title: "Welcome to the world".
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 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, from the 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 program and to identify needed modifications to ensure the future success and facilitate replication.
authors.affiliation: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7594, USA. brice@med.unc.edu
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
authors.forename: David
authors.initials: D
authors.lastname: Kingdon
authors.forename: Carol
authors.initials: C
authors.lastname: Runyan
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017144:Focus Groups; D006801:Humans; D009657:North Carolina; D015397:Program Evaluation; D012189:Retrospective Studies; D014947:Wounds and Injuries