title: A six-step protocol to systematic process evaluation of multicomponent cluster-randomised health promoting interventions illustrated by the Boost study.
abstract: BACKGROUND
  In multicomponent interventions it is important to examine the implementation of each component to enable valid assessments of the effectiveness of each component. Many studies do not systematically document, evaluate and report the level of implementation and there is a lack of systematic approaches to conduct process evaluation studies to guide researchers and evaluators. The aim of this study was to present a systematic approach to plan process evaluation of the implementation of randomised multicomponent interventions.
  
  
  METHODS
  Building on existing process evaluation frameworks and concepts, we developed a six-step protocol: 1. Brainstorm of processes necessary for full implementation and potential barriers and facilitators to implementation; 2. Application of process evaluation concepts to ensure inclusion of important implementation processes; 3. Measurement of proximal outcomes; 4. Identification of relevant data sources; 5. Selection of methods and timing of data collection of process measures; 6. Development of instruments. The protocol was applied to the Boost study, a multicomponent school-based dietary intervention.
  
  
  CONCLUSIONS
  The protocol was readily applicable for planning process evaluation of environmental and educational intervention components in a school setting. The protocol ensures systematic assessment of the implementation processes that are crucial for interpretation of intervention effects.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN11666034.
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, University of Southern Denmark, National Institute of Public Health, Øster Farimagsgade 5A 2nd Floor, 1353 Copenhagen K, Denmark. Electronic address: aka@niph.dk.
authors.forename: Anne Kristine
authors.initials: AK
authors.lastname: Aarestrup
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, University of Southern Denmark, National Institute of Public Health, Øster Farimagsgade 5A 2nd Floor, 1353 Copenhagen K, Denmark. Electronic address: thsj@niph.dk.
authors.forename: Thea Suldrup
authors.initials: TS
authors.lastname: Jørgensen
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, University of Southern Denmark, National Institute of Public Health, Øster Farimagsgade 5A 2nd Floor, 1353 Copenhagen K, Denmark. Electronic address: pdu@niph.dk.
authors.forename: Pernille
authors.initials: P
authors.lastname: Due
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, University of Southern Denmark, National Institute of Public Health, Øster Farimagsgade 5A 2nd Floor, 1353 Copenhagen K, Denmark. Electronic address: rkr@niph.dk.
authors.forename: Rikke
authors.initials: R
authors.lastname: Krølner
mesh_terms: D002648:Child; D003718:Denmark; D005260:Female; D005638:Fruit; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D010934:Planning Techniques; D017064:Process Assessment, Health Care / Q000379:methods*; D015397:Program Evaluation; D012574:Schools; D012931:Social Environment; D014675:Vegetables
keywords: Adolescent; Dietary; Multicomponent intervention; Process evaluation; School