separate factors, which ensured that the right research participants were identified for the study. This included ensuring that since the participants had a mean age of 10 years, consent was obtained from the parents and youth. This included written consent and signed assents along with informed consent by the youth before their participation in the intervention. 

Another strength was the use of multiple research instruments to assess the effectiveness of the intervention. The use of several sources of data ensured that a lot of information was collected at a faster rate and at a lower cost within the specified time. It also ensured that all four core elements of the intervention were adequately evaluated. Moreover, the use of various data sources per each component also ensured a comprehensive evaluation of every component. The data sources used include curriculum intervention mapping matrices, program staff, LHA coordinators, and Youth ambassadors. This placed a strong emphasis on naturalism, which resulted in a high level of reliability concerning its process. 

The researcher clearly outlines the steps they took during the research process, which provides proper comprehension of not only how HIV/STIs affect the African American youth in rural areas but also how the intervention was focused on this challenge. 


The main weakness of this study is progressive focusing. While the authors mention the use of social learning theory as a framework that guided their intervention content, there is no explanation of how exactly this theory acted as a guideline. Furthermore, there is no assessment of how the inductive approach is used for content analysis. This reduces the clarity associated with the research process as it is challenging to point out how the identified and stated theories are applied in the research method. 

The studies did not engage in the assessment of facilitators and barriers to recruitment. The identification of a proper recruitment strategy would be a significant aspect of the study. The study was also primarily a qualitative evaluation apart from the survey that was included. The qualitative method presented subjectivity as a characteristic of the data collected, which could be difficult to interpret as a result of the variance of interpretations from observers and facilitators. 


Albritton, T., Hodge-Sallah, S., Akers, A., Blumenthal, C., O’Brien, S., Council, B., ... & Corbie-Smith, G. (2014). A process evaluation of an HIV/STI intervention for rural African American youth.  Qualitative health research 24 (7), 969-982. 

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StudyBounty. (2023, September 15). Formative and Process Evaluation.


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