Formative Evaluation

“…a rigorous assessment process designed to identify potential and actual influences on the progress and effectiveness of implementation efforts.”^[1]

• Conceived as occurring “before, during, and after implementation to optimize the potential for success and to better understand the nature of an initiative, need for refinements, and the worth of extending the project to other settings[p,S2-3, 23].”

Four progressive, integrated stages are described by Stetler, et al:

1. Developmental Evaluation (pre-implementation) to explore/assess:
• actual degree of less-than-best practice
• determinants of current practice to guide adaptation of the intervention
• barriers and facilitators for change and implementation
• feasibility and tailoring of implementation strategy

2. Implementation-focused Evaluation (during implementation) to:
• Reduce Type III errors
• Identify modifiable barriers to enable implementation (& understand role of non-modifiable barriers)
• Facilitate refinements to original plan
• Enhance interpretation of project results
• Identify critical factors to replicate (positive) results elsewhere

3. Progress-focused Evaluation (during implementation) to monitor progress and impact of progress toward goals.

4. Interpretive Evaluation (post-implementation) to:
• Explain summative evaluation results
• Evaluate implementation process, attainment, sustainability
• Develop tools for wider dissemination
• Assess evidence for CFIR constructs
• Develop hypotheses for future studies

References

1. Stetler, C., Legro, M. W., Wallace, C. M., Bowman, C., Guihan, M., Hagedorn, H.,Kimmel, B.,Sharp, N. D.,Smith, J. L, Getting The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med, 2006. 21 Suppl 2: p. S1-8.